Neuropathic PainNCT02255643
Motor Threshold and Motor Cortex Stimulation
A study testing Change of PMT setting in people with Neuropathic Pain, run by University of British Columbia at 1 site in Canada.
Trial summary
Motor cortex stimulation (MCS) is a form of brain stimulation for patients with neuropathic pain not responsive to medication. An electrode is placed on the surface of the brain and connected to a programmable battery in the chest. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Neuropathic Pain
- What is being tested?
- Change of PMT setting
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 7 participants
- Where
- 1 siteCanada
- Study dates
- Oct 2014to Dec 2014
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Adult patient more than 18 years of age
- Chronic neuropathic pain effectively treated with motor cortex stimulation
- Stable medication during the trial
- Willing and able to comply with the study protocol and to return per the follow-up visit schedule and able to provide informed consent.
Who cannot join
- Evidence of an active disruptive psychiatric disorder or other known condition significant enough to impact the perception of pain, compliance to intervention and/or ability to evaluate treatment outcome as determined by the investigator
- Technical malfunction of the MCS device
- History of seizures
- Unable to provide informed consent
Trial locations and contacts
1 site in 1 country.
About this study
Official title: The Relationship Between Motor Threshold and Effective Stimulation Threshold During Motor Cortex Stimulation
Motor cortex stimulation (MCS) is a form of brain stimulation for patients with neuropathic pain not responsive to medication. An electrode is placed on the surface of the brain and connected to a programmable battery in the chest.
The strength of stimulation can be individually adjusted by changing the voltage of stimulation. A too high voltage will produce side effects (e.g. seizures) while a too low voltage will not provide pain control. The aim of this study is to analyze the optimal stimulation parameters in patients already implanted with a motor cortex stimulation who have received good pain relief. The actual voltage may vary widely between patients but the investigators feel that there may be an "ideal" voltage if it is measured as a percentage of motor threshold (PMT). If motor threshold is the stimulation voltage that can evoke a muscle contraction then a PMT = 80% would be a voltage that was eighty percent of that value. Although the actual voltage may be widely different between patients, the percentage needed may be very similar. The investigators therefore plan to measure the effect of different percentages of PMT in patients already being treated with motor cortex stimulation.
Systematic analysis of the findings of this study might help the individual participant and future patients to better programming and less side effects.
Read the detailed description
Motor cortex stimulation (MCS) is a form of brain stimulation for patients with medically refractory neuropathic pain. The strength of stimulation can be individually adjusted by changing the voltage of stimulation. Too high voltage will produce side effects (e.g. seizures) while too low voltage will not provide pain control. The aim of this study is to analyze the optimal stimulation parameters in patients already implanted with a motor cortex stimulation who have received good pain relief. The actual voltage may vary widely between patients (because of the individual variations in tissue resistance) but the investigators feel that there may be an "ideal" voltage if it is measured as a percentage of motor threshold (PMT).
If motor threshold is the voltage that can evoke a muscle contraction then a PMT = 80% would be a voltage that was eighty percent of that value. Although the actual voltage may be different between patients, the effective PMT may be similar since it represents a more physiologic measure of stimulation.
Systematic analysis of the findings of this study might help the individual participant and future patients by reducing voltage to the lowest effective setting and reducing the chance of seizures.
Motor cortex stimulation is used in the treatment of neuropathic pain since 1991 but still no guidelines for programming exist and programming is therefore mainly bases on trial and error. This is mostly due to many variables influencing the choice of stimulation parameters and significant individual differences in susceptibility to stimulation. Routinely the motor threshold is determined during programming to identify the superior limit of voltage at which twitching is induced. No stimulation above the motor threshold should be performed as this is known to cause seizures. The voltage of simulation that will be effective for an individual is unknown at the beginning of the treatment.
The investigators try to find the lowest effective voltage because that will reduce the risk of stimulation-induced seizures and prolong the life of the pacemaker.
- Conditions
- Neuropathic Pain
- Being tested
- Change of PMT setting
- Keywords
- motor cortex stimulation, chronic neuropathic pain
- Medical subject headings
- Neuralgia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Change of PMT settingDevice
The patients current motor threshold is determined and the patient is set to a new PMT (= new treatment arm)
| Study group | Role | What they receive |
|---|---|---|
| -10% of effective PMT | Experimental | Patients are set to a voltage 10% less than their original PMT at start of study, Changes in PMT settings Receives: Device: Change of PMT setting |
| former setting (+/- 0% of PMT) | Active comparator | Patients are set to their original PMT at start of study, Changes in PMT settings Receives: Device: Change of PMT setting |
| +10% of effective PMT | Experimental | Patients are set to a voltage 10% more than their original PMT at start of study, Changes in PMT settings Receives: Device: Change of PMT setting |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Pain measured on the Visual Analogue Scale with different PMT Settings
Measured: at the End of each trial period, typically 14 days after changes in PMT Settings
Secondary outcomes (1)
Quality of Life assessment with the SF-36 questionnaire
Measured: at the end of each trial period, typically at 14 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted2 Oct 2014 (estimated)
- Study startOct 2014
- Primary completionNov 2014
- Study completionDec 2014
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for Neuropathic PainStudies of the same condition, open and under way.
- More trials run by University of British ColumbiaThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 7 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of British Columbia
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Christopher R Honey, MD, DPhil, Principal investigator, UBC
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02255643
- Sponsor's protocol ID
- H14-01258
- Status last verified
- Dec 2014
- First submitted
- 25 Sep 2014
- Last updated
- 18 Dec 2014
- Results posted
- No
- Data monitoring committee
- No
Publications
Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Treatment of thalamic pain by chronic motor cortex stimulation. Pacing Clin Electrophysiol. 1991 Jan;14(1):131-4. doi: 10.1111/j.1540-8159.1991.tb04058.x.
PubMed 1705329Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl (Wien). 1991;52:137-9. doi: 10.1007/978-3-7091-9160-6_37.
PubMed 1792954Peyron R, Garcia-Larrea L, Deiber MP, Cinotti L, Convers P, Sindou M, Mauguiere F, Laurent B. Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study. Pain. 1995 Sep;62(3):275-286. doi: 10.1016/0304-3959(94)00211-V.
PubMed 8657427Lima MC, Fregni F. Motor cortex stimulation for chronic pain: systematic review and meta-analysis of the literature. Neurology. 2008 Jun 10;70(24):2329-37. doi: 10.1212/01.wnl.0000314649.38527.93.
PubMed 18541887
Study at a glance
From the registry record, last updated by the sponsor on 18 Dec 2014. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Relationship Between Motor Threshold and Effective Stimulation Threshold During Motor Cortex Stimulation
- ClinicalTrials.gov ID
- NCT02255643
- Acronym / sponsor ID
- H14-01258
- Conditions
- Neuropathic Pain
- Keywords
- motor cortex stimulation, chronic neuropathic pain
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 7 participants (actual)
- Lead sponsor
- University of British ColumbiaUniversity, hospital or other
- Study start
- Oct 2014
- Primary completion
- Nov 2014 (actual)
- Study completion
- Dec 2014 (actual)
- First posted
- 2 Oct 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Motor cortex stimulation (MCS) is a form of brain stimulation for patients with neuropathic pain not responsive to medication. An electrode is placed on the surface of the brain and connected to a programmable battery in the chest.
The strength of stimulation can be individually adjusted by changing the voltage of stimulation. A too high voltage will produce side effects (e.g. seizures) while a too low voltage will not provide pain control. The aim of this study is to analyze the optimal stimulation parameters in patients already implanted with a motor cortex stimulation who have received good pain relief. The actual voltage may vary widely between patients but the investigators feel that there may be an "ideal" voltage if it is measured as a percentage of motor threshold (PMT). If motor threshold is the stimulation voltage that can evoke a muscle contraction then a PMT = 80% would be a voltage that was eighty percent of that value. Although the actual voltage may be widely different between patients, the percentage needed may be very similar. The investigators therefore plan to measure the effect of different percentages of PMT in patients already being treated with motor cortex stimulation.
Systematic analysis of the findings of this study might help the individual participant and future patients to better programming and less side effects.
Detailed description
Motor cortex stimulation (MCS) is a form of brain stimulation for patients with medically refractory neuropathic pain. The strength of stimulation can be individually adjusted by changing the voltage of stimulation. Too high voltage will produce side effects (e.g. seizures) while too low voltage will not provide pain control. The aim of this study is to analyze the optimal stimulation parameters in patients already implanted with a motor cortex stimulation who have received good pain relief. The actual voltage may vary widely between patients (because of the individual variations in tissue resistance) but the investigators feel that there may be an "ideal" voltage if it is measured as a percentage of motor threshold (PMT).
If motor threshold is the voltage that can evoke a muscle contraction then a PMT = 80% would be a voltage that was eighty percent of that value. Although the actual voltage may be different between patients, the effective PMT may be similar since it represents a more physiologic measure of stimulation.
Systematic analysis of the findings of this study might help the individual participant and future patients by reducing voltage to the lowest effective setting and reducing the chance of seizures.
Motor cortex stimulation is used in the treatment of neuropathic pain since 1991 but still no guidelines for programming exist and programming is therefore mainly bases on trial and error. This is mostly due to many variables influencing the choice of stimulation parameters and significant individual differences in susceptibility to stimulation. Routinely the motor threshold is determined during programming to identify the superior limit of voltage at which twitching is induced. No stimulation above the motor threshold should be performed as this is known to cause seizures. The voltage of simulation that will be effective for an individual is unknown at the beginning of the treatment.
The investigators try to find the lowest effective voltage because that will reduce the risk of stimulation-induced seizures and prolong the life of the pacemaker.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Single blind (participant)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| -10% of effective PMT | Experimental | Device: Change of PMT settingPatients are set to a voltage 10% less than their original PMT at start of study, Changes in PMT settings |
| former setting (+/- 0% of PMT) | Active comparator | Device: Change of PMT settingPatients are set to their original PMT at start of study, Changes in PMT settings |
| +10% of effective PMT | Experimental | Device: Change of PMT settingPatients are set to a voltage 10% more than their original PMT at start of study, Changes in PMT settings |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (4 listed)
- Adult patient more than 18 years of age
- Chronic neuropathic pain effectively treated with motor cortex stimulation
- Stable medication during the trial
- Willing and able to comply with the study protocol and to return per the follow-up visit schedule and able to provide informed consent.
Key exclusion criteria (4 listed)
- Evidence of an active disruptive psychiatric disorder or other known condition significant enough to impact the perception of pain, compliance to intervention and/or ability to evaluate treatment outcome as determined by the investigator
- Technical malfunction of the MCS device
- History of seizures
- Unable to provide informed consent
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Change of PMT settingThe patients current motor threshold is determined and the patient is set to a new PMT (= new treatment arm) | Device | +10% of effective PMT, -10% of effective PMT, former setting (+/- 0% of PMT) |
Primary outcome
Change in Pain measured on the Visual Analogue Scale with different PMT Settings
Time frame: at the End of each trial period, typically 14 days after changes in PMT Settings
1 secondary outcome
Quality of Life assessment with the SF-36 questionnaire
Time frame: at the end of each trial period, typically at 14 days
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 Dec 2014.
- Background: PubMed 1705329Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Treatment of thalamic pain by chronic motor cortex stimulation. Pacing Clin Electrophysiol. 1991 Jan;14(1):131-4. doi: 10.1111/j.1540-8159.1991.tb04058.x.
- Background: PubMed 1792954Tsubokawa T, Katayama Y, Yamamoto T, Hirayama T, Koyama S. Chronic motor cortex stimulation for the treatment of central pain. Acta Neurochir Suppl (Wien). 1991;52:137-9. doi: 10.1007/978-3-7091-9160-6_37.
- Background: PubMed 8657427Peyron R, Garcia-Larrea L, Deiber MP, Cinotti L, Convers P, Sindou M, Mauguiere F, Laurent B. Electrical stimulation of precentral cortical area in the treatment of central pain: electrophysiological and PET study. Pain. 1995 Sep;62(3):275-286. doi: 10.1016/0304-3959(94)00211-V.
- Background: PubMed 18541887Lima MC, Fregni F. Motor cortex stimulation for chronic pain: systematic review and meta-analysis of the literature. Neurology. 2008 Jun 10;70(24):2329-37. doi: 10.1212/01.wnl.0000314649.38527.93.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Christopher R Honey, MD, DPhil principal investigator
UBC
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Change of PMT setting in people with Neuropathic Pain, run by University of British Columbia at 1 site in Canada.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 18 Dec 2014. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Canada. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Pain measured on the Visual Analogue Scale with different PMT Settings (time frame: at the End of each trial period, typically 14 days after changes in PMT Settings). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02255643, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Dec 2014.