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This exploratory study will determine if there are differences in cortical excitability between patients suffering from cyclic vomiting syndrome (CVS) and healthy control subjects, as assessed by a non-invasive method of brain stimulation (Transcranial Magnetic Stimulation, TMS).
This exploratory study will determine if there are differences in cortical excitability between patients suffering from cyclic vomiting syndrome (CVS) and healthy control subjects, as assessed by a non-invasive method of brain stimulation (Transcranial Magnetic Stimulation, TMS).
Using the paired-pulse TMS paradigm, intracortical inhibition and facilitation of cortical circuitry will be assessed by stimulating the motor cortex and using the electromyographic (EMG) response of a target muscle as readout. In such studies, a conditioning stimulus modulates the amplitude of the motor-evoked potential (MEP) produced by the test stimulus. Depending on the inter-stimulus interval, effects can be attributed to different aspects of cortical processing. Brief intervals (1-5 ms) will be used to assess short-interval intracortical inhibition (SICI) and short-interval intracortical facilitation (SICF), intermediate intervals (7-20 ms) to assess intracortical facilitation (ICF) and long intervals (50-200 ms) to assess long-interval intracortical inhibition (LICI).
Some clinical, demographic, and autonomic data (i.e. EKG) will be recorded and used as covariates to investigate any systematic impact on cortical excitability measures collected with the paired-pulse protocols.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CVS subjects | Experimental | Subjects diagnosed with Cyclic Vomiting Syndrome (CVS) |
|
| healthy, non-CVS subjects | Active Comparator | Subjects not diagnosed with CVS |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| TMS Paired-Pulse assessment of cortical excitability | Other | Using the paired-pulse TMS paradigm, intracortical inhibition and facilitation of cortical circuitry will be assessed by stimulating the motor cortex and using the electromyographic (EMG) response of a target muscle as readout. In such studies, a conditioning stimulus modulates the amplitude of the motor-evoked potential (MEP) produced by the test stimulus. Depending on the inter-stimulus interval, effects can be attributed to different aspects of cortical processing. Brief intervals (1-5 ms) will be used to assess short-interval intracortical inhibition (SICI) and short-interval intracortical facilitation (SICF), intermediate intervals (7-20 ms) to assess intracortical facilitation (ICF) and long intervals (50-200 ms) to assess long-interval intracortical inhibition (LICI). |
| Measure | Description | Time Frame |
|---|---|---|
| Paired-pulse ratios | Percentage Change in Paired Pulse (PP) TMS induced MEP responses with inhibitory or facilitatory stimulation. | Multiple study sessions spanning up to 12 months |
| Measure | Description | Time Frame |
|---|---|---|
| TMS motor threshold | TMS stimulator output necessary to elicit 200 microvolt MEP responses | Multiple study sessions spanning up to 12 months |
| Cortical silent period | Length (milliseconds) of EMG inactivity following TMS stimulation |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Paul HM Kullmann, PhD | Contact | 412-647-1533 | phmk@pitt.edu | |
| David J Levinthal, MD PhD | Contact | 412-303-0525 | levinthald@upmc.edu |
| Name | Affiliation | Role |
|---|---|---|
| David J Levinthal, MD PhD | University of Pittsburgh | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Pittsburgh Medical Center | Recruiting | Pittsburgh | Pennsylvania | 15232 | United States |
There is no current plan to place participant data into a open-access, shared data repository. However, a data sharing agreement can be made if requested.
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| ID | Term |
|---|---|
| C536228 | Familial cyclic vomiting syndrome |
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This is a comparative study looking at differences in electrophysiologic measures of cortical excitability between those with Cyclic Vomiting Syndrome and healthy controls.
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| Autonomic activity | Other | Autonomic function will be determined using continuously recorded EKG and used as covariates to investigate any systematic impact on cortical excitability measures collected with the paired-pulse protocols. |
|
| Multiple study sessions spanning up to 12 months |
| Heart rate variability | Spectral frequency analysis (via Fast Fourier Transformation) of R-R intervals | Multiple study sessions spanning up to 12 months |