Managing MTBI-related Headaches With rTMS
Maneno muhimu
Kikemikali
Maelezo
Headache is one of the most common debilitating chronic pain conditions in either active or retired military personnel with MTBI. This high prevalence of persistent chronic headache is often associated with neuropsychological dysfunction in mood, attention, and memory, which casts a profound negative impact on patients' quality of life and increases stress in their caregivers. Unfortunately, as witnessed by the investigators in their clinical practices, conventional pharmacological treatments for MTBI related headache (MTBI-HA) has not been shown to be effective and drugs such as narcotics contain many long-term untoward psychosomatic and abusive side effects. This calls for an urgent need in developing alternate and innovative long-term headache management strategies for this rapidly increasing patient population.
Coinciding with other published treatment protocols related to traumatic brain injury and pain, this initial clinical evidence provides compelling support for the current proposal aiming to assess the effect of a longer duration of rTMS protocol in managing MTBI-HA for up to 10 weeks after the initiation of the treatment. Given existing treatment options for MTBI-HA are limited, validating such a non-pharmacological and non-invasive treatment option will significantly enhance the capability of the VA healthcare system in caring for this rapidly increasing patient population.
1. PRE-TREATMENT PHASE (weeks 1-2) consists of Visit 1 (Screening Visit) and Visit 2 (Pre-treatment Assessments);
2. TREAMENT PHASE (week 3-4) consists of Visits 3-12 (Neuronagvigation guided rTMS consisting of 10 weekday treatments at >24 and < 72 hours apart, weekends excluded, maximum 5 weeks for treatment completion) rTMS will take place in Building 23 Room 105 at the VASDHS; and
3. POST-TREATMENT PHASE (week 5-14) consists of two initial weekly visits (Visits 13&14) and two additional biweekly visits (Visits 15&16) and one monthly visit (Visit 17).
Brain anatomical and functional MRI will be performed within 72 hours after Visits 2 and 13. Subjects will be required to fill out headache diary between assessment visits. Headache assessments along with quality of life, mood and functions assessments will be carried out at Visits 1,2, and 13--17. This frequency of treatment and duration of follow-up is in line with recently published rTMS articles related to TBI, headache and pain, and also in accordance with the 3-month post treatment initiation follow-up guideline/recommendation [32; 55; 80].
Tarehe
| Imethibitishwa Mwisho: | 03/31/2020 |
| Iliyowasilishwa Kwanza: | 10/03/2017 |
| Uandikishaji uliokadiriwa Uliwasilishwa: | 10/16/2017 |
| Iliyotumwa Kwanza: | 10/18/2017 |
| Sasisho la Mwisho Liliwasilishwa: | 04/13/2020 |
| Sasisho la Mwisho Lilichapishwa: | 04/14/2020 |
| Tarehe halisi ya kuanza kwa masomo: | 12/31/2017 |
| Tarehe ya Kukamilisha Msingi iliyokadiriwa: | 09/29/2020 |
| Tarehe ya Kukamilisha Utafiti: | 09/29/2022 |
Hali au ugonjwa
Uingiliaji / matibabu
Device: Transcranial Magnetic Stimulation
Device: Sham Transcranial Magnetic Stimulation
Awamu
Vikundi vya Arm
| Mkono | Uingiliaji / matibabu |
|---|---|
| Experimental: Transcranial Magnetic Stimulation Active-repetitive transcranial magnetic stimulation (rTMS) at the left motor cortex. | Device: Transcranial Magnetic Stimulation Active-repetitive transcranial magnetic stimulation (rTMS) at the left motor cortex. |
| Sham Comparator: Sham Transcranial Magnetic Stimulation Sham rTMS will consist of the same parameters as active, however, the subject will not receive the actual magnetic stimulation to the left motor cortex. | Device: Sham Transcranial Magnetic Stimulation Sham rTMS will consist of the same parameters as active, however, the subject will not receive the actual magnetic stimulation to the left motor cortex due to the use of a double sided Active/Sham coil used specifically for research studies. |
Vigezo vya Kustahiki
| Zama zinazostahiki Kujifunza | 18 Years Kwa 18 Years |
| Jinsia Inastahiki Kujifunza | All |
| Hupokea Wajitolea wa Afya | Ndio |
| Vigezo | Inclusion Criteria: - The following diagnostic criteria for MTBI based on the 1993 American Congress of Rehabilitation Medicine and recent recommendation from the DOD, and the current diagnostic criteria adopted by the VASDHS TBI Clinic will be used for the study. A traumatically induced physiological disruption of brain function, as manifested by at least one of the following: - any loss of consciousness - any loss of memory for events immediately before or after the accident - any alteration in mental state at the time of the accident, e.g.: - feeling dazed - disoriented - confused) - Focal neurologic deficit (s) that may or may not be transient but where the severity of the injury does not exceed the following: - loss of consciousness of approximately 30 min or less - after 30 min, an initial Glasgow Coma Scale score of 13-15 - post-traumatic amnesia not greater than 24 hrs - In addition, the following established diagnostic criteria for " Persistent headache attributed to mild traumatic injury headache" based on the International Classification of Headache Disorder (ICHD-3) will be applied to the study subjects: - A. Any headache fulfilling criteria C and D - B. Traumatic injury to the head has occurred - C. Headache is reported to have developed within 7 d after one of the following: - 1. injury to the head - 2. regaining of consciousness following the injury - 3. discontinuation of medication(s) that impairs the ability to sense or report headache following the injury - D. Headache persists for >3 mo after injury to the head - E. Not better accounted for by another ICHD-3 diagnosis Additional Inclusion Criteria: - no prior experience of TMS treatment - average persistent headache intensity more than 30 on the 0-100 mechanical visual analog scale(M-VAS) at the screening visit (visit 1)[64] and average persistent headache intensity score greater than 3/10 on a numerical rating scale (NRS) reported in the headache diary (between visits 1&2) - no history of daily persistent headache prior to the MTBI incidence Exclusion Criteria: - pregnancy; To be eligible for the study and to ensure no pregnancy risk, you will need to utilize contraception or practice abstinence until your study participation is completed - history of pacemaker implant - any ferromagnetic material in the brain or body that would prohibit the patients from having a brain MRI, e.g.: - bullet fragment - shrapnel - device implant - history of dementia, major psychiatric or life threatening diseases - presence of any other chronic neuropathic pain states; - history of seizure - pending litigation - lack of ability to understand the experimental protocol and to adequately communicate in English - history of chronic headache diagnoses such migraine, tension or cluster headaches prior to the incidence of MTBI. - history of chronic headache prior to the MTBI incidence at a frequency more than once a month lasting more than one hour. - evidence in the chart of recent exacerbation of depressive or anxiety symptoms, active substance dependence, suicidal intent or attempt within the previous month, and/or current psychotic symptoms |
Matokeo
Hatua za Matokeo ya Msingi
1. Reduce the intensity, frequency and duration of MTBI-headaches [The measure will be assessed daily from baseline to the 3-month post-treatment follow up visit.]
2. Change from Baseline to Post-Treatment Quality of Life scores [The measure will be assessed at the Baseline visit, 1-Week, 1-Month, 2-Month and 3-month post-treatment follow up visits.]
3. Change from Baseline to Post-Treatment Depression scores [The measure will be assessed at the Baseline visit, 1-Week, 1-Month, 2-Month and 3-month post-treatment follow up visits.]
4. Change in attention scores from Baseline to Post-Treatment visits [The measure will be assessed at the Baseline visit, 1-Week, 1-Month, 2-Month and 3-month post-treatment follow up visits.]
5. Change from Baseline to Post-Treatment Global Pain scores. [The measure will be assessed at the Baseline visit, 1-Week, 1-Month, 2-Month and 3-month post-treatment follow up visits.]
6. Change from Baseline to Post-Treatment Post Traumatic Stress Disorder (PTSD) scores [The measure will be assessed at the Baseline visit, 1-Month, 2-Month and 3-month post-treatment follow up visits.]
7. Change from Baseline to Post-Treatment memory scores [The measure will be assessed at the Baseline visit, 1-Week, 1-Month, 2-Month and 3-month post-treatment follow up visits.]
8. Change from Baseline to Post-Treatment Executive Functioning [The measure will be assessed at the Baseline visit, 1-Week, 1-Month, 2-Month and 3-month post-treatment follow up visits.]
Hatua za Matokeo ya Sekondari
1. Explore the treatment effect on the pain related network of the brain [Subjects will have 2 functional magnetic imaging scans, at baseline and then at the 1-week post treatment follow-up.]
