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Disorder-tailored Transcranial Direct Current Stimulation (tDCS) of the Prefrontal Cortex (MRSDC1)

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ClinicalTrials.gov Identifier: NCT02715128
Recruitment Status : Recruiting
First Posted : March 22, 2016
Last Update Posted : June 2, 2020
Sponsor:
Information provided by (Responsible Party):
Daniel Keeser, Ludwig-Maximilians - University of Munich

Brief Summary:

Major depressive disorder (MDD) is a common, recurrent, and frequent chronic disorder. Among others, deficient cognitive control over emotional distraction is a central characteristic of MDD (Ochsner & Gross 2005; Disner et al. 2011; Beck 2008). Hypoactivation of the dorsolateral prefrontal cortex (DLPFC) has been linked with this deficit (Dolcos & McCarthy 2006). Moreover, aberrant functional connectivity patterns have been found in MDD patients (Kaiser et al. 2015). Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method that has been largely investigated in experimental neurosciences and tDCS of the prefrontal cortex (PFC) has been proposed as novel treatment in MDD. In addition, it is increasingly investigated as treatment for negative symptoms in schizophrenia (SCZ) (Brunelin et al. 2012). So far, prefrontal tDCS has been shown to enhance cognitive control over emotional distraction in MDD patients (Wokenstein & Plewnia 2013). Also, tDCS-induced connectivity changes found in fMRI studies comparing resting-state networks configurations before and after prefrontal tDCS may reflect a state of enhanced alertness (Keeser, Meindl, et al., 2011; Park et al., 2013).

The aim of this study is to investigate the neurophysiological correlates of tDCS effects in patients with different psychiatric disorders for which tDCS is a possible intervention, in particular MDD and SCZ, as compared to healthy individuals. For this purpose, we determine the most promising protocol in from investigations in healthy volunteers and apply this protocol in the patient sample including age- and gender-matched controls. First, functional magnetic resonance imaging (fMRI) data is collected during the execution of a cognitive control task as well as during a resting-state condition together with application of real or sham tDCS inside the scanner. It is hypothesized that prefrontal tDCS as compared to sham a) reduces distractibility by compensating for deficient DLPFC activity and b) enhances functional connectivity in networks associated with externally directed attention or cognitive engagement. Second, magnetic resonance spectroscopy (MRS) is performed to measure concentrations of GABA and glutamate in target regions of tDCS. It is hypothesized that tDCS effects are mediated via modulation of the inhibitory/excitatory systems and GABA and glutamate are used as markers of these systems.

In this placebo-controlled study healthy volunteers and patients with a diagnosis of MDD or SCZ receive a single treatment with prefrontal tDCS (anode over electrode position F3, cathode over F4, 20 min, 2mA intensity) or sham tDCS (frequency and duration correspondent active tDCS, ramp in and ramp out periods only without intermittent stimulation). We conduct resting-state and MRS measurements combined with application of tDCS in the fMRI scanner. Subsequently, participants perform the cognitive control task (in dependence of Plewnia, C., Schroeder, P. A., & Wolkenstein, L. (2015)) in the scanner. The participants are assigned to either the real or sham tDCS condition according to a randomised, double-blind parallel design.


Condition or disease Intervention/treatment Phase
Major Depressive Disorder Schizophrenia Device: Transcranial direct current stimulation (tDCS) Not Applicable

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 30 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Basic Science
Official Title: Disorder-tailored Transcranial Direct Current Stimulation (tDCS) of the Prefrontal Cortex: fMRI Study in Major Depression and Schizophrenia
Actual Study Start Date : March 2016
Estimated Primary Completion Date : January 2021
Estimated Study Completion Date : January 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Schizophrenia

Arm Intervention/treatment
Active Comparator: real tDCS
anode over electrode position F3, cathode over F4, 20 min, 2mA intensity
Device: Transcranial direct current stimulation (tDCS)
non-invasive electric brain stimulation method

Sham Comparator: sham tDCS
frequency and duration correspondent active tDCS, ramp in and ramp out periods only without intermittent stimulation
Device: Transcranial direct current stimulation (tDCS)
non-invasive electric brain stimulation method




Primary Outcome Measures :
  1. FMRI modulations [ Time Frame: 2 hours ]
    differences in the cognitive control task (performance and activations) between the sham and real group as well as changes in resting-state connectivity between and within (following stimulation compared to baseline) groups

  2. GABA and Glutamate modulations [ Time Frame: 2 hours ]
    differences in excitatory and inhibitory system modulation visualised via GABA and Glutamate concentrations determined by H1-MRS measurements


Secondary Outcome Measures :
  1. Clinical trajectories [ Time Frame: 8 weeks ]
    Influence of observed online modulatory effects on clinical trajectories in patients



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Men and women 18-60 years of age.
  • Capable and willing to provide informed consent.
  • MDD: Primary ICD-10 diagnosis of Major Depression and a total HDRS-21 ≥15 and/or BDI ≥15 at the screening visit; no antidepressant medication and stable medication ≥4 days before study onset and during study period.
  • SCZ: Primary ICD10 diagnosis of Schizophrenia and a stable antipsychotic medication ≥1 weeks before study onset and during study period.

Exclusion Criteria:

  • Contraindications for brain stimulation, such as history of brain surgery or severe brain injury, as well as contraindications for MRI, such as metallic implants, any other non-MR safe implants, or claustrophobia.
  • Investigators, site personnel directly affiliated with this study, and their immediate families (immediate family is defined as a spouse, parent, child or sibling, whether by birth or legal adoption).
  • Acute risk for suicide (MADRS, item 10 score of >4 or as assessed by the C-SSRS, agree to item 4 and/or agree to item 5).
  • Treatment with electroconvulsive therapy in the present episode.
  • Treatment with deep brain stimulation or vagus nerve stimulation and/or any other intracranial implants (clips, cochlear implants).
  • Any other relevant psychiatric axis-I- and/or axis-II-disorder.
  • Any relevant instable medical condition.
  • Pregnancy.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02715128


Contacts
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Contact: Frank Padberg, Prof. Dr. +40 (0)89 440053358 frank.padberg@med.uni-muenchen.de

Locations
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Germany
Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University Munich Recruiting
Munich, Germany, 80336
Contact: Daniel Keeser, Dr.    +40 (0)89 44005755    daniel.keeser@med.uni-muenchen.de   
Contact: Lucia Bulubas, Dr. med.    +40 (0)89 440055821    lucia.bulubas@med.uni-muenchen.de   
Sponsors and Collaborators
Ludwig-Maximilians - University of Munich
Investigators
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Principal Investigator: Frank Padberg, Prof. Dr. Ludwig-Maximilians-Universität München
Additional Information:
Publications:

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Responsible Party: Daniel Keeser, Dr. rer. biol. hum., Ludwig-Maximilians - University of Munich
ClinicalTrials.gov Identifier: NCT02715128    
Other Study ID Numbers: 493-14
First Posted: March 22, 2016    Key Record Dates
Last Update Posted: June 2, 2020
Last Verified: May 2020
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Additional relevant MeSH terms:
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Schizophrenia
Depressive Disorder
Depressive Disorder, Major
Schizophrenia Spectrum and Other Psychotic Disorders
Mental Disorders
Mood Disorders