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Rehabilitative Trial for the Rescue of Neurophysiological Parameters in Progranulin Deficient Subjects (ReRescuePGR)

Primary Purpose

Frontotemporal Dementia, GRN Related Frontotemporal Dementia

Status
Completed
Phase
Not Applicable
Locations
Italy
Study Type
Interventional
Intervention
Anodal transcranial direct current stimulation
Sham transcranial direct current stimulation
Sponsored by
Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Frontotemporal Dementia focused on measuring TMS, tDCS, Rehabilitation

Eligibility Criteria

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

Inclusion Criteria: presymptomatic carriers, symptomatic genetic FTD patients, symptomatic sporadic FTD patients.

  • Presymptomatic carriers: defined as participants who are known carriers of a pathogenic mutation in the GRN gene, who do not fulfill current criteria for the behavioral variant FTD (bvFTD) (Rascovsky et al. 2011) or for the Primary Progressive Aphasias (PPA) (Gorno-Tempini et al. 2011). All subjects will be genotyped for known pathogenic mutations for FTD (GRN, C9orf72, MAPT, TDP-43) before participation.
  • Symptomatic genetic FTD: defined as patients who are known carriers of pathogenic mutation in the GRN gene, fulfilling current clinical criteria for behavioral variant FTD (bvFTD) (Rascovsky et al. 2011) or the agrammatic variant of Primary Progressive Aphasia (avPPA) (Gorno-Tempini et al. 2011).
  • Symptomatic sporadic FTD: defined as patients fulfilling current clinical criteria for behavioral variant FTD (bvFTD) (Rascovsky et al. 2011) or the agrammatic variant of Primary Progressive Aphasia (avPPA) (Gorno-Tempini et al. 2011), with a negative screening for pathogenic mutations in known FTD genes (GRN, C9orf72, MAPT, TDP-43). CSF analysis or amyloid PET imaging will be carried out to exclude focal variants of AD.

Exclusion Criteria:

  • Cerebrovascular disorders, previous stroke, hydrocephalus, and intra-cranial mass documented by MRI.
  • History of traumatic brain injury or other neurological diseases.
  • Serious medical illness other than FTD
  • History of seizures
  • Pregnancy
  • Metal implants in the head (except dental fillings)
  • Electronic implants (i.e. pace-maker, implanted medical pump)
  • Age <18 years

Sites / Locations

  • Azienda Ospedaliera Spedali Civili di Brescia

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

Experimental

Sham Comparator

Experimental

Sham Comparator

Arm Label

Presymptomatic real tDCS

Presymptomatic sham tDCS

Symptomatic real tDCS

Symptomatic sham tDCS

Arm Description

Asymptomatic subjects - 10 days anodal transcranial direct current stimulation

Asymptomatic subjects - 10 days sham transcranial direct current stimulation

Symptomatic patients - 10 days anodal transcranial direct current stimulation

Symptomatic patients - 10 days sham transcranial direct current stimulation

Outcomes

Primary Outcome Measures

Change in SICI measurements from Baseline
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on short interval intracortical inhibition (SICI)
Change in ICF measurements from Baseline
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on intracortical facilitation (ICF).

Secondary Outcome Measures

Change in SICI measurements from Baseline
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on short interval intracortical inhibition (SICI)
Change in ICF measurements from Baseline
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on intracortical facilitation (ICF).
Change in LICI measurements from Baseline
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on long interval intracortical inhibition (LICI).
Change in SICF measurements from Baseline
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on short interval intracortical facilitation (SICF).
Change in MMSE scores from Baseline
The Mini Mental State Examination (MMMSE) is a 30-point questionnaire that is used to measure cognitive impairment.
Change in phonemic fluencies scores from Baseline
Produce as many words as possible beginning with a specified letter in 60 seconds
Change in semantic fluencies scores from Baseline
Produce as many words as possible from a category in 60 seconds
Change in digit span forward scores from Baseline
Participants hear a sequence of numerical digits and are tasked to recall the sequence correctly, with increasingly longer sequences being tested in each trial. The participant's span is the longest number of sequential digits that can accurately be remembered.
Change in digit span backward scores from Baseline
Participants hear a sequence of numerical digits and are tasked to recall the sequence correctly in reverse order, with increasingly longer sequences being tested in each trial. The participant's span is the longest number of sequential digits that can accurately be remembered.
Change in camel and cactus test scores from Baseline
Evaluates associative semantic memory with 64 items presented for naming and word-picture matching.
Change in TMTA scores from Baseline
The task requires a subject to connect a sequence of 25 consecutive targets on a sheet of paper to examine cognitive processing speed.
Change in TMTB scores from Baseline
The task requires a subject to connect a sequence of 25 consecutive targets on a sheet of paper, alternating between numbers and letters, to examine executive functioning.
Change in Stroop test scores from Baseline
Measure a person's selective attention capacity and skills, as well as their processing speed ability.
Change in Symbol Digit test scores from Baseline
It consists of digit-symbol pairs followed by a list of digits. Under each digit the subject should write down the corresponding symbol as fast as possible. The number of correct symbols within the allowed time is measured.
Change in Block Design test scores from Baseline
To evaluated spatial visualization ability and motor skills. The test-taker uses hand movements to rearrange blocks that have various color patterns on different sides to match a pattern. The items in a block design test are scored both by accuracy in matching the pattern and by speed in completing each item.
Change in The modified EkmanFaces Test from Baseline
Each face is presented on a sheet with six labels of basic emotions below the photograph. The patient was required to respond verbally, deciding the label that best described the facial expression shown.

Full Information

First Posted
December 2, 2016
Last Updated
March 1, 2020
Sponsor
Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia
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1. Study Identification

Unique Protocol Identification Number
NCT02999282
Brief Title
Rehabilitative Trial for the Rescue of Neurophysiological Parameters in Progranulin Deficient Subjects
Acronym
ReRescuePGR
Official Title
Rehabilitative Trial for the Recovery of Neurophysiological Parameters in Progranulin Mutation Carriers Through the Use of Transcranial Direct Current Stimulation (tDCS)
Study Type
Interventional

2. Study Status

Record Verification Date
March 2020
Overall Recruitment Status
Completed
Study Start Date
October 31, 2016 (Actual)
Primary Completion Date
June 30, 2019 (Actual)
Study Completion Date
June 30, 2019 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
In this randomized, double-blind, sham-controlled study, the investigators will evaluate the effects of frontal and prefrontal anodal transcranial direct current stimulation (tDCS) on neurophysiological parameters of cortical connectivity, assessed by transcranial magnetic stimulation (TMS), in asymptomatic subjects bearing a pathogenic GRN mutation and in symptomatic patients with frontotemporal dementia.
Detailed Description
In this randomized, double-blind, sham-controlled study, the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation (tDCS) on neurophysiological parameters of cortical connectivity, assessed by transcranial magnetic stimulation (TMS), in asymptomatic subjects bearing a pathogenic GRN mutation and in symptomatic patients with frontotemporal dementia. All patients will undergo genetic screening for progranulin mutations, a baseline neuropsychological and neurophysiological evaluation, including assessment of short interval intracortical inhibition, intracortical facilitation, short interval intracortical facilitation and long interval intracortical inhibition. Subjects will then be randomized in two groups, one receiving a 10 day (5 days/week for 2 weeks) treatment with anodal frontal and prefrontal anodal tDCS and the other receiving sham stimulation with identical parameters. After the intervention, patients will be reassessed with a neuropsychological and neurophysiological evaluation at 2 weeks, 1 month (only neurophysiological evaluation), 3 months and 6 month after treatment.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Frontotemporal Dementia, GRN Related Frontotemporal Dementia
Keywords
TMS, tDCS, Rehabilitation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigator
Allocation
Randomized
Enrollment
70 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Presymptomatic real tDCS
Arm Type
Experimental
Arm Description
Asymptomatic subjects - 10 days anodal transcranial direct current stimulation
Arm Title
Presymptomatic sham tDCS
Arm Type
Sham Comparator
Arm Description
Asymptomatic subjects - 10 days sham transcranial direct current stimulation
Arm Title
Symptomatic real tDCS
Arm Type
Experimental
Arm Description
Symptomatic patients - 10 days anodal transcranial direct current stimulation
Arm Title
Symptomatic sham tDCS
Arm Type
Sham Comparator
Arm Description
Symptomatic patients - 10 days sham transcranial direct current stimulation
Intervention Type
Device
Intervention Name(s)
Anodal transcranial direct current stimulation
Intervention Description
10 sessions of anodal transcranial direct current stimulation (5 days/week for 2 weeks)
Intervention Type
Device
Intervention Name(s)
Sham transcranial direct current stimulation
Intervention Description
10 sessions of sham transcranial direct current stimulation (5 days/week for 2 weeks)
Primary Outcome Measure Information:
Title
Change in SICI measurements from Baseline
Description
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on short interval intracortical inhibition (SICI)
Time Frame
Baseline - 2 weeks
Title
Change in ICF measurements from Baseline
Description
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on intracortical facilitation (ICF).
Time Frame
Baseline - 2 weeks
Secondary Outcome Measure Information:
Title
Change in SICI measurements from Baseline
Description
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on short interval intracortical inhibition (SICI)
Time Frame
Baseline - 1 month - 3 months - 6 months
Title
Change in ICF measurements from Baseline
Description
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on intracortical facilitation (ICF).
Time Frame
Baseline - 1 month - 3 months - 6 months
Title
Change in LICI measurements from Baseline
Description
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on long interval intracortical inhibition (LICI).
Time Frame
Baseline - 1 month - 3 months - 6 months
Title
Change in SICF measurements from Baseline
Description
By using transcranial magnetic stimulation (TMS), the investigators will evaluate the effects of frontal and prefrontal anodal transcranial magnetic stimulation on short interval intracortical facilitation (SICF).
Time Frame
Baseline - 1 month - 3 months - 6 months
Title
Change in MMSE scores from Baseline
Description
The Mini Mental State Examination (MMMSE) is a 30-point questionnaire that is used to measure cognitive impairment.
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in phonemic fluencies scores from Baseline
Description
Produce as many words as possible beginning with a specified letter in 60 seconds
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in semantic fluencies scores from Baseline
Description
Produce as many words as possible from a category in 60 seconds
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in digit span forward scores from Baseline
Description
Participants hear a sequence of numerical digits and are tasked to recall the sequence correctly, with increasingly longer sequences being tested in each trial. The participant's span is the longest number of sequential digits that can accurately be remembered.
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in digit span backward scores from Baseline
Description
Participants hear a sequence of numerical digits and are tasked to recall the sequence correctly in reverse order, with increasingly longer sequences being tested in each trial. The participant's span is the longest number of sequential digits that can accurately be remembered.
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in camel and cactus test scores from Baseline
Description
Evaluates associative semantic memory with 64 items presented for naming and word-picture matching.
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in TMTA scores from Baseline
Description
The task requires a subject to connect a sequence of 25 consecutive targets on a sheet of paper to examine cognitive processing speed.
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in TMTB scores from Baseline
Description
The task requires a subject to connect a sequence of 25 consecutive targets on a sheet of paper, alternating between numbers and letters, to examine executive functioning.
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in Stroop test scores from Baseline
Description
Measure a person's selective attention capacity and skills, as well as their processing speed ability.
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in Symbol Digit test scores from Baseline
Description
It consists of digit-symbol pairs followed by a list of digits. Under each digit the subject should write down the corresponding symbol as fast as possible. The number of correct symbols within the allowed time is measured.
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in Block Design test scores from Baseline
Description
To evaluated spatial visualization ability and motor skills. The test-taker uses hand movements to rearrange blocks that have various color patterns on different sides to match a pattern. The items in a block design test are scored both by accuracy in matching the pattern and by speed in completing each item.
Time Frame
Baseline - 2 weeks - 3 months - 6 months
Title
Change in The modified EkmanFaces Test from Baseline
Description
Each face is presented on a sheet with six labels of basic emotions below the photograph. The patient was required to respond verbally, deciding the label that best described the facial expression shown.
Time Frame
Baseline - 2 weeks - 3 months - 6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: presymptomatic carriers, symptomatic genetic FTD patients, symptomatic sporadic FTD patients. Presymptomatic carriers: defined as participants who are known carriers of a pathogenic mutation in the GRN gene, who do not fulfill current criteria for the behavioral variant FTD (bvFTD) (Rascovsky et al. 2011) or for the Primary Progressive Aphasias (PPA) (Gorno-Tempini et al. 2011). All subjects will be genotyped for known pathogenic mutations for FTD (GRN, C9orf72, MAPT, TDP-43) before participation. Symptomatic genetic FTD: defined as patients who are known carriers of pathogenic mutation in the GRN gene, fulfilling current clinical criteria for behavioral variant FTD (bvFTD) (Rascovsky et al. 2011) or the agrammatic variant of Primary Progressive Aphasia (avPPA) (Gorno-Tempini et al. 2011). Symptomatic sporadic FTD: defined as patients fulfilling current clinical criteria for behavioral variant FTD (bvFTD) (Rascovsky et al. 2011) or the agrammatic variant of Primary Progressive Aphasia (avPPA) (Gorno-Tempini et al. 2011), with a negative screening for pathogenic mutations in known FTD genes (GRN, C9orf72, MAPT, TDP-43). CSF analysis or amyloid PET imaging will be carried out to exclude focal variants of AD. Exclusion Criteria: Cerebrovascular disorders, previous stroke, hydrocephalus, and intra-cranial mass documented by MRI. History of traumatic brain injury or other neurological diseases. Serious medical illness other than FTD History of seizures Pregnancy Metal implants in the head (except dental fillings) Electronic implants (i.e. pace-maker, implanted medical pump) Age <18 years
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Barbara Borroni, MD
Organizational Affiliation
Azienda Ospedaliera Spedali Civili, Brescia
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Alberto Benussi, MD
Organizational Affiliation
Università degli Studi di Brescia
Official's Role
Principal Investigator
Facility Information:
Facility Name
Azienda Ospedaliera Spedali Civili di Brescia
City
Brescia
ZIP/Postal Code
25123
Country
Italy

12. IPD Sharing Statement

Plan to Share IPD
Yes
IPD Sharing Plan Description
All data, including outcome measure results, study protocol and statistical analysis plan, will be shared.
IPD Sharing Time Frame
Data will be shared after the study completion indefinitely.
IPD Sharing Access Criteria
Reasonable request
Citations:
PubMed Identifier
27438089
Citation
Benussi A, Cosseddu M, Filareto I, Dell'Era V, Archetti S, Sofia Cotelli M, Micheli A, Padovani A, Borroni B. Impaired long-term potentiation-like cortical plasticity in presymptomatic genetic frontotemporal dementia. Ann Neurol. 2016 Sep;80(3):472-6. doi: 10.1002/ana.24731. Epub 2016 Aug 10.
Results Reference
background
PubMed Identifier
27372845
Citation
Bikson M, Grossman P, Thomas C, Zannou AL, Jiang J, Adnan T, Mourdoukoutas AP, Kronberg G, Truong D, Boggio P, Brunoni AR, Charvet L, Fregni F, Fritsch B, Gillick B, Hamilton RH, Hampstead BM, Jankord R, Kirton A, Knotkova H, Liebetanz D, Liu A, Loo C, Nitsche MA, Reis J, Richardson JD, Rotenberg A, Turkeltaub PE, Woods AJ. Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016. Brain Stimul. 2016 Sep-Oct;9(5):641-661. doi: 10.1016/j.brs.2016.06.004. Epub 2016 Jun 15.
Results Reference
background
PubMed Identifier
25797650
Citation
Rossini PM, Burke D, Chen R, Cohen LG, Daskalakis Z, Di Iorio R, Di Lazzaro V, Ferreri F, Fitzgerald PB, George MS, Hallett M, Lefaucheur JP, Langguth B, Matsumoto H, Miniussi C, Nitsche MA, Pascual-Leone A, Paulus W, Rossi S, Rothwell JC, Siebner HR, Ugawa Y, Walsh V, Ziemann U. Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and peripheral nerves: Basic principles and procedures for routine clinical and research application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol. 2015 Jun;126(6):1071-1107. doi: 10.1016/j.clinph.2015.02.001. Epub 2015 Feb 10.
Results Reference
background

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Rehabilitative Trial for the Rescue of Neurophysiological Parameters in Progranulin Deficient Subjects

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