Stroke, AcuteNCT05332652
Establishing a Prognostic Model for Stroke Recovery
A study testing trancranial magnetic stimulation in people with Stroke, Acute, run by National University Hospital, Singapore at 2 sites in Singapore.
Trial summary
This main aim of the study is to investigate the changes in neurophysiological features after stroke, and its association with upper limb motor recovery, so as to establish a prognostic model for upper limb motor recovery after stroke. Read more about this study
- Who is it for?
- Ages 21 to 80 yearsHealthy volunteers can take part
- Conditions the study is for
- Stroke, Acute
- What is being tested?
- trancranial magnetic stimulation
- Type of treatment
- Medical device
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 41 participants
- Where
- 2 sitesSingapore
- Study dates
- 1 Sep 2020to 16 Jul 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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 21 to 80 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- 21-80 years old;
- First ever stroke less than 6 weeks;
- Moderate to severe upper limb impairment with Manual Muscle Testing (MMT) score on shoulder abduction plus finger extension (SAFE) <5 within the first week post-stroke.
- Age 21-80 years old;
- No known medical history.
Who cannot join
- Pregnancy;
- Any metal implants inside the body that are contraindications of MRI scan;
- cardiac pacemakers;
- History of epilepsy;
- Sensorimotor disturbance due to other causes other than stroke;
- Claustrophobia;
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- Uncontrolled medical conditions including hypertension, diabetes mellitus and unstable angina;
- Major depression and a history of psychotic disorders;
- Terminal diagnosis with life expectancy <=1 year.
- Pregnancy;
- Any metal implants inside the body that are contraindications of MRI scan;
- cardiac pacemakers;
- Claustrophobia.
Trial locations and contacts
2 sites in 1 country.
Singapore2 sites
Alexandra Hospital
Singapore
National University Hospital
Singapore
About this study
Official title: Neural Network Reorganization Associated With Upper Limb Motor Recovery in Stroke Patients- Establishing a Prognostic Model and Tailoring Neuromodulation for Rehabilitation
This main aim of the study is to investigate the changes in neurophysiological features after stroke, and its association with upper limb motor recovery, so as to establish a prognostic model for upper limb motor recovery after stroke. The investigators hypothesize that a combination of neurophysiological features measured by transcranial magnetic stimulation (TMS), high density electroencephalography (HD-EEG), functional magnetic resonance imaging (fMRI) and Diffusion Tensor Imaging (DTI) might be used as biomarkers to predict upper limb motor outcomes after stroke. The investigators also hypothesize that non-invasive brain stimulation strategies such as tDCS will more effectively improve motor outcomes as an adjunct to therapy, if tailored according to patient's predicted pattern of neural reorganization.
Read the detailed description
This study comprises 2 parts. Study 1 is a longitudinal cohort study to characterize the neurophysiological changes with upper limb motor recovery in stroke patients with moderate to severe upper limb motor function impairment, and its correlation with motor function recovery.
120 stroke subjects within 3 weeks post-stroke will be recruited from National University Hospital (NUH), Alexandra Hospital (AH), and Tan Tock Seng Hospital (TTSH). We will follow changes in cortical activity over time using Transcranial Magnetic Stimulation (TMS), MRI and EEG measures and correlate these with clinical outcome measures at the same time points, to study the interaction between neural excitability and functional outcome.
10 healthy subjects will be needed as control group to compare outcomes obtained from MRI scans.
Outcome measures of brain corticospinal excitability, clinical measures on upper limb motor function and cognitive tests, will be performed 4 times- within 4 weeks, at 3 months, 6 months and 1 year after stroke onset, except for MRI which will not be performed at 1 year after stroke onset.
Subjects from Study 1 whose ARAT (Action Research Arm test) score is < = 42 at 3 months post-stroke will proceed to Study 2. ARAT score < = 42 indicates limited functional capacity and below. The aim of Study 2 is to investigate the efficacy and the neurophysiological effects of 2 types of tDCS protocols in facilitating upper limb motor recovery in patients with significant limitations in upper limb function.
There are a total of 4 groups in Study 2. Subjects who are agreeable for transcranial direct current stimulation (tDCS) will be randomized into 3 groups with 17 subjects in each group, by stratified randomization using Microsoft Excel, according to the lesion location (cortical vs. subcortical), and type of stroke (haemorrhagic vs. ischemic). Subjects who refuse tDCS will be enrolled in the control group without receiving any tDCS stimulation.
- Group 1 will receive 1 mA anodal tDCS stimulation to the ipsilesional M1 of cortical representation of the affected upper limb;
- Group 2 to receive 1mA anodal tDCS to the contralesional premotor cortex;
- Group 3 to receive sham tDCS stimulation with anode placed over the scalp area corresponding to ipsilesional M1.
- Group 4: Subjects who fulfill the inclusion criteria of Study 2 but refuse tDCS stimulation.
Cathode for all 3 tDCS groups will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training. Subjects in Study 2 will continue with the 6-month and 1 year assessment, as in Study 1.
- Conditions
- Stroke, Acute
- Being tested
- trancranial magnetic stimulation
- Keywords
- stroke, motor recovery, prognostic model, transcranial magnetic stimulation, transcranial direct current stimulation, neuromodulation
- Medical subject headings
- Stroke
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
trancranial magnetic stimulationDevice
A trained research staff or physician will perform tDCS to the subject. Direct current will be delivered by a battery-operated, constant current stimulator, through 2 rubber electrodes embedded in a pair of saline-soaked sponge bag. Stimulation intensity will be ramped up to 1 mA over 30 seconds and maintain at 1 mA for 20 minutes, and then ramped down to 0 mA over 30 seconds.
| Study group | Role | What they receive |
|---|---|---|
| Anodal tDCS stimulation to the ipsilesional M1 | Experimental | Participant will receive 1 mA anodal tDCS stimulation to the ipsilesional M1 of cortical representation of the affected upper limb.
Cathode will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training. Receives: Device: trancranial magnetic stimulation |
| Anodal tDCS to the contralesional premotor cortex | Experimental | Participant will receive 1mA anodal tDCS to the contralesional premotor cortex. Cathode will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training. Receives: Device: trancranial magnetic stimulation |
| Sham tDCS | Sham comparator | Participant will receive sham tDCS stimulation with anode placed over the scalp area corresponding to ipsilesional M1.
Cathode will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training. Receives: Device: trancranial magnetic stimulation |
| Control group | No intervention | Subjects who fulfill the inclusion criteria of Study 2 but refuse tDCS stimulation. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change of cortical excitability using Transcranial Magnetic Stimulation (TMS)
measures of cortical excitability for those without TMS contraindications
Measured: Change of the cortical excitability within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
Change of neural excitability using Magnetic resonance imaging (MRI) scan
Participants will go through one of the following image acquisition procedures 1) a functional MRI scans for brain activity together with motor task. 2) a 3D MPRAGE sequence for brain structure. 3) an advanced multishell high-resolution diffusion MRI for characterizing brain microstructure and extracellular space. 4) a FLAIR scan to measure white matter hyperintensity. Both functional and anatomical image acquisition will be undertaken using but not limited to gradient echo EPI sequence or its modified version.
Measured: Change of the neural excitability within 4 weeks, at 3 months, 6 months after stroke onset
Change of neural excitability using electroencephalogram (EEG)
High density EEG (electroencephalogram) evaluation of the electrical activity of the brain
Measured: Change of the neural excitability within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
Change of the upper extremity motor function using Fugl-Meyer scale
Upper limb function, Minimum score 0, Maximum score 66, the higher the score the better the upper limb function.
Measured: Change of the upper extremity motor function within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
Change of upper extremity performance (coordination, dexterity and functioning) using Action Research Arm Test
Upper limb function, Minimum score 0, Maximum score 57, the higher the score the better the upper limb function.
Measured: Change of upper extremity performance within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
Change of muscle spasticity using Modified Ashworth scale for spasticity (MAS)
Upper limb function, 6 point scale, Scores range from 0 to 4 (namely 0, 1, 1+, 2, 3 and 4), where lower scores represent normal muscle tone and higher scores represent spasticity or increased resistance to passive movement.
Measured: Change of muscle spasticity within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
Secondary outcomes (1)
Change of cognitive function using cognitive test
The following cognitive test will be performed to assess cognitive function :
- Digit Span Task
- Digit Symbol Substitution Task
- Trail-making test (TMT)-A \&B
- Clock-Drawing Test (CDT)
- Controlled Oral Word Association Test (COWAT) -animals \& FAS
- Mini-Mental State Exam (MMSE)
- Rey Auditory Verbal Learning Test (RAVL)
- Spatial span forward/backward test
- Visuospatial Paired Associate Learning (VPA)
Measured: Change of cognitive function within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted18 Apr 2022
- Study start1 Sep 2020
- Primary completion16 Jul 2026 (estimated)
- Study completion16 Jul 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Stroke, AcuteStudies of the same condition, open and under way.
- 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
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Subjects from Study 1 whose ARAT score is \< = 42 at 3 months post-stroke will proceed to Study 2. Subjects who are agreeable for transcranial direct current stimulation (tDCS) will be randomized into 3 groups with 17 subjects in each group, by stratified randomization, according to the lesion location (cortical vs. subcortical), and type of stroke (haemorrhagic vs. ischemic). Subjects who refuse tDCS will be enrolled in the control group without receiving any tDCS stimulation. * Group 1 will receive 1 mA anodal tDCS stimulation to the ipsilesional M1 of cortical representation of the affected upper limb; * Group 2 to receive 1mA anodal tDCS to the contralesional premotor cortex; * Group 3 to receive sham tDCS stimulation with anode placed over the scalp area corresponding to ipsilesional M1. * Group 4: Subjects who fulfill the inclusion criteria of Study 2 but refuse tDCS stimulation.
- Masking
- Single blind
- Who is masked
- Participant
- Enrolment
- 41 participants (actual)
Sponsor and investigators
- Lead sponsor
- National University Hospital, Singapore
- Sponsor type
- University, hospital or other
- Collaborators
- Alexandra Hospital, National University of Singapore, Nanyang Technological University
- Responsible party
- Sponsor
- Investigators
- Effie Chew, MBBS, Principal investigator, National University Hospital, Singapore
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05332652
- Sponsor's protocol ID
- 2019/00932
- Other IDs
- 2019
- Status last verified
- Sep 2025
- First submitted
- 13 Sep 2021
- Last updated
- 20 Feb 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 20 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Neural Network Reorganization Associated With Upper Limb Motor Recovery in Stroke Patients- Establishing a Prognostic Model and Tailoring Neuromodulation for Rehabilitation
- ClinicalTrials.gov ID
- NCT05332652
- Acronym / sponsor ID
- 2019/00932
- Conditions
- Stroke, Acute
- Keywords
- stroke, motor recovery, prognostic model, transcranial magnetic stimulation, transcranial direct current stimulation, neuromodulation
- Study type
- Interventional
- Recruitment status
- Active, not recruiting
- Enrolment
- 41 participants (actual)
- Lead sponsor
- National University Hospital, SingaporeUniversity, hospital or other
- Collaborators
- Alexandra Hospital, National University of Singapore, Nanyang Technological University
- Study start
- 1 Sep 2020 (actual)
- Primary completion
- 16 Jul 2026 (estimated)
- Study completion
- 16 Jul 2026 (estimated)
- First posted
- 18 Apr 2022 (actual)
- 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.
This main aim of the study is to investigate the changes in neurophysiological features after stroke, and its association with upper limb motor recovery, so as to establish a prognostic model for upper limb motor recovery after stroke. The investigators hypothesize that a combination of neurophysiological features measured by transcranial magnetic stimulation (TMS), high density electroencephalography (HD-EEG), functional magnetic resonance imaging (fMRI) and Diffusion Tensor Imaging (DTI) might be used as biomarkers to predict upper limb motor outcomes after stroke. The investigators also hypothesize that non-invasive brain stimulation strategies such as tDCS will more effectively improve motor outcomes as an adjunct to therapy, if tailored according to patient's predicted pattern of neural reorganization.
Detailed description
This study comprises 2 parts. Study 1 is a longitudinal cohort study to characterize the neurophysiological changes with upper limb motor recovery in stroke patients with moderate to severe upper limb motor function impairment, and its correlation with motor function recovery.
120 stroke subjects within 3 weeks post-stroke will be recruited from National University Hospital (NUH), Alexandra Hospital (AH), and Tan Tock Seng Hospital (TTSH). We will follow changes in cortical activity over time using Transcranial Magnetic Stimulation (TMS), MRI and EEG measures and correlate these with clinical outcome measures at the same time points, to study the interaction between neural excitability and functional outcome.
10 healthy subjects will be needed as control group to compare outcomes obtained from MRI scans.
Outcome measures of brain corticospinal excitability, clinical measures on upper limb motor function and cognitive tests, will be performed 4 times- within 4 weeks, at 3 months, 6 months and 1 year after stroke onset, except for MRI which will not be performed at 1 year after stroke onset.
Subjects from Study 1 whose ARAT (Action Research Arm test) score is < = 42 at 3 months post-stroke will proceed to Study 2. ARAT score < = 42 indicates limited functional capacity and below. The aim of Study 2 is to investigate the efficacy and the neurophysiological effects of 2 types of tDCS protocols in facilitating upper limb motor recovery in patients with significant limitations in upper limb function.
There are a total of 4 groups in Study 2. Subjects who are agreeable for transcranial direct current stimulation (tDCS) will be randomized into 3 groups with 17 subjects in each group, by stratified randomization using Microsoft Excel, according to the lesion location (cortical vs. subcortical), and type of stroke (haemorrhagic vs. ischemic). Subjects who refuse tDCS will be enrolled in the control group without receiving any tDCS stimulation.
- Group 1 will receive 1 mA anodal tDCS stimulation to the ipsilesional M1 of cortical representation of the affected upper limb;
- Group 2 to receive 1mA anodal tDCS to the contralesional premotor cortex;
- Group 3 to receive sham tDCS stimulation with anode placed over the scalp area corresponding to ipsilesional M1.
- Group 4: Subjects who fulfill the inclusion criteria of Study 2 but refuse tDCS stimulation.
Cathode for all 3 tDCS groups will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training. Subjects in Study 2 will continue with the 6-month and 1 year assessment, as in Study 1.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (participant)
- Number of arms
- 4
- Model description
- Subjects from Study 1 whose ARAT score is < = 42 at 3 months post-stroke will proceed to Study 2. Subjects who are agreeable for transcranial direct current stimulation (tDCS) will be randomized into 3 groups with 17 subjects in each group, by stratified randomization, according to the lesion location (cortical vs. subcortical), and type of stroke (haemorrhagic vs. ischemic). Subjects who refuse tDCS will be enrolled in the control group without receiving any tDCS stimulation. * Group 1 will receive 1 mA anodal tDCS stimulation to the ipsilesional M1 of cortical representation of the affected upper limb; * Group 2 to receive 1mA anodal tDCS to the contralesional premotor cortex; * Group 3 to receive sham tDCS stimulation with anode placed over the scalp area corresponding to ipsilesional M1. * Group 4: Subjects who fulfill the inclusion criteria of Study 2 but refuse tDCS stimulation.
| Arm | Type | Receives |
|---|---|---|
| Anodal tDCS stimulation to the ipsilesional M1 | Experimental | Device: trancranial magnetic stimulationParticipant will receive 1 mA anodal tDCS stimulation to the ipsilesional M1 of cortical representation of the affected upper limb. Cathode will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training. |
| Anodal tDCS to the contralesional premotor cortex | Experimental | Device: trancranial magnetic stimulationParticipant will receive 1mA anodal tDCS to the contralesional premotor cortex. Cathode will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training. |
| Sham tDCS | Sham comparator | Device: trancranial magnetic stimulationParticipant will receive sham tDCS stimulation with anode placed over the scalp area corresponding to ipsilesional M1. Cathode will be used as reference electrode and placed over the supraorbital area contralateral to the anode. tDCS stimulation will be conducted daily for 20 sessions in consecutive days in the 4th month after stroke, with each session lasting for 20 minutes and combined with online occupational therapy training. |
| Control group | No intervention | –Subjects who fulfill the inclusion criteria of Study 2 but refuse tDCS stimulation. |
Who may qualify
- Ages
- 21 to 80 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
Key exclusion criteria (13 listed)
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 |
|---|---|---|
| trancranial magnetic stimulationA trained research staff or physician will perform tDCS to the subject. Direct current will be delivered by a battery-operated, constant current stimulator, through 2 rubber electrodes embedded in a pair of saline-soaked sponge bag. Stimulation intensity will be ramped up to 1 mA over 30 seconds and maintain at 1 mA for 20 minutes, and then ramped down to 0 mA over 30 seconds. | Device | Anodal tDCS stimulation to the ipsilesional M1, Anodal tDCS to the contralesional premotor cortex, Sham tDCS |
Primary outcome
Change of cortical excitability using Transcranial Magnetic Stimulation (TMS)
Time frame: Change of the cortical excitability within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
measures of cortical excitability for those without TMS contraindications
Change of neural excitability using Magnetic resonance imaging (MRI) scan
Time frame: Change of the neural excitability within 4 weeks, at 3 months, 6 months after stroke onset
Participants will go through one of the following image acquisition procedures 1) a functional MRI scans for brain activity together with motor task. 2) a 3D MPRAGE sequence for brain structure. 3) an advanced multishell high-resolution diffusion MRI for characterizing brain microstructure and extracellular space. 4) a FLAIR scan to measure white matter hyperintensity. Both functional and anatomical image acquisition will be undertaken using but not limited to gradient echo EPI sequence or its modified version.
Change of neural excitability using electroencephalogram (EEG)
Time frame: Change of the neural excitability within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
High density EEG (electroencephalogram) evaluation of the electrical activity of the brain
Change of the upper extremity motor function using Fugl-Meyer scale
Time frame: Change of the upper extremity motor function within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
Upper limb function, Minimum score 0, Maximum score 66, the higher the score the better the upper limb function.
Change of upper extremity performance (coordination, dexterity and functioning) using Action Research Arm Test
Time frame: Change of upper extremity performance within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
Upper limb function, Minimum score 0, Maximum score 57, the higher the score the better the upper limb function.
Change of muscle spasticity using Modified Ashworth scale for spasticity (MAS)
Time frame: Change of muscle spasticity within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
Upper limb function, 6 point scale, Scores range from 0 to 4 (namely 0, 1, 1+, 2, 3 and 4), where lower scores represent normal muscle tone and higher scores represent spasticity or increased resistance to passive movement.
1 secondary outcome
Change of cognitive function using cognitive test
Time frame: Change of cognitive function within 4 weeks, at 3 months, 6 months and 1 year after stroke onset
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Feb 2026.
- Individual participant dataSharing planned: No
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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.
Effie Chew, MBBS principal investigator
National University Hospital, Singapore
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing trancranial magnetic stimulation in people with Stroke, Acute, run by National University Hospital, Singapore at 2 sites in Singapore.
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 5 inclusion and 13 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: under way, not looking for participants, as of the sponsor's last update on 20 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in Singapore. 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. Some participants in this study may receive a placebo. 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?
This study is still under way. Results are not available in the source record yet.
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 of cortical excitability using Transcranial Magnetic Stimulation (TMS) (time frame: Change of the cortical excitability within 4 weeks, at 3 months, 6 months and 1 year after stroke onset). The study lists 6 primary outcomes in all. 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 Feb 2026.