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Role of GABAergic Transmission in Auditory Processing in Autism Spectrum Disorder

Primary Purpose

Autism Spectrum Disorder

Status
Recruiting
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Continuous Theta Burst Stimulation
Sponsored by
National Institute of Mental Health (NIMH)
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Autism Spectrum Disorder focused on measuring GABA, Language, ASD, MEG, MRS

Eligibility Criteria

14 Years - 25 Years (Child, Adult)All SexesAccepts Healthy Volunteers
  • INCLUSION CRITERIA:

Pilot Phase

Inclusion criteria

  1. Ability to provide informed consent
  2. Age: 18-25 years
  3. Must meet the definition of Healthy Control having completed the screening assessment under protocol 01-M-0254, The Evaluation of Patients with Mood and Anxiety Disorders and Healthy Volunteers or under protocol 17-M-0181, Recruitment and Characterization of Research Volunteers for NIMH Intramural Studies .

Main Study Phase

Inclusion criteria

  1. Ability to provide informed assent and parent consent
  2. Age: 14-17 years
  3. Community Diagnosis of ASD based on DSM-IV or DSM-5 criteria
  4. Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II). WASI-II will be used as a measure of intellectual function. Children will be included when FSIQ > 70.
  5. Right-handed: to reduce heterogeneity.
  6. Hearing: Normal hearing in order to complete the behavioural assessments.

EXCLUSION CRITERIA:

Participants will be screened to exclude individuals with neurological, psychological/behavioral or medical conditions, as well as to exclude subjects in whom MRI or rTMS might result in increased risk of side effects or complications. This accounts for the majority of the exclusion criteria listed:

Pilot Phase

  1. Non-English Speakers
  2. Known Neurological Disorder
  3. Known Psychiatric Disorder
  4. Known genetic disorder (e.g., NF1, tuberous sclerosis), acquired neurologic disease (e.g. stroke, tumour), cerebral palsy, intracranial pathology or significant dysmorphology;
  5. History of fainting spells of unknown or undetermined etiology that might constitute seizures;
  6. History of seizures, diagnosis of epilepsy, or immediate (1st degree relative) family history epilepsy;
  7. Chronic (particularly) uncontrolled medical conditions that may cause a medical emergency in case of a provoked seizure (cardiac malformation, cardiac dysrhythmia, asthma, etc.);
  8. Past or Current History of Tinnitus
  9. Any implant, prosthesis or other permanent alteration of the body that, in the opinion of the investigator, would be unsafe with MRI or TMS or that would produce an artifact that would compromise the integrity of data;
  10. Signs of increased intracranial pressure;
  11. Intracranial lesion (including incidental finding on MRI) that, in the opinion of the investigator, would be unsafe with MRI or TMS or that would produce an artifact that would compromise the integrity of data;
  12. History of any head trauma within 6 months of screening, or beyond 6 months prior to screening, history of head trauma with evidence of traumatic abnormality appearing on a brain scan, or with loss of consciousness >5 minutes, or with other sequelae, excluding headache, lasting > 24 hours.
  13. Pregnancy;
  14. Participants who have received rTMS less than 7 days prior to enrollment;
  15. Individuals currently taking GABAergic medications or any other medication that, in the opinion of the investigator, significantly lowers seizure threshold;
  16. Individuals for whom it is not safe or appropriate to remain on a stable pharmacotherapy (for nonexclusionary medications) for six weeks prior to and over the course of their participation in the study;
  17. A current NIMH employee or staff or their immediate family member.

Main Study Phase

  1. Non-English Speakers
  2. Known genetic disorder (e.g., NF1, tuberous sclerosis), acquired neurologic disease (e.g. stroke, tumour), cerebral palsy, intracranial pathology or significant dysmorphology;
  3. History of fainting spells of unknown or undetermined etiology that might constitute seizures;
  4. History of seizures, diagnosis of epilepsy, or immediate (1st degree relative) family history epilepsy;
  5. Any progressive (e.g., neurodegenerative) neurological disorder;
  6. Chronic (particularly) uncontrolled medical conditions that may cause a medical emergency in case of a provoked seizure (cardiac malformation, cardiac dysrhythmia, asthma, etc.);
  7. Past or Current History of Tinnitus
  8. Any implant, prosthesis or other permanent alteration of the body that, in the opinion of the investigator, would be unsafe with MRI or TMS or that would produce an artifact that would compromise the integrity of data;
  9. Signs of increased intracranial pressure;
  10. Intracranial lesion (including incidental finding on MRI) that, in the opinion of the investigator, would be unsafe with MRI or TMS or that would produce an artifact that would compromise the integrity of data ;
  11. <TAB>History of any head trauma within 6 months of screening, or beyond 6 months prior to screening, history of head trauma with evidence of traumatic abnormality appearing on a brain scan, or with loss of consciousness >5 minutes, or with other sequelae, excluding headache, lasting > 24 hours.
  12. Pregnancy;
  13. Participants who have received prior rTMS;
  14. Active or History of psychosis, bipolar disorder, active severe substance use disorders (within the last month), have active suicidal intent or plan as detected on screening instruments or in the investigator team s opinion is likely to attempt suicide within 6 months;
  15. Individuals currently taking GABAergic medications or any other medication that, in the opinion of the investigator, significantly lowers seizure threshold.
  16. Individuals for whom it is not safe or appropriate to remain on a stable pharmacotherapy (for nonexclusionary medications) for six weeks prior to and over the course of their participation in the study.
  17. A current NIMH employee or staff or their immediate family member.

Sites / Locations

  • National Institutes of Health Clinical CenterRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Sham Comparator

Arm Label

Active cTBS

Sham cTBS

Arm Description

This intervention involves active repetitive magnetic stimulation. The coil emits a magnetic field

This intervention involves sham (placebo) repetitive transcranial magnetic stimulation. The coil is blinded, but does not emit any magnetic field

Outcomes

Primary Outcome Measures

MRS
GABA+/Cr concentrations in the left pSTC
MEG
Evoked fields and Spectral Power
fcMRI
BOLD correlations across pre-defined ROIs.
DTI
Diffusion tensor derived parameters in the auditory radiations and arcuate fasciculus.

Secondary Outcome Measures

Neuropsychological Assessments
SRS-2, CELF-5, EVT, PPVT, ADOS-2, ADI-R, VABS-III, WASI-II.
MEG
Inter-trial gamma-band coherence (ITC) and resting state alpha to gamma phase-amplitude coupling.

Full Information

First Posted
March 12, 2021
Last Updated
August 3, 2023
Sponsor
National Institute of Mental Health (NIMH)
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1. Study Identification

Unique Protocol Identification Number
NCT04798274
Brief Title
Role of GABAergic Transmission in Auditory Processing in Autism Spectrum Disorder
Official Title
Role of GABAergic Transmission in Auditory Processing in Autism Spectrum Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
August 1, 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 15, 2021 (Actual)
Primary Completion Date
June 30, 2025 (Anticipated)
Study Completion Date
June 30, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
National Institute of Mental Health (NIMH)

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No

5. Study Description

Brief Summary
Background: Autism spectrum disorder (ASD) is a complex neurodevelopmental syndrome. Researchers think brain development may be controlled by gamma-aminobutyric acid (GABA). They want to learn how abnormalities in the GABA system may contribute to ASD. Objective: To see if repetitive transcranial magnetic stimulation (rTMS) creates short-term changes in how different parts of the brain communicate. Eligibility: Right-handed people ages 14-17 with ASD, and healthy volunteers ages 18-25. Design: Participants will be screened with: Medical history Physical exam Medicine review Neurological exam Psychological tests and rating scales Forms and surveys. Participants will have a hearing test and ear exam. Participants will have magnetic resonance imaging (MRI) of the brain. They will lie on a table that moves in and out of the MRI scanner. They may look at a screen while in the scanner. A coil will be placed over their head. Participants will have magnetic resonance spectroscopy. It takes pictures of chemicals in the brain using the MRI scanner. Participants will have magnetoencephalography. They will sit in a chair. A helmet with magnetic field sensors will be placed on their head. Participants will have TMS. A wire coil will be held on their scalp. A brief electrical current will pass through the coil. Participants will have electromyography. Sticky pad electrodes will be placed on the skin during TMS. The electrical activity of their muscles will be measured. Participants will have rTMS. It uses short bursts of magnetic pulses to affect brain activity. ASD participants will have 7 visits over 2-3 months. Healthy volunteers will have 3 visits over 3-4 weeks....
Detailed Description
Study Description: This will be a within-subject, controlled, proof-of-mechanism study. Objectives: The study aims to evaluate the relationship between local GABA concentration, structural and functional network connectivity and MEG measures of auditory and language processing in adolescents with ASD and the acute impact of a single session of continuous theta burst stimulation over left posterior superior temporal cortex (pSTC) on these measures. We hypothesize that GABA concentrations, DTI measures of tissue microstructure and fcMRI obtained BOLD correlations within the language network will significantly contribute to the prediction model for MEG indices of auditory and language processing. Participation in the study involves about seven study visits. Some of the visits may be split up to shorten the length of session and limit fatigue. Visits will be scheduled about once a week. All visits must be completed within six months of the date of enrollment. Primary Objective: The overall goal of the current study is to 1) Characterize the relationship between an individual's baseline local cortical GABA concentration, DTI measures of auditory and language network tissue microstructure, and fcMRI indices of local and long-range network functional connectivity (predictor variables) and MEG indices of auditory and language processing (dependent variables). Secondary Objectives: 2) Evaluate the impact of a single session of cTBS over the left pSTC on these MRS and MEG indices in adolescents (age 14-17) with ASD. Endpoints: Primary Endpoints: MEG: Evoked fields and Spectral Power MRS: GABA+/Cr concentrations in the left pSTC DTI: Diffusion tensor derived parameters in the auditory radiations and arcuate fasciculus. fcMRI: BOLD correlations across pre-defined ROIs. Secondary Endpoints: MEG: Inter-trial gamma-band coherence (ITC) and resting state alpha to gamma phase-amplitude coupling. SRS-2, CELF-5, EVT-3, PPVT, ADOS-2 (if available), ADI-R, VABS-III, WASI- II.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Autism Spectrum Disorder
Keywords
GABA, Language, ASD, MEG, MRS

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
106 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Active cTBS
Arm Type
Experimental
Arm Description
This intervention involves active repetitive magnetic stimulation. The coil emits a magnetic field
Arm Title
Sham cTBS
Arm Type
Sham Comparator
Arm Description
This intervention involves sham (placebo) repetitive transcranial magnetic stimulation. The coil is blinded, but does not emit any magnetic field
Intervention Type
Device
Intervention Name(s)
Continuous Theta Burst Stimulation
Intervention Description
Continuous theta burst stimulation (cTBS) will be applied using a MagPro X100 (MagVenture, Inc. Alpharetta, GA). The cTBS protocol consists of bursts of three pulses of 50 Hz stimulation repeated at 200 ms intervals (5 times per second) for 40 seconds (for a total of 600 pulses). Stimulation will be applied at an intensity of 80% of active motor threshold (AMT). Brainsight (Rogue Research) frameless neuronavigation system will be used to target the specific structural MRI-defined region of stimulation.
Primary Outcome Measure Information:
Title
MRS
Description
GABA+/Cr concentrations in the left pSTC
Time Frame
immediately pre and post rTMS
Title
MEG
Description
Evoked fields and Spectral Power
Time Frame
immediately pre and post rTMS
Title
fcMRI
Description
BOLD correlations across pre-defined ROIs.
Time Frame
immediately pre and post rTMS
Title
DTI
Description
Diffusion tensor derived parameters in the auditory radiations and arcuate fasciculus.
Time Frame
immediately pre and post rTMS
Secondary Outcome Measure Information:
Title
Neuropsychological Assessments
Description
SRS-2, CELF-5, EVT, PPVT, ADOS-2, ADI-R, VABS-III, WASI-II.
Time Frame
Baseline
Title
MEG
Description
Inter-trial gamma-band coherence (ITC) and resting state alpha to gamma phase-amplitude coupling.
Time Frame
immediately pre and post rTMS

10. Eligibility

Sex
All
Minimum Age & Unit of Time
14 Years
Maximum Age & Unit of Time
25 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
INCLUSION CRITERIA: Pilot Phase Inclusion criteria Ability to provide informed consent Age: 18-25 years Must meet the definition of Healthy Control having completed the screening assessment under protocol 01-M-0254, The Evaluation of Patients with Mood and Anxiety Disorders and Healthy Volunteers or under protocol 17-M-0181, Recruitment and Characterization of Research Volunteers for NIMH Intramural Studies . Main Study Phase Inclusion criteria Ability to provide informed assent and parent consent Age: 14-17 years Community Diagnosis of ASD based on DSM-IV or DSM-5 criteria Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II). WASI-II will be used as a measure of intellectual function. Children will be included when FSIQ > 70. Right-handed: to reduce heterogeneity. Hearing: Normal hearing in order to complete the behavioural assessments. EXCLUSION CRITERIA: Participants will be screened to exclude individuals with neurological, psychological/behavioral or medical conditions, as well as to exclude subjects in whom MRI or rTMS might result in increased risk of side effects or complications. This accounts for the majority of the exclusion criteria listed: Pilot Phase Non-English Speakers Known Neurological Disorder Known Psychiatric Disorder Known genetic disorder (e.g., NF1, tuberous sclerosis), acquired neurologic disease (e.g. stroke, tumour), cerebral palsy, intracranial pathology or significant dysmorphology; History of fainting spells of unknown or undetermined etiology that might constitute seizures; History of seizures, diagnosis of epilepsy, or immediate (1st degree relative) family history epilepsy; Chronic (particularly) uncontrolled medical conditions that may cause a medical emergency in case of a provoked seizure (cardiac malformation, cardiac dysrhythmia, asthma, etc.); Past or Current History of Tinnitus Any implant, prosthesis or other permanent alteration of the body that, in the opinion of the investigator, would be unsafe with MRI or TMS or that would produce an artifact that would compromise the integrity of data; Signs of increased intracranial pressure; Intracranial lesion (including incidental finding on MRI) that, in the opinion of the investigator, would be unsafe with MRI or TMS or that would produce an artifact that would compromise the integrity of data; History of any head trauma within 6 months of screening, or beyond 6 months prior to screening, history of head trauma with evidence of traumatic abnormality appearing on a brain scan, or with loss of consciousness >5 minutes, or with other sequelae, excluding headache, lasting > 24 hours. Pregnancy; Participants who have received rTMS less than 7 days prior to enrollment; Individuals currently taking GABAergic medications or any other medication that, in the opinion of the investigator, significantly lowers seizure threshold; Individuals for whom it is not safe or appropriate to remain on a stable pharmacotherapy (for nonexclusionary medications) for six weeks prior to and over the course of their participation in the study; A current NIMH employee or staff or their immediate family member. Main Study Phase Non-English Speakers Known genetic disorder (e.g., NF1, tuberous sclerosis), acquired neurologic disease (e.g. stroke, tumour), cerebral palsy, intracranial pathology or significant dysmorphology; History of fainting spells of unknown or undetermined etiology that might constitute seizures; History of seizures, diagnosis of epilepsy, or immediate (1st degree relative) family history epilepsy; Any progressive (e.g., neurodegenerative) neurological disorder; Chronic (particularly) uncontrolled medical conditions that may cause a medical emergency in case of a provoked seizure (cardiac malformation, cardiac dysrhythmia, asthma, etc.); Past or Current History of Tinnitus Any implant, prosthesis or other permanent alteration of the body that, in the opinion of the investigator, would be unsafe with MRI or TMS or that would produce an artifact that would compromise the integrity of data; Signs of increased intracranial pressure; Intracranial lesion (including incidental finding on MRI) that, in the opinion of the investigator, would be unsafe with MRI or TMS or that would produce an artifact that would compromise the integrity of data ; <TAB>History of any head trauma within 6 months of screening, or beyond 6 months prior to screening, history of head trauma with evidence of traumatic abnormality appearing on a brain scan, or with loss of consciousness >5 minutes, or with other sequelae, excluding headache, lasting > 24 hours. Pregnancy; Participants who have received prior rTMS; Active or History of psychosis, bipolar disorder, active severe substance use disorders (within the last month), have active suicidal intent or plan as detected on screening instruments or in the investigator team s opinion is likely to attempt suicide within 6 months; Individuals currently taking GABAergic medications or any other medication that, in the opinion of the investigator, significantly lowers seizure threshold. Individuals for whom it is not safe or appropriate to remain on a stable pharmacotherapy (for nonexclusionary medications) for six weeks prior to and over the course of their participation in the study. A current NIMH employee or staff or their immediate family member.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Lindsay M Oberman
Phone
(301) 435-7962
Email
lindsay.oberman@nih.gov
First Name & Middle Initial & Last Name or Official Title & Degree
Sarah H Lisanby, M.D.
Phone
(301) 339-4831
Email
lisanbysh@mail.nih.gov
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Sarah H Lisanby, M.D.
Organizational Affiliation
National Institute of Mental Health (NIMH)
Official's Role
Principal Investigator
Facility Information:
Facility Name
National Institutes of Health Clinical Center
City
Bethesda
State/Province
Maryland
ZIP/Postal Code
20892
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
For more information at the NIH Clinical Center contact Office of Patient Recruitment (OPR)
Phone
800-411-1222
Ext
TTY8664111010
Email
prpl@cc.nih.gov

12. IPD Sharing Statement

Links:
URL
https://clinicalstudies.info.nih.gov/cgi/detail.cgi?A_2020-M-0159.html
Description
NIH Clinical Center Detailed Web Page

Learn more about this trial

Role of GABAergic Transmission in Auditory Processing in Autism Spectrum Disorder

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