Stroke and Healthy Subjects Clinical Trial
Official title:
Assessment of Paired Associative Stimulation Protocols Using Cerebellar or Visual Afferences in Post-stroke Hand Motor Deficits
Introduction The motor impairment of the upper extremity is the most common sequelae after
ischemic stroke. Transcranial magnetic stimulation (TMS) is a promising non- invasive
technique in the rehabilitation of motor deficits. However, its effect in post-stroke motor
deficits remains moderate our days. To potentiate the effect of TMS, techniques called Paired
Associative Stimulations (PAS) involving the integration of afferent sensory inputs at the
level of the ipsilesional primary motor cortex were developed in healthy subjects. PAS
techniques have shown a gain of corticospinal excitability by such phenomenon known as long
Term Potentiation (LTP) and a gain of motor performance. The investigators would like to
propose to evaluate two types of these techniques with a volley of visual afferents
(visuomotor stimulation, V_PAS) or of cerebellar afferents (CER_PAS), because these two
structures convey important information in the execution of the movement.
Design Multicenter, randomized, study, 60 patients in 3 parallel groups (V_PAS, CER_PAS,
control group with sham and sham V_PAS CER_PAS), 5 days of treatment, clinical assessment,
electrophysiological and MRI before, immediately post- and second post-assessments (4 weeks).
A group of 24 healthy subjects will undergo a parallel physiopathological study on the
underlying mechanisms of cerebellar PAS
Objectives Main objective: To determine whether (and how) Paired Associative Stimulation
technique (PAS) induces cerebral reorganization in the primary motor cortex compared to the
control group.
Aim 2: Determine whether (and which) type of PAS is capable of inducing changes in motor
performance of the upper limb paresis and duration Aim 3: Determine whether (and which) type
of PAS is capable of inducing changes in excitability of the corticospinal tract and duration
Aim 4: Determine how PAS techniques modify the functional connectivity during movement Aim 5:
Determine if connectivity changes during induced movement correlate with clinical
improvements Aim 6: Determine whether patients who benefit of a type of PAS have specific
anatomical lesion characteristics (volume, afferent and efferent white matter fasciculi
integrity)
Introduction The motor impairment of the upper extremity is the most common sequelae after
ischemic stroke. Transcranial magnetic stimulation (TMS) is a promising non- invasive
technique in the rehabilitation of motor deficits. However, its effect in post-stroke motor
deficits remains moderate the investigators days. To potentiate the effect of TMS, techniques
called Paired Associative Stimulations (PAS) involving the integration of afferent sensory
inputs at the level of the ipsilesional primary motor cortex were developed in healthy
subjects. PAS techniques have shown a gain of corticospinal excitability by such phenomenon
known as long Term Potentiation (LTP) and a gain of motor performance. The investigators
would like to propose to evaluate two types of these techniques with a volley of visual
afferents (visuomotor stimulation, V_PAS) or of cerebellar afferents (CER_PAS), because these
two structures convey important information in the execution of the movement.
Design Multicenter, randomized study, 60 patients in 3 parallel groups (V_PAS, CER_PAS,
control group with sham and sham V_PAS CER_PAS), 5 days of treatment, clinical assessment,
electrophysiological and MRI before, immediately post- and second post-assessments (4 weeks).
A group of 24 healthy subjects will undergo a parallel physiopathological study on the
underlying mechanisms of cerebellar PAS Objectives Main objective: To determine whether (and
how) Paired Associative Stimulation technique (PAS) induces cerebral reorganization in the
primary motor cortex compared to the control group.
Aim 2: Determine whether (and which) type of PAS is capable of inducing changes in motor
performance of the upper limb paresis and duration Aim 3: Determine whether (and which) type
of PAS is capable of inducing changes in excitability of the corticospinal tract and duration
Aim 4: Determine how PAS techniques modify the functional connectivity during movement Aim 5:
Determine if connectivity changes during induced movement correlate with clinical
improvements Aim 6: Determine whether patients who benefit of a type of PAS have specific
anatomical lesion characteristics (volume, afferent and efferent white matter fasciculi
integrity) Aim 7: for healthy subjects: determine the TMS parameters that will influence the
response to cerebellar PAS protocols
Hypotheses
- The sensorimotor stimulation approach (V_PAS or CER_PAS) improves motor function of the
hand compared to the control group. The CER_PAS approach may be more effective than
V_PAS as the cerebellum plays a major role in the post-stroke recovery
- This improvement would be explained by an effect on brain reorganization by increasing
the proportion of activation in the ipsilesional primary motor cortex comparing to the
contralesional side, as well as strengthening the relationships between ipsilesional
premotor and motor cortices.
- Clinical and electrophysiological effects observed in the combined approach are
correlated with specific characteristics of the sensorimotor network assessed by MRI.
Perspectives Demonstrating beneficial effects would subsequently consider protocols in order
to achieve a therapeutic effect in the long term. The low cost greatly facilitates the
implementation of feasible treatments in routine care in specialized centers (or pilot
research centers) and potentially useful in many patients. The study of the characteristics
of responders and non-responders patients would provide "patient-oriented" treatment, which
take into account the particularities of each subject.
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