Acute Stroke Clinical Trial
— tDCSOfficial title:
Transcranial Direct Current Stimulation (tDCS) in Acute Stroke Patients
Very early after the onset of the focal perfusion deficit, excitotoxic mechanisms can
lethally damage neurons and glia. Excitotoxicity triggers a number of events that can further
contribute to tissue death. Such events include peri-infarct depolarizations (PID) and
cortical spreading depolarization (CSD) within the peri-infarct zone or ischaemic penumbra.
Noninvasive brain stimulation techniques such as transcranial direct current stimulation
(tDCS) are emerging as promising tools, owing to their effects on modulating cortical
activity. Experimental studies have indicated that cathodic polarization of the cortical
surface blocks initiation of CSD. Moreover, it has been recently demonstrated in murine
stroke models that cathodal tDCS exerts a measurable neuroprotective effect in the acute
phase of stroke, decreasing the number of spreading depolarizations and reducing the infarct
volume by 20 to 30%.
The investigators propose here a pilot study, in acute middle cerebral artery stroke
patients, with a double blind randomization: cathodal tDCS versus sham tDCS. The duration of
this study will be two years. Fifty acute middle cerebral artery stroke patients will be
included. The tDCS will begin within 4.5 hours of symptom onset. The main criteria of
evaluation will be the extent of diffusion-weighted imaging (DWI) infarct volume between
imaging on admission and 24 hours later. The investigators propose the hypothesis that in
acute stroke patients, cathodal tDCS could be an adjuvant approach to recanalizing therapies.
Status | Recruiting |
Enrollment | 50 |
Est. completion date | February 2019 |
Est. primary completion date | October 2018 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - age = 18 years - middle cerebral artery stroke confirmed by MRI - neuroradiology: initial MRI with diffusion and perfusion sequences - NIHSS scale between 4 and 25 - delay since the beginning of symptoms < 4h30 - intravenous thrombolysis treatment - obtained consent - patient affiliated or benefiting from the French national insurance Exclusion Criteria: - pregnant woman - contraindications for an MRI scan : heart pace-maker, patients who have a metallic foreign body (metal sliver) in their eye or in their brain. - contraindications for the tDCS : scalp or forehead cutaneous lesion, history of intra-cranial surgery - coma - beginning of the symptoms cannot be precisely specified |
Country | Name | City | State |
---|---|---|---|
France | Centre Hospitalier Sainte Anne | Paris |
Lead Sponsor | Collaborator |
---|---|
Centre Hospitalier St Anne | Institut National de la Santé Et de la Recherche Médicale, France |
France,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Brain MRI diffusion weighted images | Brain MRI, diffusion weighted images will be used. The objective in this study is to use infarct growth attenuation as an end-point. MRI infarct growth (IG) will be determined by the subtraction of acute from follow-up (day 1) diffusion-weighted imaging (DWI) lesion volumes, measured in mL (Forkert et al, 2013; Hassen et al, 2016). | Day 1 | |
Secondary | NIHSS | Determine if tDCS improve clinical outcome. The National Institute of Health Stroke Scale (NIHSS) will be completed at 7 days after stroke by one of the investigators. | Day 7 | |
Secondary | Rankin scale | Determine if tDCS improve clinical outcome at three months. The Rankin scale will be completed at 3 months after stroke by one of the investigators, either during a neurologist consultation, either by a phone call. | 3 months | |
Secondary | tDCS safety | Assess tDCS safety and tolerability. During the tDCS stimulation, the patient will be questioned and patient's skin will be examined each hour, by one of the investigators. In order to avoid poor contact due to the tDCS electrodes drying out, impedance values will be checked each hour and electrode contact adjusted accordingly with saline solution. | Each hour during 6 hours | |
Secondary | tDCS safety | Assess tDCS safety and tolerability. Day 1 after stroke, the patient will be again questioned about eventual side effect and patient's skin (forehead and M1 area) will be examined, by one of the investigators. These data will be notified in the case report form. | Day 1 | |
Secondary | tDCS tolerability | Assess tDCS safety and tolerability. During the tDCS stimulation, the patient will be questioned and patient's skin will be examined each hour, by one of the investigators. In order to avoid poor contact due to the tDCS electrodes drying out, impedance values will be checked each hour and electrode contact adjusted accordingly with saline solution. | Each hour during 6 hours | |
Secondary | tDCS tolerability | Assess tDCS safety and tolerability. Day 1 after stroke, the patient will be again questioned about eventual side effect and patient's skin (forehead and M1 area) will be examined, by one of the investigators. These data will be notified in the case report form. | Day 1 |
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