Depression Clinical Trial
Official title:
Repetitive Transcranial MAgnetic STimulation (rTMS) for MotoR and Mood Symptoms of Parkinson's Disease (MASTER-PD), a Multicenter Clinical Trial
The purpose of this study is to determine if repetitive transcranial magnetic stimulation (rTMS), a method of noninvasive brain stimulation) is effective in the treatment of the motor (movement) and mood symptoms due to Parkinson's disease (PD).
Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive means of brain
stimulation which can produce changes to brain excitability. Following a series of daily
rTMS sessions, this modulation of neural circuits and other distant effects may help some of
the motor and neuropsychiatric symptoms of PD for months at a time. Recently, the FDA
approved daily rTMS over the prefrontal cortex as a treatment for medication-refractory
depression after demonstration of efficacy in sham-controlled trials and its safety profile.
Among several small and pilot studies of rTMS in PD patients, rTMS over either the motor
cortex or prefrontal cortex has been reported to show beneficial effects on motor and mood
(depression) symptoms with no serious adverse events. However, the relative effectiveness of
rTMS over motor, prefrontal, or both regions on both mood and motor symptoms, has yet to be
established in PD patients.
We propose to conduct a four-center, blinded, sham-controlled, randomized, parallel-group
study of fixed-dose, high-frequency rTMS in 160 PD patients who are experiencing depressive
symptoms despite an adequate trial of at least one antidepressant. Subjects will be
randomized to receive rTMS over either motor cortex, prefrontal cortex, both, or neither
(sham-rTMS). Subjects will receive rTMS for 25 minutes over either the prefrontal cortex
(the brain region associated with mood and depression), and/or primary motor cortex
(associated with motor control), and/or sham-rTMS. After 10 days of rTMS (or sham) treatment
over a 2-week period, all subjects will undergo a comprehensive assessment of motor, mood,
cognition and quality of life on the first working day after the last rTMS treatment, and
after 1, 3 and 6 months post-treatment. This study directly addresses the expansion of rTMS
as an alternative treatment for depression in the PD population and will provide evidence as
to whether motor cortex stimulation will provide additional and/or separate benefit to motor
symptoms.
;
Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Treatment
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