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Schizophreniform CatatoniaRETONICNCT03116425

Personalized Non-invasive Neuromodulation by rTMS for Chronic and Treatment Resistant Catatonia

A study testing Individualized rTMS on VERUM 1's region or network and Individualized rTMS on VERUM 2's region or network in people with Schizophreniform Catatonia and Treatment Resistant, run by University Hospital, Strasbourg, France at 1 site in France.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Investigators hypothesize that personalizing rTMS targets using functional MRI will allow to improve symptoms of patients suffering from chronic catatonia. Read more about this study

Who is it for?
Ages 18 to 70 years
What is being tested?
Individualized rTMS on VERUM 1's region or network and Individualized rTMS on VERUM 2's region or network
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
17 participants
Where
1 siteFrance
Study dates
24 Apr 2017to Jun 2022
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 to 70 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Aged from 18 to 70 Y
  • Affiliated to the health insurance
  • Having signed an informed consent
  • Suffering from catatonia according to the DSM5, unremitted since > 2Y
  • Unresponsive or incomplete remission after at least one trial of benzodiazepine and/or Electroconvulsivotherapy
  • Treatment stable for > 6 weeks

Who cannot join

  • Contraindication for MRI, rTMS or tDCS: non-removable ferromagnetic body, prosthesis, pacemaker, medication delivered by an implanted pump clip or vascular stent, heart valve or ventricular shunt, seizure disorders, skin pathology in the region of tDCS electrode placement.
  • Pregnancy
  • Severe and non-stabilized somatic pathology
  • Patients deprived of liberty or hospitalized without their consent
  • Patients unable to give informed consent.

Trial locations and contacts

1 site in 1 country.

France1 site
  • CEMNIS

    Strasbourg, 67091

Other trials in France

About this study

Official title: Personalized Non-invasive Neuromodulation by rTMS for Chronic and Treatment Resistant Catatonia - A Proof of Concept Study

Investigators hypothesize that personalizing rTMS targets using functional MRI will allow to improve symptoms of patients suffering from chronic catatonia.

Read the detailed description

Two dysfunctional networks or regions will be chosen (verum 1 and 2) based on their abnormal rCBF. In line with the symptoms, dorso-lateral prefrontal and premotor regions are expected to be chiefly concerned. A normal region regarding its rCBF will be used as placebo. Targets will be stimulated using intermittent or continuous theta-burst according to the rCBF anomaly as an attempt to "normalize" their activity. The coil will be positioned using a robotic device under the control of a neuronavigation system in order to deliver a homogeneous stimulation. Using a balanced blinded randomized cross-over design, patients will be stimulated on 5 consecutive days (4 sessions per day) and evaluated pre-, post-stimulation and 1 month after. In this pilot study the primary outcome measures will be the clinical global impression scale whereas MRI will insure that stimulations achieved the correction of the rCBF anomalies. Secondary outcome measures will include personalized target symptom scales, and scales for catatonic, apathic and obsessive-compulsive symptoms.

Being tested
Individualized rTMS on VERUM 1's region or network, Individualized rTMS on VERUM 2's region or network, Individualized rTMS on PLACEBO region
Keywords
Precision Medicine, Functional Neuroimaging, Transcranial Magnetic Stimulation, Repetitive, Transcranial Direct Current Stimulation, Monocentric, Comparative balanced, randomized, double-blind cross-over 3 Arms Study
Medical subject headings
Catatonia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Individualized rTMS on VERUM 1's region or networkDevice

    Also called Putative premotor region or network

    To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

    To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

    Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

    Patients will have 4 sessions per day on 5 successive days per arm.

  • Individualized rTMS on VERUM 2's region or networkDevice

    Also called Putative prefrontal region or network

    To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

    To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

    Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

    Patients will have 4 sessions per day on 5 successive days per arm.

  • Individualized rTMS on PLACEBO regionDevice

    Also called (One per line)

    Region will be modulated up or down according to the stimulation protocol used in VERUM 1 and 2 conditions.

    Stimulation will be replicated up to 5 times per session. Patients will have 4 sessions per day on 5 successive days per arm.

  • Individualized rTMS on VERUM 1's region or networkProcedure or surgery

    Also called Putative premotor region or network

    To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

    To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

    Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

    Patients will have 4 sessions per day on 5 successive days per arm.

  • Individualized rTMS on VERUM 2's region or networkProcedure or surgery

    Also called Putative prefrontal region or network

    To increase cortical rCBF, iTB (intermittent theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 2 sec with an inter-train interval of 8 sec.

    To decrease cortical rCBF, cTB (continuous theta burst) will be used: triplet at 50 Hz repeated at 5 Hz in trains of 40 sec. Intensity 120% of passive threshold (or 150% of active threshold).

    Stimulation protocol will be used up to 5 times per session to allow a reasonable regional or network coverage.

    Patients will have 4 sessions per day on 5 successive days per arm.

  • Individualized rTMS on PLACEBO regionProcedure or surgery

    Region will be modulated up or down according to the stimulation protocol used in VERUM 1 and 2 conditions.

    Stimulation will be replicated up to 5 times per session. Patients will have 4 sessions per day on 5 successive days per arm.

Study groups in NCT03116425
Study groupRoleWhat they receive
Verum 1 - PremotorExperimentalThe target region will be defined by comparing the rCBF scan of the patient to a control population (n = 38). rCBF will be measured using the QUIPS2 arterial spin labeling sequence on a Siemens 3T Verio. The network including the premotor region will be targeted. The therapeutic protocol will be design to correct the rCBF anomaly.
Receives: Device: Individualized rTMS on VERUM 1's region or network; Procedure: Individualized rTMS on VERUM 1's region or network
Verum 2 - PrefrontalExperimentalThe target region will be defined by comparing the rCBF scan of the patient to a control population (n = 38). rCBF will be measured using the QUIPS2 arterial spin labeling sequence on a Siemens 3T Verio. The network including the prefrontal region will be targeted. The therapeutic protocol will be design to correct the rCBF anomaly.
Receives: Device: Individualized rTMS on VERUM 2's region or network; Procedure: Individualized rTMS on VERUM 2's region or network
PlaceboActive comparatorStimulation of a region with normal rCBF and putatively unrelated to catatonic symptoms (parietal cortex).
Receives: Device: Individualized rTMS on PLACEBO region; Procedure: Individualized rTMS on PLACEBO region

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Clinical global impression (change in severity and improvement)

    Clinical Global Impression - Severity scale (CGI-S) is a 7-point scale that requires the clinician to rate the severity of the patient's illness at the time of assessment, relative to the clinician's past experience with patients who have the same diagnosis.

    Clinical Global Impression - Improvement scale (CGI-I) is a 7 point scale that requires the clinician to assess how much the patient's illness has improved or worsened relative to a baseline state at the beginning of the intervention

    Measured: In term of percentage reduction in symptoms, difference between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

Secondary outcomes (11)
  1. Change in personalized daily visual analogical scales assessing the core symptoms.

    This scale has been validated

    Measured: Points results will be averaged over the 4 days before and after each therapeutic arm.

  2. Change in Bush and Francis Catatonia Rating Scale.

    This scale has been validated.

    Measured: Points involvement in scale between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

  3. Change in psychosis: PANSS.

    This scale has been validated.

    Measured: Points involvement in scale between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

  4. Change in depression: Calgary Depression Scale.

    This scale has been validated.

    Measured: Points involvement in scale between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

  5. Change in apathy: actimetry, apathy inventory and apathy evaluation scale.

    This scale has been validated.

    Measured: Points involvement in scale between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

  6. Change in obsessive compulsive symptoms: Brief Obsessive Compulsive Scale

    This scale has been validated.

    Measured: Points involvement in scale between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

  7. Change in obsessive compulsive symptoms: Cambridge-Exeter Repetitive Thought Scale.

    This scale has been validated.

    Measured: Points involvement in scale between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

  8. Change in quality of life for the patient (SF36)

    All these scales have been validated.

    Measured: Points involvement in scale between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

  9. Change in the helping person ("Zarit scale")

    This scale has been validated.

    Measured: Points involvement in scale between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

  10. Change in functioning: Global Assessment of Functioning (GAF scale)

    This scale has been validated.

    Measured: Points involvement in scale between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

  11. Change in functioning: WHODAS 2.0.

    This scale has been validated.

    Measured: Points involvement in scale between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted17 Apr 2017
  2. Study start24 Apr 2017
  3. Primary completionJun 2022 (estimated)
  4. Study completionJun 2022 (estimated)

Resources

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
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
17 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03116425
Sponsor's protocol ID
6441
Acronym
RETONIC
Status last verified
Apr 2022
First submitted
22 Mar 2017
Last updated
20 Apr 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Individualized rTMS on VERUM 1's region or network and Individualized rTMS on VERUM 2's region or network in people with Schizophreniform Catatonia and Treatment Resistant, run by University Hospital, Strasbourg, France at 1 site in France.

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 6 inclusion and 5 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: status not confirmed, as of the sponsor's last update on 20 Apr 2022. 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 France. 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?

Results are not available in the source record.

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?

Clinical global impression (change in severity and improvement) (time frame: In term of percentage reduction in symptoms, difference between before (assessed on D1) and after (assessed on D5 to 7) and at 1 month after each therapeutic protocol (D = day of the beginning of the protocol)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 20 Apr 2022.

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