Personalized functional imaging-guided rTMS on the superior frontal gyrus for post-stroke aphasia: A randomized sham-controlled trial

Jianxun Ren; Weijing Ren; Ying Zhou; Louisa Dahmani; Xinyu Duan; Xiaoxuan Fu; Yezhe Wang; Ruiqi Pan; Jingdu Zhao; Ping Zhang; Bo Wang; Weiyong Yu; Zhenbo Chen; Xin Zhang; Jian Sun; Mengying Ding; Jianting Huang; Liu Xu; Shiyi Li; Weiwei Wang; Wuxiang Xie; Hao Zhang; Hesheng Liu

doi:10.1016/j.brs.2023.08.023

Personalized functional imaging-guided rTMS on the superior frontal gyrus for post-stroke aphasia: A randomized sham-controlled trial

Brain Stimul. 2023 Sep-Oct;16(5):1313-1321. doi: 10.1016/j.brs.2023.08.023. Epub 2023 Aug 29.

Authors

Jianxun Ren¹, Weijing Ren², Ying Zhou¹, Louisa Dahmani³, Xinyu Duan¹, Xiaoxuan Fu⁴, Yezhe Wang¹, Ruiqi Pan⁵, Jingdu Zhao⁶, Ping Zhang¹, Bo Wang⁷, Weiyong Yu⁸, Zhenbo Chen⁸, Xin Zhang⁶, Jian Sun⁵, Mengying Ding⁵, Jianting Huang⁹, Liu Xu¹⁰, Shiyi Li¹, Weiwei Wang⁵, Wuxiang Xie¹¹, Hao Zhang¹², Hesheng Liu¹³

Affiliations

¹ Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China.
² Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China; University of Health and Rehabilitation Sciences, Qingdao, Shandong, 266000, China.
³ Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
⁴ Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
⁵ Neural Galaxy Inc., Beijing, 102206, China.
⁶ Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China.
⁷ Department of Hearing and Language Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China.
⁸ Department of Radiology, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China.
⁹ Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Biomedical Pioneering Innovation Center (BIOPIC), Peking University, Beijing, 100871, China.
¹⁰ Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; West China Medical School, Sichuan University, Chengdu, 610041, China.
¹¹ Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, 100191, China.
¹² Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China; University of Health and Rehabilitation Sciences, Qingdao, Shandong, 266000, China; Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250100, China. Electronic address: zhanghao@crrc.com.cn.
¹³ Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China; Biomedical Pioneering Innovation Center (BIOPIC), Peking University, Beijing, 100871, China. Electronic address: hesheng@biopic.pku.edu.cn.

PMID: 37652135
DOI: 10.1016/j.brs.2023.08.023

Abstract

Background: Aphasia affects approximately one-third of stroke patients and yet its rehabilitation outcomes are often unsatisfactory. More effective strategies are needed to promote recovery.

Objective: We aimed to examine the efficacy and safety of the theta-burst stimulation (TBS) on the language area in the superior frontal gyrus (SFG) localized by personalized functional imaging, in facilitating post-stroke aphasia recovery.

Methods: This randomized sham-controlled trial uses a parallel design (intermittent TBS [iTBS] in ipsilesional hemisphere vs. continuous TBS [cTBS] in contralesional hemisphere vs. sham group). Participants had aphasia symptoms resulting from their first stroke in the left hemisphere at least one month prior. Participants received three-week speech-language therapy coupled with either active or sham stimulation applied to the left or right SFG. The primary outcome was the change in Western Aphasia Battery-Revised (WAB-R) aphasia quotient after the three-week treatment. The secondary outcome was WAB-R aphasia quotient improvement after one week of treatment.

Results: Ninety-seven patients were screened between January 2021 and January 2022, 45 of whom were randomized and 44 received intervention (15 in each active group, 14 in sham). Both iTBS (estimated difference = 14.75, p < 0.001) and cTBS (estimated difference = 13.43, p < 0.001) groups showed significantly greater improvement than sham stimulation after the 3-week intervention and immediately after one week of treatment (p's < 0.001). The adverse events observed were similar across groups. A seizure was recorded three days after the termination of the treatment in the iTBS group.

Conclusion: The stimulation showed high efficacy and SFG is a promising stimulation target for post-stroke language recovery.

Keywords: Functional MRI; Functional parcellation; Individual difference; Personalized neuromodulation; Post-stroke aphasia; Transcranial magnetic stimulation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aphasia* / etiology
Aphasia* / therapy
Humans
Prefrontal Cortex
Stroke Rehabilitation*
Stroke* / therapy
Transcranial Magnetic Stimulation / methods
Treatment Outcome