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出境医 / 临床实验 / Modulating the Hippocampal and Striatal Memory Networks With rTMS

Modulating the Hippocampal and Striatal Memory Networks With rTMS

Study Description
Brief Summary:

Background:

People have 2 memory systems. One helps them learn skills and the other helps them learn facts. Repetitive transcranial magnetic stimulation (rTMS) uses electronic currents to activate brain cells. This can make small changes in how brain systems operate. Researchers will use rTMS to change how memory systems work and to see if changing one system causes the other to change too. This could help find ways to improve learning and memory in people with memory disorders.

Objective:

To learn how different memory systems work with each other.

Eligibility:

Healthy adults ages 18-40 who are not pregnant

Design:

Potential participants will be screened with a neurological exam if they haven t had one from NINDS in the past 2 years. They may have urine tests.

Eligible participants will have 5-10 visits at NIH. Each visit will last 1-6 hours. Visits 1-4 will each take place 1 day apart.

At visit 1, participants will have an MRI and take memory tests. For MRI, they will lie on a table that slides in and out of a cylinder that takes pictures of their brain. They will also have rTMS. For rTMS, a metal coil is held on their scalp. Brief electrical currents pass through the coil.

At visits 2 and 3, participants will have rTMS.

At visit 4, participants will have an MRI and do memory tests.

About a week later, participants will have visit 5. They will have an MRI and do memory tests. Participants may be asked to have more visits if any technical problems occur. Participants involvement will last 2 weeks.

...


Condition or disease Intervention/treatment Phase
Normal Behavioral Patterns Other: RTMS Not Applicable

Detailed Description:

Objective

The Behavioral Neurology Unit studies the human brain systems underlying learning and adaptation with the ultimate goal of finding interventions to make these processes more efficient. We are interested in whether repetitive transcranial magnetic stimulation (rTMS) can alter functional connectivity (FC) and behavioral efficiency in two memory networks in the brain: the hippocampal network, which supports the storage and retrieval of recallable facts, concepts, and events, and the striatal network, which supports the storage and retrieval of skills and habits. Additionally, because these networks interact behaviorally and can interfere with each other, an important question is whether neuromodulation of one network changes connectivity and efficiency in the other network. Pilot data from our group suggest that exogenous stimulation of one network causes it to expand its range of FC and co-opt resources from the other, which is a potential mechanism for the observed behavioral interaction. This study is designed to test a) whether rTMS- modulates within-network FC and memory supported by that network, and b) whether this also causes FC and behavioral changes in the other network.

Study population: Healthy Volunteers

Design

This study contains four between-subjects experiments and is a mixed inter-/intra subject design. Experiment 1 will use nominally excitatory stimulation targeting the hippocampal network to increase FC within the hippocampal network. We also expect to increase FC between the hippocampal and striatal networks, increased declarative memory, and a possible decrease in procedural, learning. Experiment 2 will use excitatory stimulation targeted to the striatal network. We expect this to cause stronger within- network FC in the striatal network, increased FC between the hippocampus and the striatal network and concomitant behavioral effects. Experiments 3 and 4 will be similar except that we will target nominally inhibitory stimulation to these networks and look for the inverse results. FC will be measured under resting and task-activated conditions and active rTMS will be compared to vertex sham.

Outcome measures

The primary outcome measure is the change in FC produced by rTMS within the targeted network. Between-network FC changes and corresponding memory changes will be secondary outcomes. Exploratory measures will include correlations between individual cognitive differences (questionnaires and NIH Toolbox scores), and our primary and secondary outcome measures.

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 13 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Basic Science
Official Title: Modulating the Hippocampal and Striatal Memory Networks With rTMS
Actual Study Start Date : September 26, 2019
Actual Primary Completion Date : March 24, 2021
Actual Study Completion Date : March 24, 2021
Arms and Interventions
Arm Intervention/treatment
Active Comparator: Motor Cortex rTMS
Motor Cortex rTMS
Other: RTMS
Altering the connectivity of trans-synaptic pathways

Active Comparator: PPC rTMS
PPC rTMS
Other: RTMS
Altering the connectivity of trans-synaptic pathways

Placebo Comparator: vertex rTMS
vertex rTMS
Other: RTMS
Altering the connectivity of trans-synaptic pathways

Outcome Measures
Primary Outcome Measures :
  1. Functional Connectivity [ Time Frame: 24 hrs. ]
    Pre-to-Post rTMS differences in rsFC and tbFC within the targeted memory network


Secondary Outcome Measures :
  1. Memory Task Scores [ Time Frame: 24 hours ]
    Outcomes include percentage of correct/optimal responses and reaction time.


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   20 Years to 40 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria
  • INCLUSION CRITERIA:
  • Age 18-40 (inclusive)

EXCLUSION CRITERIA:

  • Any current major neurological or psychiatric disorder such as (but not limited to) stroke, Parkinson disease, Alzheimer disease, schizophrenia or major depression
  • History of seizure
  • Medications acting on the central nervous system, such as those that lowers the seizure threshold such as neuroleptics, beta lactams, isoniazid, metronidazole; benzodiazepines, tricyclic or other antidepressants; or prescription stimulants.
  • Ferromagnetic metal in the cranial cavity or eye, implanted neural stimulator, cochlear implant, or ocular foreign body
  • Implanted cardiac pacemaker or auto-defibrillator or pump
  • Non-removable body piercing
  • Claustrophobia
  • Inability to lie supine for 2 hours
  • Pregnancy, or plans to become pregnant during the study.
  • Members of the NINDS BNU
  • Subjects that received rTMS under protocol 17-N-0055 are excluded in order avoid learning effects from previously being exposed to the same behavioral tasks
  • Subjects who have contraindications to MRI (we will follow the NMR Center guidelines for MR safety). Some of the exclusions are:

    • Have non-MRI compatible metal in the body, such as a cardiac pacemaker, brain stimulator, shrapnel, surgical metal, clips in the brain or on blood vessels, cochlear implants, artificial heart valves or ferromagnetic fragments in the eye or oral cavity as these make having an MRI unsafe.
    • Unable to lie flat on the back for the expected length of the experiment (2 hours).
    • Have an abnormality on the brain imaging or neurologic examination not related to the diagnosis.
    • Non-removable body piercing or
    • Pregnancy (urine pregnancy test)
Contacts and Locations

Locations
Layout table for location information
United States, Maryland
National Institutes of Health Clinical Center
Bethesda, Maryland, United States, 20892
Sponsors and Collaborators
National Institute of Neurological Disorders and Stroke (NINDS)
Investigators
Layout table for investigator information
Principal Investigator: Eric M Wassermann, M.D. National Institute of Neurological Disorders and Stroke (NINDS)
Tracking Information
First Submitted Date  ICMJE June 20, 2019
First Posted Date  ICMJE June 21, 2019
Last Update Posted Date May 21, 2021
Actual Study Start Date  ICMJE September 26, 2019
Actual Primary Completion Date March 24, 2021   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: June 20, 2019)
Functional Connectivity [ Time Frame: 24 hrs. ]
Pre-to-Post rTMS differences in rsFC and tbFC within the targeted memory network
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: June 20, 2019)
Memory Task Scores [ Time Frame: 24 hours ]
Outcomes include percentage of correct/optimal responses and reaction time.
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE Modulating the Hippocampal and Striatal Memory Networks With rTMS
Official Title  ICMJE Modulating the Hippocampal and Striatal Memory Networks With rTMS
Brief Summary

Background:

People have 2 memory systems. One helps them learn skills and the other helps them learn facts. Repetitive transcranial magnetic stimulation (rTMS) uses electronic currents to activate brain cells. This can make small changes in how brain systems operate. Researchers will use rTMS to change how memory systems work and to see if changing one system causes the other to change too. This could help find ways to improve learning and memory in people with memory disorders.

Objective:

To learn how different memory systems work with each other.

Eligibility:

Healthy adults ages 18-40 who are not pregnant

Design:

Potential participants will be screened with a neurological exam if they haven t had one from NINDS in the past 2 years. They may have urine tests.

Eligible participants will have 5-10 visits at NIH. Each visit will last 1-6 hours. Visits 1-4 will each take place 1 day apart.

At visit 1, participants will have an MRI and take memory tests. For MRI, they will lie on a table that slides in and out of a cylinder that takes pictures of their brain. They will also have rTMS. For rTMS, a metal coil is held on their scalp. Brief electrical currents pass through the coil.

At visits 2 and 3, participants will have rTMS.

At visit 4, participants will have an MRI and do memory tests.

About a week later, participants will have visit 5. They will have an MRI and do memory tests. Participants may be asked to have more visits if any technical problems occur. Participants involvement will last 2 weeks.

...

Detailed Description

Objective

The Behavioral Neurology Unit studies the human brain systems underlying learning and adaptation with the ultimate goal of finding interventions to make these processes more efficient. We are interested in whether repetitive transcranial magnetic stimulation (rTMS) can alter functional connectivity (FC) and behavioral efficiency in two memory networks in the brain: the hippocampal network, which supports the storage and retrieval of recallable facts, concepts, and events, and the striatal network, which supports the storage and retrieval of skills and habits. Additionally, because these networks interact behaviorally and can interfere with each other, an important question is whether neuromodulation of one network changes connectivity and efficiency in the other network. Pilot data from our group suggest that exogenous stimulation of one network causes it to expand its range of FC and co-opt resources from the other, which is a potential mechanism for the observed behavioral interaction. This study is designed to test a) whether rTMS- modulates within-network FC and memory supported by that network, and b) whether this also causes FC and behavioral changes in the other network.

Study population: Healthy Volunteers

Design

This study contains four between-subjects experiments and is a mixed inter-/intra subject design. Experiment 1 will use nominally excitatory stimulation targeting the hippocampal network to increase FC within the hippocampal network. We also expect to increase FC between the hippocampal and striatal networks, increased declarative memory, and a possible decrease in procedural, learning. Experiment 2 will use excitatory stimulation targeted to the striatal network. We expect this to cause stronger within- network FC in the striatal network, increased FC between the hippocampus and the striatal network and concomitant behavioral effects. Experiments 3 and 4 will be similar except that we will target nominally inhibitory stimulation to these networks and look for the inverse results. FC will be measured under resting and task-activated conditions and active rTMS will be compared to vertex sham.

Outcome measures

The primary outcome measure is the change in FC produced by rTMS within the targeted network. Between-network FC changes and corresponding memory changes will be secondary outcomes. Exploratory measures will include correlations between individual cognitive differences (questionnaires and NIH Toolbox scores), and our primary and secondary outcome measures.

Study Type  ICMJE Interventional
Study Phase  ICMJE Not Applicable
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Basic Science
Condition  ICMJE Normal Behavioral Patterns
Intervention  ICMJE Other: RTMS
Altering the connectivity of trans-synaptic pathways
Study Arms  ICMJE
  • Active Comparator: Motor Cortex rTMS
    Motor Cortex rTMS
    Intervention: Other: RTMS
  • Active Comparator: PPC rTMS
    PPC rTMS
    Intervention: Other: RTMS
  • Placebo Comparator: vertex rTMS
    vertex rTMS
    Intervention: Other: RTMS
Publications * Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Completed
Actual Enrollment  ICMJE
 (submitted: May 20, 2021)
13
Original Estimated Enrollment  ICMJE
 (submitted: June 20, 2019)
122
Actual Study Completion Date  ICMJE March 24, 2021
Actual Primary Completion Date March 24, 2021   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE
  • INCLUSION CRITERIA:
  • Age 18-40 (inclusive)

EXCLUSION CRITERIA:

  • Any current major neurological or psychiatric disorder such as (but not limited to) stroke, Parkinson disease, Alzheimer disease, schizophrenia or major depression
  • History of seizure
  • Medications acting on the central nervous system, such as those that lowers the seizure threshold such as neuroleptics, beta lactams, isoniazid, metronidazole; benzodiazepines, tricyclic or other antidepressants; or prescription stimulants.
  • Ferromagnetic metal in the cranial cavity or eye, implanted neural stimulator, cochlear implant, or ocular foreign body
  • Implanted cardiac pacemaker or auto-defibrillator or pump
  • Non-removable body piercing
  • Claustrophobia
  • Inability to lie supine for 2 hours
  • Pregnancy, or plans to become pregnant during the study.
  • Members of the NINDS BNU
  • Subjects that received rTMS under protocol 17-N-0055 are excluded in order avoid learning effects from previously being exposed to the same behavioral tasks
  • Subjects who have contraindications to MRI (we will follow the NMR Center guidelines for MR safety). Some of the exclusions are:

    • Have non-MRI compatible metal in the body, such as a cardiac pacemaker, brain stimulator, shrapnel, surgical metal, clips in the brain or on blood vessels, cochlear implants, artificial heart valves or ferromagnetic fragments in the eye or oral cavity as these make having an MRI unsafe.
    • Unable to lie flat on the back for the expected length of the experiment (2 hours).
    • Have an abnormality on the brain imaging or neurologic examination not related to the diagnosis.
    • Non-removable body piercing or
    • Pregnancy (urine pregnancy test)
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 20 Years to 40 Years   (Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE United States
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03994120
Other Study ID Numbers  ICMJE 190114
19-N-0114
Has Data Monitoring Committee Not Provided
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE Not Provided
Responsible Party National Institutes of Health Clinical Center (CC) ( National Institute of Neurological Disorders and Stroke (NINDS) )
Study Sponsor  ICMJE National Institute of Neurological Disorders and Stroke (NINDS)
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Eric M Wassermann, M.D. National Institute of Neurological Disorders and Stroke (NINDS)
PRS Account National Institutes of Health Clinical Center (CC)
Verification Date May 19, 2021

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP