■导致运动神经元死亡的增强的谷氨酸能传递被认为是肌萎缩性侧索硬化症(ALS)的主要病理生理机制。经颅静态磁刺激(tSMS)可以抑制运动皮层的兴奋性,因此,tSMS可以被评估为ALS的潜在治疗方法。本研究的目的是研究tSMS在ALS中的有效性和安全性。
■在此第二阶段试验中,我们随机分配ALS患者,在6个月内接受每日tSMS或安慰剂刺激.对于每个参与者,我们计算平均疾病月进展率(MPR)作为总ALS功能评定量表修订(ALSRFS-R)评分的变化,在治疗开始之前(至少三个月的时间)和六个月的治疗期。主要疗效结果是开始治疗前后MPR的差异。次要结果包括安全性和耐受性,合规,和皮质脊髓输出的变化。考虑到复合终点事件(气管造口术或死亡),所有完成六个月治疗的患者均进行了18个月的长期随访。在ClinicalTrials.gov注册的试验,ID:NCT04393467,状态:关闭。
■40名参与者被随机分配到真实刺激(n=21)或安慰剂刺激(n=19)。32名参与者(18名real和14名安慰剂)完成了6个月的治疗。在治疗前(平均值±标准偏差;Real:1.02±0.62,Sham:1.02±0.57,p值=1.00)和治疗期间(Real:0.90±0.55,Sham:0.94±0.55,p值=0.83),两组之间的MPR没有统计学上的显着差异。次要临床终点的结果表明,该治疗是可行和安全的,遵守tSMS高。两组之间皮质脊髓输出的变化没有显着差异。在18个月的长期随访结束时,与安慰剂组患者相比,真实组患者无气管造口术生存率显著提高(风险比=0.2795%置信区间0.09~0.80,p值=0.019).
■tSMS在6个月的治疗期间没有改变疾病进展。然而,长期随访显示,在更大和更长时间的研究中,支持tSMS评估的真实刺激治疗患者的无气管造口生存率显著提高.
■\"Fondazione\''NicolaIrti\'每一个人的艺术/文化”,罗马,意大利,支持本研究。
UNASSIGNED: Enhanced glutamatergic transmission leading to motor neuron death is considered the major pathophysiological mechanism of amyotrophic lateral sclerosis (ALS). Motor cortex excitability can be suppressed by transcranial static magnetic stimulation (tSMS), thus tSMS can be evaluated as a potential treatment for ALS. The aim of present study was to investigate the efficacy and safety of tSMS in ALS.
UNASSIGNED: In this phase 2 trial, we randomly assigned ALS patients to receive daily tSMS or placebo stimulation over a period of 6 months. For each participant we calculated mean disease monthly progression rate (MPR) as the variation of the total ALS Functional Rating Scale-Revised (ALSRFS-R) score, before the beginning of the treatment (over a period of at least three months) and over the six-month treatment period. The primary efficacy outcome was the difference in MPR before and after the beginning of treatment. Secondary outcomes included safety and tolerability, compliance, and changes in corticospinal output. A long-term follow-up of 18 months was performed in all patients who completed the six-month treatment considering a composite endpoint event (tracheostomy or death). Trial registered at ClinicalTrials.gov, ID: NCT04393467, status: closed.
UNASSIGNED: Forty participants were randomly assigned to real (n = 21) or placebo stimulation (n = 19). Thirty-two participants (18 real and 14 placebo) completed the 6-month treatment. The MPR did not show statistically significant differences between the two arms during the pre-treatment (mean ± Standard deviation; Real: 1.02 ± 0.62, Sham: 1.02 ± 0.57, p-value = 1.00) and treatment period (Real: 0.90 ± 0.55, Sham: 0.94 ± 0.55, p-value = 0.83). Results for secondary clinical endpoints showed that the treatment is feasible and safe, being compliance with tSMS high. The change in corticospinal output did not differ significantly between the two groups. At the end of the long-term follow-up of 18 months, patients of real group had a statistically significant higher tracheostomy-free survival compared with patients of placebo group (Hazard Ratio = 0.27 95% Confidence interval 0.09-0.80, p-value = 0.019).
UNASSIGNED: tSMS did not modify disease progression during the 6 months of treatment. However, long-term follow-up revealed a substantial increase in tracheostomy free survival in patients treated with real stimulation supporting the evaluation of tSMS in larger and more prolonged studies.
UNASSIGNED: The \"Fondazione \'Nicola Irti\' per le opere di carità e di cultura\", Rome, Italy, supported present study.