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Working MemoryNCT06252532

Causal Role of Top-Down Theta Oscillations in Prioritization

A study testing Direct cortical stimulation (DCS) Alpha, Direct cortical stimulation (DCS) Theta and Direct cortical stimulation (DCS) In-Phase Theta in people with Working Memory and Epilepsy, run by University of North Carolina, Chapel Hill at 1 site in United States.

Enrolling by invitation

Enrolling by invitation. The study team selects and invites participants, usually from an existing group of patients.

Sites and contacts
Official record
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Trial summary

Purpose: The purpose of this pilot study is to investigate the dynamics between theta and alpha oscillations in the control of working memory. These findings will be informative of what types of brain stimulation are most effective at modulating brain activity. Read more about this study

Who is it for?
Ages 18 to 80 years
Conditions the study is for
Working Memory, Epilepsy
What is being tested?
Direct cortical stimulation (DCS) Alpha, Direct cortical stimulation (DCS) Theta and Direct cortical stimulation (DCS) In-Phase Theta
Type of treatment
Medical device
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
50 participants
Where
1 siteUnited States
Study dates
1 Jul 2024to 31 Jan 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 to 80 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Able to provide informed consent
  • History of medically intractable epilepsy
  • Speak and understand English
  • For the stimulation session, the participant must have electrodes in the relevant locations

Who cannot join

  • Current diagnosis of other neurological illnesses including ischemic stroke, intracerebral hemorrhage, brain neoplasm
  • Major systemic illness
  • Severe cognitive impairment - diagnosed by clinician in neuropsychiatric evaluation
  • Severe psychiatric illness
  • Excessive use of alcohol or other substances
  • Anything that, in the opinion of the investigator, would place the participant at increased risk or preclude the participant's full compliance with or completion of the study

Trial locations and contacts

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

United States1 site
  • University of North Carolina at Chapel Hill

    Chapel Hill, North Carolina, 27599

Other trials in United States

About this study

Official title: Modulating Oscillations and Working Memory in Patients With Subdural Electrodes

Purpose: The purpose of this pilot study is to investigate the dynamics between theta and alpha oscillations in the control of working memory. These findings will be informative of what types of brain stimulation are most effective at modulating brain activity. Deep brain stimulation and transcranial magnetic stimulation are used for an increasing number of neurological and psychiatric disorders. Participants: Eligible participants are patients who have previously had electrodes implanted to monitor epilepsy (outside of research activity). 50 participants will be recruited, 25 participants for each phase of the study. Procedures (methods): The participants will perform a cognitive control task. During the task, rhythmic trains of direct cortical stimulation will be delivered to the frontal cortex alone or to the frontal and parietal cortex. Electrocorticography will be collected concurrent with stimulation.

Read the detailed description

The aim of this study is to investigate the causal role of functional interactions between frontal-theta dependent selection processes and posterior-alpha dependent suppression processes in the context of cognitive control by targeting theta and alpha oscillations in frontal and parietal cortex separately in phase one of the experiment. Theta and alpha oscillations are hypothesized to play complementary roles such that theta oscillations are excitatory (related to active processing) whereas alpha oscillations are inhibitory (related to suppression of processing).

Thus, the investigators hypothesize that rhythmic brain stimulation can be used to drive activity in opposite directions. In the second phase of the experiment the investigators target functional connectivity between these regions. In particular, theta oscillations are hypothesized to play a critical role in orchestrating the prioritization and suppression of information across the cerebral cortex. Thus, the investigators hypothesize that in-phase theta frequency connectivity will be causally related to working memory success, but alpha frequency connectivity will be inconsequential and anti-phase theta connectivity will be detrimental. Together these findings suggest an overall model by which the amplitude of theta oscillations in prefrontal and the amplitude of alpha oscillations in parietal play a causal role in prioritization and suppression respectively, but functional connectivity between frontal and parietal cortex within the theta frequency band alone is critical to these cognitive processes. This experiment is of critical importance to the design of future interventions that use brain stimulation for the treatment of psychiatric and neurological disorders. For example, the use of frequency specific brain stimulation is key to controlling the impact of brain stimulation on neural activity. Design considerations like this one might be fundamental to improving the efficacy of future interventions such as the use of deep brain stimulation for the treatment of Parkinson's disease and for the use of transcranial magnetic stimulation for the treatment of major depressive disorder.

Being tested
Direct cortical stimulation (DCS) Alpha, Direct cortical stimulation (DCS) Theta, Sham Direct cortical stimulation (DCS), Direct cortical stimulation (DCS) In-Phase Theta, Direct cortical stimulation (DCS) Anti-Phase Theta
Medical subject headings
Epilepsy

What participants receive

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

  • Direct cortical stimulation (DCS) AlphaDevice

    Also called CereStim M96

    Rhythmic alpha stimulation

  • Direct cortical stimulation (DCS) ThetaDevice

    Also called CereStim M96

    Rhythmic theta stimulation applied

  • Sham Direct cortical stimulation (DCS)Device

    Also called CereStim M96

    Arrhythmic stimulation paradigm applied

  • Direct cortical stimulation (DCS) In-Phase ThetaDevice

    Also called CereStim M96

    Rhythmic in-phase theta stimulation applied

  • Direct cortical stimulation (DCS) Anti-Phase ThetaDevice

    Also called CereStim M96

    Rhythmic anti-phase theta stimulation applied

Study groups in NCT06252532
Study groupRoleWhat they receive
Frontal StimulationActive comparatorDirect Cortical Stimulation (DCS) in alpha and theta frequencies is applied through electrodes located in the frontal cortex.
Receives: Device: Direct cortical stimulation (DCS) Alpha; Device: Direct cortical stimulation (DCS) Theta; Device: Sham Direct cortical stimulation (DCS)
Frontal Parietal StimulationSham comparatorDirect Cortical Stimulation (DCS) in in-phase and anti-phase theta frequencies is applied through electrodes located in the frontal and parietal cortex.
Receives: Device: Sham Direct cortical stimulation (DCS); Device: Direct cortical stimulation (DCS) In-Phase Theta; Device: Direct cortical stimulation (DCS) Anti-Phase Theta

What is being measured

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

  1. Change in Working Memory Task Performance - Pashler's working memory capacity metric (k)

    The participant will be presented with three colored squares in both visual fields during a practice session. Then the participant is presented with an informative retro-cue, an arrow to the left or right, that is 100% predictive of the upcoming probe, or an uninformative neural cue, an arrow pointing in both directions. Finally, in the probe epoch participants are presented with an array of squares on the left or the right side of the screen. Participants must determine if the array of colored squares is the same or different from those held in memory. Performance will be defined as: k=N*(HR*FA)/(1-FA) where N is the number of the items that are held in memory. HR is the hit rate defined as the percent correct for trials where the probe does not match the encoding array. FA is the false alarm rate defined as the percent incorrect for trials where the probe does match the encoding array.

    Measured: During the 1- to 1.5-hour test at Baseline and Stimulation Session conducted over a 1 to 2 day period

  2. Change in Working Memory Task Performance - Reaction Time

    The participant will be presented with three colored squares in both visual fields during a practice session. Then the participant is presented with an informative retro-cue, an arrow to the left or right, that is 100% predictive of the upcoming probe, or an uninformative neural cue, an arrow pointing in both directions. Finally, in the probe epoch participants are presented with an array of squares on the left or the right side of the screen. Participants must determine if the array of colored squares is the same or different from those held in memory. Reaction times will be quantified in milliseconds.

    Measured: During the 1- to 1.5-hour test at Baseline and Stimulation Session conducted over a 1 to 2 day period

  3. Intracranial EEG Multi-taper fft

    Time-frequency analysis of electrophysiology data will be performed using methods like multi-taper fft. This will be compared between sham (arrhythmic) and stimulation trials to identify if stimulation enhances neuronal entrainment.

    Measured: During the 1- to 1.5-hour test at Baseline and Stimulation Session conducted over a 1 to 2 day period

  4. Intracranial EEG weighted phase lag index (wPLI)

    Functional connectivity will be measured using weighted phase lag index (WPLI). To calculate WPLI, first Morlet wavelet convolution is performed to extract instantaneous phase and amplitude for the frequency of interest for the two target sites. Next, the cross-spectral density is calculated (one signal multiplied by the complex conjugate of the other). From the cross-spectral density the imaginary component of the resulting signal is extracted. Then those imaginary values are averaged over the time frame of instance (here, the second half of the stimulation train). Finally, the magnitude of the resulting vector is taken to be the wPLI. This metric quantifies the consistency of phase lag between the two target regions and is weighted towards signals with a 90 or 270 degree offset to address a common confound in electrophysiology, volume conduction.

    Measured: During the 1- to 1.5-hour test at Baseline and Stimulation Session conducted over a 1 to 2 day period

Secondary outcomes (3)
  1. Intracranial EEG Wavelets

    Spectral analysis and functional connectivity analysis of electrophysiology data will be performed using methods like wavelets. This will be compared between sham (arrhythmic) and stimulation trials to identify if stimulation enhances neuronal entrainment.

    Measured: During the 1- to 1.5-hour test at Baseline and Stimulation Session conducted over a 1 to 2 day period

  2. Intracranial EEG phase locking

    Spectral analysis and functional connectivity analysis of electrophysiology data will be performed using methods like phase locking. This will be compared between sham (arrhythmic) and stimulation trials to identify if stimulation enhances neuronal entrainment.

    Measured: During the 1- to 1.5-hour test at Baseline and Stimulation Session conducted over a 1 to 2 day period

  3. Intracranial EEG Granger causality

    Spectral analysis and functional connectivity analysis of electrophysiology data will be performed using methods like Granger causality. This will be compared between sham (arrhythmic) and stimulation trials to identify if stimulation enhances neuronal entrainment.

    Measured: During the 1- to 1.5-hour test at Baseline and Stimulation Session conducted over a 1 to 2 day period

Timeline

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

  1. First posted9 Feb 2024
  2. Study start1 Jul 2024
  3. Primary completion31 Jan 2027 (estimated)
  4. Study completion31 Jan 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
Basic science
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
50 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06252532
Sponsor's protocol ID
23-1652
Other IDs
5R01MH124387
Status last verified
Aug 2026
First submitted
1 Feb 2024
Last updated
19 Aug 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
Yes
Individual data sharing
Yes: Deidentified individual data that supports the results will be shared beginning 9 to 36 months following publication provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with UNC.

Publications

  • Alagapan S, Riddle J, Huang WA, Hadar E, Shin HW, Frohlich F. Network-Targeted, Multi-site Direct Cortical Stimulation Enhances Working Memory by Modulating Phase Lag of Low-Frequency Oscillations. Cell Rep. 2019 Nov 26;29(9):2590-2598.e4. doi: 10.1016/j.celrep.2019.10.072.

    PubMed 31775030
  • Alagapan S, Lustenberger C, Hadar E, Shin HW, Frӧhlich F. Low-frequency direct cortical stimulation of left superior frontal gyrus enhances working memory performance. Neuroimage. 2019 Jan 1;184:697-706. doi: 10.1016/j.neuroimage.2018.09.064. Epub 2018 Sep 27.

    PubMed 30268847

Questions about this trial

What is this clinical trial studying?

A study testing Direct cortical stimulation (DCS) Alpha, Direct cortical stimulation (DCS) Theta and Direct cortical stimulation (DCS) In-Phase Theta in people with Working Memory and Epilepsy, run by University of North Carolina, Chapel Hill at 1 site in United States.

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 6 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: enrolling by invitation, as of the sponsor's last update on 19 Aug 2026. 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 United States. 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 in Working Memory Task Performance - Pashler's working memory capacity metric (k) (time frame: During the 1- to 1.5-hour test at Baseline and Stimulation Session conducted over a 1 to 2 day period). 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?

On the ClinicalTrials.gov record for NCT06252532, which also lists 2 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 19 Aug 2026.

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