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Ischemic StrokeNCT06244914

Combined taVNS and tDCS in Subacute Stroke Patients

A study testing tDCS stimulation and taVNS stimulation in people with Ischemic Stroke, run by National Cheng-Kung University Hospital at 1 site in Taiwan.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Ischemic stroke, the most prevalent neurological disorder, is treated with medication and thrombectomy but with limited success, especially in chronic stages where traditional rehabilitation is the primary option. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Ischemic Stroke
What is being tested?
tDCS stimulation and taVNS stimulation
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
80 participants
Where
1 siteTaiwan
Study dates
15 Feb 2024to 30 Apr 2027
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 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 18 years old
  • Subacute ischemic stroke patients within 7-30 days after stroke symptoms is stabilized
  • Stroke will be documented by DWI-MRI
  • Lesion locations at least involve supratentorial area
  • Patients have unilateral weakness documented with manual muscle testing scales less than 4
  • Stable vital signs and stable neurological signs
  • Able to receive regular rehabilitation programs, and 8) modified Rankin Scales (mRS) less than 5.

Who cannot join

  • A National Institute of Health Stroke Scale (NIHSS) score > 25 at study entry
  • The presence of hemineglect
  • Moderate-to-severe pain in any limb
  • Unstable clinical condition
  • Recurrent strokes or brainstem strokes
  • Marked arrhythmia or cardiovascular complications
Show all 18Show fewer
  • Bradycardia (HR≤50 bpm) or low blood pressure (SBP≤100 mmHg or DBP≤60mmHg) at admission
  • Patients with radiographic evidence or suspicion of chronic conditions that may predispose them to intracranial hemorrhage including brain arteriovenous malformations, cerebral cavernous malformations, cerebral telangiectasia, multiple previous intracerebral hemorrhages (amyloid angiopathy)
  • Pre-existing coagulopathy, consist of platelet count of ≤100, INR≥ 3, PTT≥ 90
  • Patients suspected of having infective endocarditis and ischemic stroke related to septic emboli
  • Signs or symptoms of acute myocardial infarction, including EKG findings
  • Concomitant experimental therapy
  • Suspected cerebral vasculitis based on medical history and CTA/Magnetic Resonance Angiogram (MRA)
  • Suspected cranial dural arteriovenous fistula, and evidence of dissection in the intracranial cerebral arteries
  • Cerebral venous thrombosis and significant mass effect with midline shift
  • History of left atrial myxoma
  • Presence of contraindication for VNS (TENS) and tDCS: (A) Intracranial space occupied lesion, (B) Presence of a pacemaker, (C) History of brain neurosurgery, (D) Active CNS or systemic infection, (E) Presence of a metallic foreign body implant, (F) Skin abnormalities, (G) History of alcohol/drug abuse, (H) Epilepsy/History of epilepsy at family (I) Hyperacusis, (J) Cognitive/Consciousness disturbance, (K) Pregnancy or nursing females, (L) Use of neuropsycoactive drugs, (M) Psychiatric/ Neurologic disease
  • Not suitable for equipping ECG recorders: (A) Chronic disease, and allergic to polyester, (B) Acute and severe patients

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Taiwan1 site, 1 recruiting
  • National Cheng Kung University Hospital

    Tainan, Tainan, 71144

    Chou-Ching Lin, MD, phD, +886-62353535 ext. 2692, cxl45@mail.ncku.edu.tw

    Recruiting

Other trials in Taiwan

About this study

Official title: Combining Closed-loop Transcutaneous Auricular Vagus Nerve Stimulation and Focal Transcranial Direct Current Stimulation as an Adjuvant Treatment for Acute and Subacute Strokes

Ischemic stroke, the most prevalent neurological disorder, is treated with medication and thrombectomy but with limited success, especially in chronic stages where traditional rehabilitation is the primary option. Stroke often leads to post-stroke autonomic imbalance, deteriorating functional outcomes and increasing recurrence risk. Emerging non-pharmacological treatments like Transcutaneous Auricular Vagus Nerve Stimulation (VNS) and Focused Transcranial Direct Current Stimulation (tDCS) offer new possibilities. VNS targets post-stroke tissue injury and promotes healing and neurogenesis, while tDCS aims to enhance motor learning by rebalancing brain activity. Both therapies seek to improve outcomes in both acute and chronic stroke stages.

Read the detailed description

Ischemic stroke is the most common neurological disease. The main treatment options include medication and endovascular thrombectomy. The benefits of treatments at acute stage are significant but far from satisfactory. There is no effective treatment for improvement at chronic stage, except traditional rehabilitation. In addition, stroke may induce post-stroke autonomic imbalance, further leading to worse post-stroke functional outcomes and the risk of recurrent stroke.

Except for pharmacological therapy against the risk of stroke, non-pharmacological neuromodulation may be proposed as another therapeutic options. Transcutaneous auricular vagus nerve stimulation (VNS) and focused transcranial direct current stimulation (tDCS) may be two of the options. The function of VNS is to modulate post-stroke tissue injury and promote angiogenesis/neurogenesis through non-pharmacological pathway. VNS may increase the parasympathetic activity for balancing the hyper-sympathetic state in the acute stage and enhancing neural plasticity in the chronic stage. On the other hand, the purpose of tDCS is to make substantial motor learning improvements, which may be through the re-balance both excitatory and inhibitory activation between hemispheres after stroke.

Conditions
Ischemic Stroke
Being tested
tDCS stimulation, taVNS stimulation, sham tDCS stimulation, sham taVNS stimulation
Medical subject headings
Ischemic Stroke

What participants receive

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

  • tDCS stimulationDevice

    tDCS 1mA will be applied for 20min. tDCS will be applied around the infract area. taVNS or sham taVNS wil be applied before tDCS. The intervention will be applied before physical therapy. A total of 10 sections are applied during the intervention period of 2 weeks.

  • taVNS stimulationDevice

    taVNS will be applied for 30 min. The electrode will be placed on the left ear of the patient. The amplitude of taVNS will be adjusted under the patient's pain threshold. After taVNS, tDCS will be applied for 20 min. The intervention will be applied before physical therapy. A total of 10 sections are applied during the intervention period of 2 weeks.

  • sham tDCS stimulationDevice

    sham tDCS 1mA will be applied for 20min. sham tDCS will be applied around the infract area. The stimulation will be applied for only 10 seconds and no stimulation afterward. taVNS or sham taVNS wil be applied before sham tDCS.The intervention will be applied before physical therapy. A total of 10 sections are applied during the intervention period of 2 weeks.

  • sham taVNS stimulationDevice

    sham taVNS will be applied for 30 min. The electrode will be placed on the left ear of the patient. The amplitude of sham taVNS will be adjusted under the patient's pain threshold. The stimulation was only applied for 5 seconds and no stimulation afterward. After sham taVNS, tDCS or sham tDCS will be applied for 20 min. The intervention will be applied before physical therapy. A total of 10 sections are applied during the intervention period of 2 weeks.

Study groups in NCT06244914
Study groupRoleWhat they receive
tDCS + taVNSExperimentaltDCS + taVNS will be applied before rehabilitation.
Receives: Device: tDCS stimulation; Device: taVNS stimulation
tDCS + sham-taVNSActive comparatortDCS + sham-taVNS will be applied before rehabilitation.
Receives: Device: tDCS stimulation; Device: sham taVNS stimulation
sham-tDCS + taVNSActive comparatorsham-tDCS + taVNS will be applied before rehabilitation.
Receives: Device: taVNS stimulation; Device: sham tDCS stimulation
sham-tDCS + sham-taVNSSham comparatorsham-tDCS + sham-taVNS will be applied before rehabilitation.
Receives: Device: sham tDCS stimulation; Device: sham taVNS stimulation

What is being measured

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

  1. Disability Severity Assessment Using the Modified Rankin Scale (mRS)

    • Description: The Modified Rankin Scale (mRS) is a widely used 6-point disability scale evaluating the degree of disability or dependence in daily activities of people who have suffered a stroke.
    • Scale Range: 0 (no symptoms) to 5 (severe disability).
    • Score Interpretation: Higher scores indicate a worse outcome, reflecting increased disability.

    Measured: 0, 4, 12 week

  2. Motor Function Assessment Using Fugl-Meyer Assessment (FMA) for Upper Extremity (UE) and Lower Extremity (LE)

    • Description: The Fugl-Meyer Assessment (FMA) is a stroke-specific, performance-based impairment index designed to assess motor functioning, balance, sensation, and joint functioning in patients with post-stroke hemiplegia. It evaluates the motor recovery post-stroke, focusing on voluntary movements and joint functions.
    • Scale Range:

    Upper Extremity (UE): 0 to 66 Lower Extremity (LE): 0 to 34

    • Score Interpretation: Higher scores indicate better motor functioning, reflecting greater voluntary movement capability and reduced impairment.

    Measured: 0, 4, 12 week

  3. Upper Limb Motor Function Evaluation Using the Wolf Motor Function Test (WMFT)

    • Description: The WMFT is designed to assess motor ability through timed and functional tasks in individuals with upper extremity motor impairment.
    • Scale Range:

    Timed Tasks: Seconds to complete, up to 120 seconds per task. Functional Tasks: Scored 0 to 5 on functional ability.

    • Score Interpretation:

    Timed Tasks: Lower completion times indicate better motor function. Functional Tasks: Higher scores represent greater functional ability and more normal movement patterns.

    Measured: 0, 4, 12 week

  4. Mobility and Balance Assessment Using the Time Up and Go Test (TUG)

    • Description: The TUG test measures the time taken by an individual to stand up from a seated position, walk a short distance, turn around, walk back, and sit down.
    • Scale Range: Time in seconds.
    • Score Interpretation: Lower times indicate better mobility and balance.

    Measured: 0, 4, 12 week

Secondary outcomes (4)
  1. Autonomic Function Assessment through Heart Rate Variability (HRV) Analysis

    • Description: HRV is used to evaluate autonomic nervous system function by analyzing the variation in time intervals between heartbeats.
    • Scale Range:

    SDNN: Measured in milliseconds, with a wide variability range. RMSSD: Also measured in milliseconds, with higher values indicating increased parasympathetic activity.

    • Score Interpretation: Higher HRV values signify greater heart rate variability, typically reflecting better autonomic function and cardiovascular health.

    Measured: 0, 4, 12 week

  2. Cognitive Function Assessment Using Montreal Cognitive Assessment (MoCA)

    • Description: The MoCA is utilized to assess various cognitive abilities, including memory, language, attention, and spatial and temporal orientation, offering a comprehensive overview of an individual's cognitive status.
    • Scale Range: The total score ranges from 0 to 30, with higher scores indicating better cognitive performance.
    • Score Interpretation: Scores near 30 suggest normal cognitive functioning, while scores below 26 may indicate cognitive impairments, warranting further clinical evaluation.

    Measured: 0, 4, 12 week

  3. Depression Severity Measurement Using Montgomery-Asberg Depression Rating Scale (MADRS)

    • Description: The MADRS is a clinician-administered scale assessing the depth and severity of depressive symptoms, focusing on both psychological and physical aspects of depression. It is valuable in tracking symptom changes and treatment efficacy.
    • Scale Range: The total score ranges from 0 to 60, derived from ten items each scored from 0 to 6.
    • Score Interpretation: Scores nearer to 60 reflect more severe depression, while lower scores indicate milder depressive symptoms.

    Measured: 0, 4, 12 week

  4. Quality of Life Evaluation Using the EQ-5D-5L

    • Description: The EQ-5D-5L is a comprehensive tool assessing health-related quality of life across five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, each rated on a five-point severity scale.
    • Scale Range:

    Descriptive Profile: 1 (no problems) to 5 (extreme problems) for each dimension.

    EQ VAS: 0 (worst imaginable health state) to 100 (best imaginable health state).

    • Score Interpretation:

    Descriptive Profile: Lower scores indicate better health status in each dimension.

    EQ VAS: Higher scores reflect better overall health and quality of life.

    Measured: 0, 4, 12 week

Timeline

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

  1. First posted6 Feb 2024
  2. Study start15 Feb 2024
  3. Primary completion30 Apr 2025 (estimated)
  4. Study completion30 Apr 2027 (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
Parallel groups
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
80 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06244914
Sponsor's protocol ID
A-BR-112-009
Status last verified
Jan 2024
First submitted
4 Jan 2024
Last updated
20 Mar 2024
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 tDCS stimulation and taVNS stimulation in people with Ischemic Stroke, run by National Cheng-Kung University Hospital at 1 site in Taiwan.

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 7 inclusion and 18 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: looking for participants now, as of the sponsor's last update on 20 Mar 2024. 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 Taiwan. 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?

Contact Pi-Shan Sung, MD,PhD (+886-62353535 ext. 3891, pishansung@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Disability Severity Assessment Using the Modified Rankin Scale (mRS) (time frame: 0, 4, 12 week). The study lists 4 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 Mar 2024.

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