Brain and Nerve Stimulation for Hand Muscles in Spinal Cord Injury and ALS

Description

Most neurological injuries such as spinal cord injuries (SCI) and amyotrophic lateral sclerosis (ALS) spare a portion of nerve circuitry. Strengthening spared nerve circuits may be an important method to improve functional recovery. In this study, the investigators aim to use non-invasive magnetic and electrical stimulation to strengthen motor circuits between the brain and hands. Magnetic stimulation will be used over the motor cortex (scalp). Two methods of electrical stimulation will be compared: stimulation of the median nerve at the wrist; or direct stimulation of the cervical spinal cord across the skin on the back of the neck. Several different combinations of magnetic and electrical stimulation will be compared to find the conditions that best strengthen nerve circuits between the brain and hands - "Fire Together, Wire Together".

Study Start Date

June 2015

Estimated Completion Date

August 2016

Interventions

  • Device: Median nerve stimulation
  • Device: Cervical transcutaneous stimulation
  • Device: Transcranial magnetic stimulation

Specialties

  • Nursing: Neurology
  • Neurology: Demyelinating Disorders,Spine,Trauma
  • Emergency Medicine: Neurology/Neurosurgery
  • Physician Assistant: Neurology

MeSH Terms

  • Amyotrophic Lateral Sclerosis
  • Central Nervous System Diseases
  • Neurodegenerative Diseases
  • Spinal Cord Injuries

Study ID

Bronx VA Medical Center -- HAR-15-001

Status

Unknown

Trial ID

NCT02469675

Study Type

Interventional

Trial Phase

N/A

Enrollment Quota

30

Sponsor

Bronx VA Medical Center

Inclusion Criteria

  • Males or females age 21-65 years
  • Chronic (>12 months since injury) incomplete SCI between levels C5-C8 or diagnosis of definite or probable ALS
  • Incomplete weakness of left or right hand muscles: score of 3 or 4 (out of 5) on manual muscle testing of finger extension, finger flexion, or finger abduction
  • Detectable F-wave responses of the left or right abductor pollicis brevis muscle to median nerve stimulation
  • Detectable motor evoked potentials in left or right abductor pollicis brevis muscle to transcranial magnetic stimulation.

Exclusion Criteria

  • Multiple spinal cord lesions
  • History of seizures
  • Ventilator dependence or patent tracheostomy site
  • Use of medications that significantly lower seizure threshold, such as tricyclic antidepressants, amphetamines, neuroleptics, dalfampridine, and bupropion
  • History of stroke, brain tumor, brain abscess, or multiple sclerosis
  • History of moderate to severe head trauma (loss of consciousness for greater than one hour or evidence of brain contusion or hemorrhage or depressed skull fracture on prior imaging)
  • History of implanted brain/spine/nerve stimulators, aneurysm clips, ferromagnetic metallic implants, or cardiac pacemaker/defibrillator
  • Significant coronary artery or cardiac conduction disease
  • History of autonomic dysreflexia
  • History of bipolar disorder
  • History of suicide attempt
  • Active psychosis
  • Heavy alcohol consumption (greater than equivalent of 5 oz of liquor) within previous 48 hours
  • Open skin lesions over the face, neck, shoulders, or arms
  • Pregnancy
  • Unsuitable for study participation as determined by study physician.

Gender

Both

Ages

21 Years to 65 Years

Accepts Healthy Volunteers

No

Study Locations and Contact Information (1)

Study Location Distance Name Phone Email
James J Peters VA Medical Center Bronx NY - Bronx, New York 41.7 miles Noam Y Harel MD PhD 718-584-9000 noam.harel@va.gov

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