Transcranial Direct Current Stimulation and Cognitive Remediation Therapy for Interictal Dysfunction in Epilepsy

Epilepsy Clinical Trial

Official title:

Transcranial Direct Current Stimulation and Cognitive Remediation Therapy for Interictal Dysfunction in Epilepsy

Clinical Trial Details — Status: Withdrawn

Administrative data

• NCT number: NCT02950506
• Other study ID #: CTSI24219
• Status: Withdrawn
• Phase: N/A
• Start date: January 1, 2020
• Est. completion date: March 1, 2020

Study information

• Verified date: January 2022
• Source: University of Minnesota
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to investigate whether tDCS enhances the effect of cognitive remediation therapy on cognition and functional outcome in patients with epilepsy. There has been evidence that working memory performance is enhanced in healthy subjects. Acute tDCS studies have found improvements in working memory performance in subjects with other neurological diseases. To date, there have been no published studies examining whether can enhance learning during multi-session cognitive remediation over 2 weeks in subjects with epilepsy. This study could have potential application as a non-invasive clinical intervention for interictal dysfunction in epilepsy.

Description:

Epilepsy is a chronic neurological disorder affecting 50 million people worldwide. Patients suffer not only from recurring seizures, but also from cognitive deficits despite adequate treatment control. Cognitive remediation therapy (CRT) is a therapeutic intervention that has recently shown promise in improving cognitive impairment in many neuropsychological disorders. Transcranial direct current stimulation (tDCS) is a non-invasive method that modulates cortical excitability. It works by applying weak electrical currents to the scalp that induce acute modifications of neuronal membrane potentials, producing long-lasting changes in the bioelectric activity of underlying brain tissue. It is postulated that tDCS enhances benefit gained through cognitive remediation therapy. These interventions have yet to be combined with each other for the treatment of interictal dysfunction in patients with epilepsy. The goal of the study is to investigate whether the introduction of tDCS in addition to CRT is effective in the treatment of cognitive impairment in patients suffering from epilepsy.

Recruitment information / eligibility

• Status: Withdrawn
• Enrollment: 0
• Est. completion date: March 1, 2020
• Est. primary completion date: March 1, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 64 Years

Eligibility

Inclusion Criteria:

• Age 18-64

• Epilepsy diagnosis confirmed by the UMN Comprehensive Epilepsy Center

• Complete seizure logs of the type in standard clinic use at the UMN Comprehensive Epilepsy Center for at least 12 weeks prior to study entry

• Stable CNS medications for the 2 weeks prior to the initiation visit and expected to continue with current medication doses for the two weeks of the intervention

• No diagnosis of mental retardation (IQ not less than 70) or pervasive developmental disorder

• At least one subtest of learning and memory less than --1.5 SD

• Sufficient spoken English so as to be able to comprehend testing procedures

• Competent and willing to provide consent

Exclusion Criteria:

• Occurrence of generalized convulsive status epilepticus or of complex partial status epilepticus within 1 year prior to study entry

• Occurrence of more than 1 generalized tonic-clonic (GTC) seizure per month, or more than 4 complex partial (CP) seizures per week, as reported in the subject's seizure logs for 12 weeks prior to study entry

• Occurrence of GTC seizure within 48 hours before testing

• Any anti-epileptic medication changes or hospitalizations in the previous 4 weeks

• Additional neurologic disorder other epilepsy and cognitive dysfunctions

• History of metallic cranial plates, screws, or implanted devices

• History of craniotomy

Related Conditions & MeSH terms

• Epilepsy

Intervention

Device:
• transcranial direct current stimulation
The anode will be placed over left DLPFC at F3, according to the 10-20 international system for EEG electrode placement. The cathode will be placed over the contralateral supraorbital area. They will be placed via two saline soaked electrode sponges (3 cm x 4.5 cm).After electrodes have been placed, the participants will be instructed to log into CRT software using a unique patient identifier. The CRT software that will be used will be Cogmed working memory training program (Pearson Education, Inc.)Active tDCS will be applied at a ramp-like fashion from 0 to 2mA over 10 seconds, and will be ramped down for the last 10 seconds of stimulation. Active tDCS will last 20 minutes each session. The sham procedure involves only 30 seconds of stimulation at 2mA.

Other:
• Cognitive Remediation Therapy
The CRT software that will be used will be Cogmed working memory training program (Pearson Education, Inc.). Cogmed is a targeted computerized training program that has been shown to improve working memory and attention. (Spencer-Smith 2015).

Locations

Country	Name	City	State
United States	University of Minnesota Comprehensive Epilepsy Center(MINCEP)	Saint Louis Park	Minnesota

Sponsors (1)

Lead Sponsor	Collaborator
University of Minnesota

Country where clinical trial is conducted

United States, 

References & Publications (38)

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* Note: There are 38 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Cogstate Brief Battery	The Cogstate Battery is a computerized cognitive assessment program which measures a wide; range of cognitive functions (e.g. psychomotor speed, reaction time, working memory, divided; attention, learning), which can be repeated with little to none observed practice effects (Falleti; 2006). All tasks within the battery were adaptations of standard neuro-psychological and; experimental psychological tests. Time to administer requires approximately 15-20 minutes; consists of 8 tasks in the form of card games that are presented in succession.	Change from baseline to 5 days, 1 month, and 3 months after last intervention visit.
Primary	Rey Auditory Verbal Learning Test (AVLT)	The Rey Auditory Verbal Learning Test (AVLT) is a measure of immediate auditory and verbal; memory as well as delayed recall. Participants are given a list of 15 unrelated words repeated; over five different trials and are asked to repeat. Another list of 15 unrelated words are given and; the client must again repeat the original list of 15 words and then again after 30 minutes.; Approximately 45-50 minutes is required for the procedure. (Loring et al. 2008, Strauss 2006)	Change from baseline to 5 days, 1 month, and 3 months after last intervention visit.
Primary	Picture Sequence Memory Test	The Picture Sequence Memory Test (PSMT) is a measure for use in the assessment of episodic; memory. Participants are asked to recall, in increasing length, a series of illustrated objects and; activities that are presented in a particular order on the computer screen. The participants are; asked to recall the sequence of pictures that is demonstrated over two learning trials. The number; of pictures may vary depending on the age. The test takes approximately 7 minutes to administer.; (Dikmen et al. 2014)	Change from baseline to 5 days, 1 month, and 3 months after last intervention visit.
Primary	Flanker Inhibitory Control and Attention Task	This task measures both a participant's attention and inhibitory control. The test requires the; participant to focus on a given arrow while inhibiting attention to other arrows surrounding it.; (Heaton et al. 2014) Sometimes the middle stimulus is pointing in the same direction as the; "flankers" (congruent) and sometimes in the opposite direction (incongruent). Scoring is based; on a combination of accuracy and reaction time. The test takes approximately 3 minutes to; administer.	Change from baseline to 5 days, 1 month, and 3 months after last intervention visit.
Primary	Dimensional Change Card Sort Test	DCCS is an assessment to measure of cognitive flexibility. Two target pictures are presented that vary along two dimensions (e.g., shape and color). Participants are asked to match a series of bivalent test pictures (e.g., yellow balls and blue trucks) to the target pictures, first according to one dimension (e.g., color) and then, after a number of trials, according to the other dimension(e.g., shape). "Switch" trials are also employed, in which the participant must change the dimension being matched. For example, after 4 straight trials matching on shape,the participant may be asked to match on color on the next trial and then go back to shape, thus requiring the cognitive flexibility to quickly choose the correct stimulus. Scoring is based on a combination of accuracy and reaction time. This test takes approximately 4 minutes to administer.	Change from baseline to 5 days, 1 month, and 3 months after last intervention visit.
Secondary	Oral Symbol Digit Test	This instrument is a measure of processing speed. (Denboer et al. 2014). The participant is presented with a set of nine symbols on the computer screen, each associated with a number 1-9, and is then presented with a series of symbols without numbers and is asked to orally say each number that should go with that symbol, without skipping any. The score is equal to the number of symbols correctly identified orally within two minutes. This takes approximately 3 minutes.	Change from baseline to 5 days, 1 month, and 3 months after last intervention visit.
Secondary	Cogstate Brief Battery	The Cogstate Battery is a computerized cognitive assessment program which measures a wide; range of cognitive functions (e.g. psychomotor speed, reaction time, working memory, divided; attention, learning), which can be repeated with little to none observed practice effects (Falleti; 2006). All tasks within the battery were adaptations of standard neuro-psychological and; experimental psychological tests. Time to administer requires approximately 15-20 minutes; consists of 8 tasks in the form of card games that are presented in succession.	Change from baseline to 5 days, 1 month, and 3 months after last intervention visit.
Secondary	Quality of Life	To asses quality of life the Quality of Life in Epilepsy Inventory 31 will be administered.	Change from baseline to 5 days, 1 month, and 3 months after last intervention visit.