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Huntington's disease is a disabling neurodegenerative disease. Patients present with involuntary movements of the body and cognitive symptoms like behavioral problem, difficulty in planning tasks, etc. No effective treatment is currently available for them apart from symptomatic therapy. Currently, studies are going on the effectiveness of noninvasive brain stimulation (NIBS) in neurodegenerative diseases. It is a mode of brain stimulation technique where current is delivered into the brain by placing electrodes into their scalp. Transcranial pulsed current stimulation (tPCS) is a new modality of noninvasive brain stimulation. It is a device that generates electrical impulses. The current generated from this device can stimulate underlying brain areas. The investigators have planned to study the feasibility of non-invasive brain stimulation via tPCS in these patients of Huntington's disease.
At first, the investigators will rate their involuntary body movement by a standard scale, assess arm movements by a robotic device, assess speech with standard protocol, assess brain electrophysiology by electroencephalography (EEG) and will also do gait (walking) analysis. Next, the investigators will give them 2 week (20 min/day) stimulation via real tPCS (active stimulation) or placebo (sham stimulation). After 2 weeks of stimulation, the investigators will re-assess the patient using the same tools mentioned pre-stimulation.
Each patient will receive real and placebo stimulation with a 1-month gap in between. They will not know whether they are receiving real stimulation or placebo. Assessment will be done before stimulation, after 2 week real stimulation and after 2 week sham stimulation.
The investigators have planned to study the feasibility of non-invasive brain stimulation via Transcranial pulsed current stimulation (tPCS) in patients of Huntington's disease. Anodal stimulation will be given to the brain area based on quantitative electroencephalography (qEEG) findings.
Patients will be assessed clinically by standard rating scale (UHDRS) and by qEEG, KinArm and Gait - before and after 2 week (20 min per day) stimulation via tPCS or sham stimulation.
The investigators have planned to assess-
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Real tPCS | Active Comparator | Patients of Huntington's disease will be randomly allocated into both the arms. Real tPCS arm will receive active tPCS. Then they will be crossed over to Sham tPCS arm. |
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| Sham tPCS | Sham Comparator | Patients of Huntington's disease will be randomly allocated into both the arms. Sham tPCS arm will receive sham tPCS. Then they will be crossed over to Real tPCS arm. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Active Transcranial pulsed current stimulation (tPCS) | Device | Active tPCS will be delivered through a pair of saline soaked (0.9% NaCl) surface sponge electrodes. Anodal stimulation will be given to brain area based on qEEG findings |
| Measure | Description | Time Frame |
|---|---|---|
| Feasibility of recruitment | Can we recruit 15 HD patients for non-invasive brain stimulation study | 1 year |
| Feasibility of finishing the study | Can 15 participants finish the study | 1 year |
| Feasibility of home based stimulation | Can non-invasive brain stimulation in the form of transcranial pulsed current stimulation (tPCS) be appropriately applied at home | 1 year |
| Feasibility of network targeting | Can dysfunctional brain area in HD be targeted for stimulation non-invasively, using qEEG as a guide | 1 year |
| Measure | Description | Time Frame |
|---|---|---|
| Change in UHDRS | The investigators will evaluate the effectiveness of tPCS in patients of Huntington's disease. The investigators will apply Unified Huntington's disease rating scale (UHDRS) pre and post stimulation. The scale is for assessment of chorea, dystonia, ataxia, extraocular movements, speech, gait, postural imbalance. Each subsection can be scored from 0-4. By summing up, the total score ranges from minimum 0 and maximum 124. Higher score means more severity. |
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Inclusion Criteria:
Exclusion Criteria:
• Patients who can't walk even with support, like wheel chair bound patients.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mandar S Jog | Contact | 5196676708 | 3814 | Mandar.Jog@lhsc.on.ca |
| Jacky Ganguly | Contact | jganguly@uwo.ca |
| Name | Affiliation | Role |
|---|---|---|
| Mandar S Jog | London Health Sciences Centre | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28390970 | Background | Eddy CM, Shapiro K, Clouter A, Hansen PC, Rickards HE. Transcranial direct current stimulation can enhance working memory in Huntington's disease. Prog Neuropsychopharmacol Biol Psychiatry. 2017 Jul 3;77:75-82. doi: 10.1016/j.pnpbp.2017.04.002. Epub 2017 Apr 5. | |
| 24112923 | Background | Berardelli A, Suppa A. Noninvasive brain stimulation in Huntington's disease. Handb Clin Neurol. 2013;116:555-60. doi: 10.1016/B978-0-444-53497-2.00044-9. |
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| ID | Term |
|---|---|
| D006816 | Huntington Disease |
| ID | Term |
|---|---|
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| Sham Transcranial pulsed current stimulation (tPCS) | Device | Electrode placement will be the same as active stimulation but the electric current will be ramped down 5 seconds after the beginning of the stimulation to make this condition indistinguishable from the experimental active stimulation. |
|
| 3 months |
| Changes in spatiotemporal gait measures using objective gait analysis | The investigators will use Zeno Walkway Gait carpet and the spatiotemporal details of the gait will be analyzed by ProtoKinetics Movement Analysis Software (PKMAS) software, pre and post stimulation.The Zeno walkway will be used in conjunction with the ProtoKinetics Movement Analysis Software (PKMAS). The walkway contains a series of pressure sensors to detect footfalls. These data will be captured and collated via the PKMAS software, resulting in numerous spatial, temporal and pressure-related gait parameters. Timed-up-and-go (TUG) task will be used, consisting of rising from chair, walking across the 20-foot gait carpet, turning around off the carpet, walking back and sitting down. | 3 months |
| Change in upper limb movements | The investigators will use KinArm pre and post stimulation to have objective measurement of upper limb movements. KinArm is a robotic manipulator arm. The patients will hold the manipulator arm and move it across to certain points shown on the computer screen. The investigators will use standard KinArm testing protocols to assess upper limb movements. | 3 months |
| Change in speech | The investigators will use standardized speech protocol pre and post stimulation to assess speech. Participant's speech will be recorded using a head-mounted microphone (AKG-c520) and a digital recording device (Zoom H4nPro) while performing the following calibrated tasks. Calibration involves a sound level meter placed at 15cm from the mouth while talker says 'ah' at 70dBA. The following speech tasks will be assessed- Prolonged phonation, Rapid repetitions of the sounds, Two productions of a sentence with selected speech sounds, Two times louder production of a sentence with selected speech sounds, Repetition of a continuous vowel at normal and fast rates without making any voice breaks or pauses. f) Read aloud a section of a standard passage - standard rainbow passage g) Monologue. Talk for two minutes about an interesting vacation (or an interesting hobby or activity). | 3 months |
| Changes in Network fragmentation using Quantitative EEG | The investigators will do network fragmentation by 5 mins of resting quantitative Electroencephalography (EEG), pre and post stimulation.Quantitative EEG signals will be recorded using g. Nautilus g.tec wireless system. The g. tech system uses ear clip reference sensors. Patient will sit in a comfortable arm chair in a quiet place with less light or electromagnetic perturbations. The patient will be instructed to sit relaxed with eyes closed for 5 min. | 3 months |
| D003704 | Dementia |
| D002819 | Chorea |
| D020820 | Dyskinesias |
| D009069 | Movement Disorders |
| D020271 | Heredodegenerative Disorders, Nervous System |
| D019636 | Neurodegenerative Diseases |
| D030342 | Genetic Diseases, Inborn |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D003072 | Cognition Disorders |
| D019965 | Neurocognitive Disorders |
| D001523 | Mental Disorders |