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Deep Transcranial Magnetic Stimulation (dTMS) of the Medial Prefrontal Cortex in Food Addiction and Obesity (FAOB-mPFC)

Primary Purpose

Food Addiction, Obesity, Morbid

Status
Unknown status
Phase
Not Applicable
Locations
Israel
Study Type
Interventional
Intervention
dTMS with mPFC stimulation
Sponsored by
Soroka University Medical Center
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Food Addiction

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • 30 ≤ BMI ≥ 50.
  • Having had at least one prior conventional weight loss attempt, but no current weight loss attempts or over the last 3 months.
  • Having satisfied a safety screening questionnaire for TMS (Keel, 2001)
  • Omnivorous
  • Have not had experience with TMS of any kind
  • Exclusion Criteria:
  • They experience tremor in any limb.
  • They experience seizures.
  • They have a history of epilepsy or seizure (EXCEPT those therapeutically induced by ECT, or febrile childhood seizures).
  • They are at increased risk for seizures for any reason, including prior diagnosis of increased intracranial pressure (such as after large infarctions or trauma), or a history of significant head trauma with loss of consciousness for > 5 minutes.
  • A history of clinically significant neurological disorders, including organic brain disease, epilepsy, stroke, brain lesions, multiple sclerosis, previous neurosurgery or personal history of head trauma that resulted in loss of consciousness for > 5 minutes and retrograde amnesia for > 30 minutes (self-reported history).
  • They have a clinically significant hearing impairment, unless a medical letter is provided permitting the participant to receive a dTMS treatment.
  • The participant has an unstable physical disease, such as acute unstable cardiac disease, or high blood pressure (>150 mmHg, systolic/> 110 mmHg diastolic, unless a medical letter is provided permitting the participant to receive a dTMS treatment.

Exclusion criteria:

  • They experience tremor in any limb.
  • They experience seizures.
  • They have a history of epilepsy or seizure (EXCEPT those therapeutically induced by ECT, or febrile childhood seizures).
  • They are at increased risk for seizures for any reason, including prior diagnosis of increased intracranial pressure (such as after large infarctions or trauma), or a history of significant head trauma with loss of consciousness for > 5 minutes.
  • A history of clinically significant neurological disorders, including organic brain disease, epilepsy, stroke, brain lesions, multiple sclerosis, previous neurosurgery or personal history of head trauma that resulted in loss of consciousness for > 5 minutes and retrograde amnesia for > 30 minutes (self-reported history).
  • They have a clinically significant hearing impairment, unless a medical letter is provided permitting the participant to receive a dTMS treatment.
  • The participant has an unstable physical disease, such as acute unstable cardiac disease, or high blood pressure (>150 mmHg, systolic/> 110 mmHg diastolic, unless a medical letter is provided permitting the participant to receive a dTMS treatment.
  • The participant is at a high risk for severe violence or suicidal tendencies, has current DSM5 diagnosis of schizophrenia, bipolar disorder, or other psychotic disorder, as reported during the screening interview (see appendix 3).
  • The participant has metallic particles in the eye, implanted cardiac pacemaker or any intracardiac lines, implanted neuro-stimulators, intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear implants, or electrodes) or implanted medical pumps.
  • The participant is having, or has had, any metal in the head (outside the mouth).
  • The participant has any cognitive or functional disability, according to criteria specified in the DSM-V, such as active and unstable psychiatric disorder according to DSM-V (Axis I and Axis II), diagnosed within the last year.
  • The participant has started or changed a psychotropic prescription within the past three months.
  • The participant has current alcohol or other substance abuse or dependence, or has had one over the past 12 months prior to recruitment.
  • The participant can't reliably communicate with the investigator, or is unlikely to cope with the requirements of the experiment.
  • The participant is having a known or suspected pregnancy or lactation.
  • The motor threshold can't be found or quantified.
  • The PI decides that the participant should be withdrawn from the study for the safety and welfare of the participant. For example, the participant experiences adverse event which is contraindicated with the continuation in the study.
  • The participant has a history of intolerance to a TMS treatment. The participant asks for withdrawal.

Sites / Locations

  • Soroka University Medical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Active

Placebo

Arm Description

Active dTMS

Placebo dTMS

Outcomes

Primary Outcome Measures

Change in BMI
Unit of measure: BMI in kg/m^2 (weight in kilograms, height in meters)
Change in BMI
Unit of measure: BMI in kg/m^2 (weight in kilograms, height in meters)

Secondary Outcome Measures

Change in food addiction symptoms on the Yale Food Addiction Scale (YFAS)
The YFAS includes 1-7 symptoms, while participants are recruited to the study if they have 3 symptoms or more. The greater the symptoms, the more food addiction the participants experience.
Change in food addiction symptoms on the Yale Food Addiction Scale (YFAS)
The YFAS includes 1-7 symptoms, while participants are recruited to the study if they have 3 symptoms or more. The greater the symptoms, the more food addiction the participants experience.
Cognitive regulation of eating
Cognitive regulation of eating will be assessed with a computerized Food Stroop task. A change in reaction time (milliseconds) in response to high-calorie food, low-calorie food, and non-food items will be assessed.
Cognitive regulation of eating
Cognitive regulation of eating will be assessed with a computerized Food Stroop task. A change in reaction time (milliseconds) in response to high-calorie food, low-calorie food, and non-food items will be assessed.
Depressive symptoms
Depressive symptoms will be assessed with the 21-question multiple-choice self-report inventory, the Beck Depression Inventory (BDI). The highest possible total for the whole test would be sixty-three and the lowest possible score for the test would be zero.
Depressive symptoms
Depressive symptoms will be assessed with the 21-question multiple-choice self-report inventory, the Beck Depression Inventory (BDI). The highest possible total for the whole test would be sixty-three and the lowest possible score for the test would be zero.
Eating behavior [cognitive restraint (CR), emotional eating (EE), uncontrollable eating (UE)] will be assessed with the Three Factor Eating Questionnaire (TFEQ).
The TFEQ measures CR, EE, and UE. A change (decrease or increase) in the symptoms of each of the scales will be assessed at the end of the intervention and at follow up.
Eating behavior [cognitive restraint (CR), emotional eating (EE), uncontrollable eating (UE)] will be assessed with the Three Factor Eating Questionnaire (TFEQ).
The TFEQ measures CR, EE, and UE. A change (decrease or increase) in the symptoms of each of the scales will be assessed at the end of the intervention and at follow up.
Eating behavior [restrictive eating (RE), emotional eating (EME), external eating (EXE)] will be assessed with the Dutch Eating Behavior Questionnaire (DEBQ)
The DEBQ measures RE, EME and EXE, A change (decrease or increase) in the symptoms of each of the scales will be assessed at the end of the intervention and at follow up.
Eating behavior [restrictive eating (RE), emotional eating (EME), external eating (EXE)]
The DEBQ measures RE, EME and EXE, A change (decrease or increase) in the
Binge eating frequency
Binge eating will be assessed with the Eating disorder examination-questionnaire with Instructions (EDE-Q-I). This questionnaire assesses binge eating frequency over the past 28 days.
Binge eating frequency
Binge eating will be assessed with the Eating disorder examination-questionnaire with Instructions (EDE-Q-I). This questionnaire assesses binge eating frequency over the past 28 days.
Quality of life
Health Status Scale Short-form 36 (SF-36)
Quality of life
Health Status Scale Short-form 36 (SF-36)
General mood
Positive Affect Negative Affect Schedule (PANAS).
General mood
Positive Affect Negative Affect Schedule (PANAS).

Full Information

First Posted
September 24, 2020
Last Updated
December 31, 2020
Sponsor
Soroka University Medical Center
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1. Study Identification

Unique Protocol Identification Number
NCT04692909
Brief Title
Deep Transcranial Magnetic Stimulation (dTMS) of the Medial Prefrontal Cortex in Food Addiction and Obesity
Acronym
FAOB-mPFC
Official Title
Deep Transcranial Magnetic Stimulation (dTMS) of the Medial Prefrontal Cortex (mPFC) in Food Addiction and Obesity
Study Type
Interventional

2. Study Status

Record Verification Date
September 2020
Overall Recruitment Status
Unknown status
Study Start Date
January 15, 2021 (Anticipated)
Primary Completion Date
December 1, 2022 (Anticipated)
Study Completion Date
December 1, 2022 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Soroka University Medical Center

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This experiment is based on a unique technique of deep Transcranial magnetic stimulation (dTMS) of the brain's cortex, aiming to produce weight loss in food-addicted severely obese adults.
Detailed Description
The neurobiological underpinnings of food addiction in obesity point to chemical, structural and functional imbalance in the mesolimbic dopaminergic brain system. This may cause symptoms of altered reward processing, excessive cravings for hyperpalatable food and repeated self-regulation failures to control food intake in this population. Specifically, the medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC) and deeper reward-related brain regions function differentially from healthy controls and similarly to individuals with substance or behavioral addiction. Deep transcranial magnetic stimulation of the mPFC has been shown efficacious in reducing cravings and other addictive symptoms in individuals with SUD, as well as symptoms of compulsivity in obsessive compulsive disorder (OCD). In this study the investigators use deep transcranial magnetic stimulation (dTMS) with an H-coil to safely stimulate the mPFC and deeper brain regions, in individuals with obesity and food addiction. The investigators aim to produce neuroplasticity favoring the restoration of mPFC functioning, alleviating food addiction symptoms and promoting weight loss.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Food Addiction, Obesity, Morbid

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
24 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Active
Arm Type
Active Comparator
Arm Description
Active dTMS
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Placebo dTMS
Intervention Type
Device
Intervention Name(s)
dTMS with mPFC stimulation
Intervention Description
dTMS with Brainsway's H7 device, stimulating the mPFC.
Primary Outcome Measure Information:
Title
Change in BMI
Description
Unit of measure: BMI in kg/m^2 (weight in kilograms, height in meters)
Time Frame
Change in BMI between baseline and the end of the treatment (day 15) and follow-up (a month after day 15)
Title
Change in BMI
Description
Unit of measure: BMI in kg/m^2 (weight in kilograms, height in meters)
Time Frame
Change in BMI between baseline and follow-up (a month after day 15)
Secondary Outcome Measure Information:
Title
Change in food addiction symptoms on the Yale Food Addiction Scale (YFAS)
Description
The YFAS includes 1-7 symptoms, while participants are recruited to the study if they have 3 symptoms or more. The greater the symptoms, the more food addiction the participants experience.
Time Frame
The change in the number of symptoms on day 15 compared to baseline will be assessed.
Title
Change in food addiction symptoms on the Yale Food Addiction Scale (YFAS)
Description
The YFAS includes 1-7 symptoms, while participants are recruited to the study if they have 3 symptoms or more. The greater the symptoms, the more food addiction the participants experience.
Time Frame
The change in the number of symptoms on day 16 (a month after day 15) compared to baseline will be assessed.
Title
Cognitive regulation of eating
Description
Cognitive regulation of eating will be assessed with a computerized Food Stroop task. A change in reaction time (milliseconds) in response to high-calorie food, low-calorie food, and non-food items will be assessed.
Time Frame
The change in reaction time on the Food Stroop task between day 15 and baseline.
Title
Cognitive regulation of eating
Description
Cognitive regulation of eating will be assessed with a computerized Food Stroop task. A change in reaction time (milliseconds) in response to high-calorie food, low-calorie food, and non-food items will be assessed.
Time Frame
The change in reaction time on the Food Stroop task between day 16 (a month after day 15) and baseline.
Title
Depressive symptoms
Description
Depressive symptoms will be assessed with the 21-question multiple-choice self-report inventory, the Beck Depression Inventory (BDI). The highest possible total for the whole test would be sixty-three and the lowest possible score for the test would be zero.
Time Frame
A change in BDI score from baseline to day 15.
Title
Depressive symptoms
Description
Depressive symptoms will be assessed with the 21-question multiple-choice self-report inventory, the Beck Depression Inventory (BDI). The highest possible total for the whole test would be sixty-three and the lowest possible score for the test would be zero.
Time Frame
A change in BDI score from baseline to day 16.
Title
Eating behavior [cognitive restraint (CR), emotional eating (EE), uncontrollable eating (UE)] will be assessed with the Three Factor Eating Questionnaire (TFEQ).
Description
The TFEQ measures CR, EE, and UE. A change (decrease or increase) in the symptoms of each of the scales will be assessed at the end of the intervention and at follow up.
Time Frame
The change in these parameters will be assessed between baseline and day 15.
Title
Eating behavior [cognitive restraint (CR), emotional eating (EE), uncontrollable eating (UE)] will be assessed with the Three Factor Eating Questionnaire (TFEQ).
Description
The TFEQ measures CR, EE, and UE. A change (decrease or increase) in the symptoms of each of the scales will be assessed at the end of the intervention and at follow up.
Time Frame
The change in these parameters will be assessed between day 16 (a month after day 15) and baseline.
Title
Eating behavior [restrictive eating (RE), emotional eating (EME), external eating (EXE)] will be assessed with the Dutch Eating Behavior Questionnaire (DEBQ)
Description
The DEBQ measures RE, EME and EXE, A change (decrease or increase) in the symptoms of each of the scales will be assessed at the end of the intervention and at follow up.
Time Frame
The change in these parameters will be assessed between baseline and day 15.
Title
Eating behavior [restrictive eating (RE), emotional eating (EME), external eating (EXE)]
Description
The DEBQ measures RE, EME and EXE, A change (decrease or increase) in the
Time Frame
The change in these parameters will be assessed between day 16 (a month after day 15) and baseline.
Title
Binge eating frequency
Description
Binge eating will be assessed with the Eating disorder examination-questionnaire with Instructions (EDE-Q-I). This questionnaire assesses binge eating frequency over the past 28 days.
Time Frame
The change in binge eating frequency between baseline and day 15.
Title
Binge eating frequency
Description
Binge eating will be assessed with the Eating disorder examination-questionnaire with Instructions (EDE-Q-I). This questionnaire assesses binge eating frequency over the past 28 days.
Time Frame
The change in binge eating frequency between baseline and day 16.
Title
Quality of life
Description
Health Status Scale Short-form 36 (SF-36)
Time Frame
The change in the SF-36 score between baseline and day 15.
Title
Quality of life
Description
Health Status Scale Short-form 36 (SF-36)
Time Frame
The change in the SF-36 score between baseline and day 16.
Title
General mood
Description
Positive Affect Negative Affect Schedule (PANAS).
Time Frame
The change in the overall score (positive affect minus negative affect) between baseline and day 15.
Title
General mood
Description
Positive Affect Negative Affect Schedule (PANAS).
Time Frame
The change in the overall score (positive affect minus negative affect) between baseline and day 16.

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 30 ≤ BMI ≥ 50. Having had at least one prior conventional weight loss attempt, but no current weight loss attempts or over the last 3 months. Having satisfied a safety screening questionnaire for TMS (Keel, 2001) Omnivorous Have not had experience with TMS of any kind Exclusion Criteria: They experience tremor in any limb. They experience seizures. They have a history of epilepsy or seizure (EXCEPT those therapeutically induced by ECT, or febrile childhood seizures). They are at increased risk for seizures for any reason, including prior diagnosis of increased intracranial pressure (such as after large infarctions or trauma), or a history of significant head trauma with loss of consciousness for > 5 minutes. A history of clinically significant neurological disorders, including organic brain disease, epilepsy, stroke, brain lesions, multiple sclerosis, previous neurosurgery or personal history of head trauma that resulted in loss of consciousness for > 5 minutes and retrograde amnesia for > 30 minutes (self-reported history). They have a clinically significant hearing impairment, unless a medical letter is provided permitting the participant to receive a dTMS treatment. The participant has an unstable physical disease, such as acute unstable cardiac disease, or high blood pressure (>150 mmHg, systolic/> 110 mmHg diastolic, unless a medical letter is provided permitting the participant to receive a dTMS treatment. Exclusion criteria: They experience tremor in any limb. They experience seizures. They have a history of epilepsy or seizure (EXCEPT those therapeutically induced by ECT, or febrile childhood seizures). They are at increased risk for seizures for any reason, including prior diagnosis of increased intracranial pressure (such as after large infarctions or trauma), or a history of significant head trauma with loss of consciousness for > 5 minutes. A history of clinically significant neurological disorders, including organic brain disease, epilepsy, stroke, brain lesions, multiple sclerosis, previous neurosurgery or personal history of head trauma that resulted in loss of consciousness for > 5 minutes and retrograde amnesia for > 30 minutes (self-reported history). They have a clinically significant hearing impairment, unless a medical letter is provided permitting the participant to receive a dTMS treatment. The participant has an unstable physical disease, such as acute unstable cardiac disease, or high blood pressure (>150 mmHg, systolic/> 110 mmHg diastolic, unless a medical letter is provided permitting the participant to receive a dTMS treatment. The participant is at a high risk for severe violence or suicidal tendencies, has current DSM5 diagnosis of schizophrenia, bipolar disorder, or other psychotic disorder, as reported during the screening interview (see appendix 3). The participant has metallic particles in the eye, implanted cardiac pacemaker or any intracardiac lines, implanted neuro-stimulators, intracranial implant (e.g., aneurysm clips, shunts, stimulators, cochlear implants, or electrodes) or implanted medical pumps. The participant is having, or has had, any metal in the head (outside the mouth). The participant has any cognitive or functional disability, according to criteria specified in the DSM-V, such as active and unstable psychiatric disorder according to DSM-V (Axis I and Axis II), diagnosed within the last year. The participant has started or changed a psychotropic prescription within the past three months. The participant has current alcohol or other substance abuse or dependence, or has had one over the past 12 months prior to recruitment. The participant can't reliably communicate with the investigator, or is unlikely to cope with the requirements of the experiment. The participant is having a known or suspected pregnancy or lactation. The motor threshold can't be found or quantified. The PI decides that the participant should be withdrawn from the study for the safety and welfare of the participant. For example, the participant experiences adverse event which is contraindicated with the continuation in the study. The participant has a history of intolerance to a TMS treatment. The participant asks for withdrawal.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Abraham Zangen, PhD
Phone
97286472646
Email
azangen@bgu.ac.il
First Name & Middle Initial & Last Name or Official Title & Degree
Shahar Atias, MD
Phone
972544783129
Email
atiassh@yahoo.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Roni Aviram-Friedman, PhD
Organizational Affiliation
Ben-Gurion University of the Negev
Official's Role
Study Director
Facility Information:
Facility Name
Soroka University Medical Center
City
Beer Sheva
Country
Israel
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Shahar Atias, MD
Phone
972544783129
Email
atiassh@yahoo.com

12. IPD Sharing Statement

Plan to Share IPD
Undecided

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Deep Transcranial Magnetic Stimulation (dTMS) of the Medial Prefrontal Cortex in Food Addiction and Obesity

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