Transcranial Magnetic Stimulation for Aphasia: Efficacy and Neural Basis

项目摘要 经颅磁刺激（TMS）已被证明可以改善语言功能 在一些小型研究中，慢性失语症患者中， 对照组虽然治疗似乎有希望，但迄今为止的数据不允许 充分评估该技术的实用性。我们建议研究经颅磁刺激的作用 结合约束诱导语言治疗（CILT）在75例慢性 失语症受试者将以2：1的比例随机分配至TMS + CILT组或假TMS + CILT组。 将在90%运动阈值下向右侧额下回输送1 Hz TMS，持续20 在2周内10次会议中进行10分钟的语言治疗;将提供1小时的语言治疗 每次TMS会议结束后立即举行。西方国家较基线的变化 TMS治疗结束后6个月的失语症成套失语症商数将作为 主要结果测量。第二个目的是确定解剖学和行为学上的预测因子， 对治疗的反应最后，第三个目标是确定有利的潜在机制， 使用各种成像技术的治疗效果。受试者没有 MRI禁忌症患者将在治疗前和治疗后6个月接受fMRI成像。 使用现代网络分析和强大的机器学习技术，我们将识别 语言网络中节点之间连接强度的变化， 关于TMS和CILT对大脑组织影响的具体假设， 与对治疗的有益反应有关。

PROJECT SUMMARY Transcranial Magnetic Stimulation (TMS) has been demonstrated to improve language function in subjects with chronic aphasia in a number of small studies, many of which did not include a control group. Although the treatment appears promising, data to date do not permit an adequate assessment of the utility of the technique. We propose to study the effects of TMS combined with Constraint Induced Language Therapy (CILT) in 75 subjects with chronic aphasia. Subjects will be randomized in a 2:1 ratio to TMS with CILT or sham TMS with CILT. One Hz TMS at 90% motor threshold will be delivered to the right inferior frontal gyrus for 20 minutes in 10 sessions over 2 weeks; language therapy will be provided for one hour immediately after the conclusion of each session of TMS. Change from baseline in the Western Aphasia Battery Aphasia Quotient at 6 months after the end of TMS treatment will serve as the primary outcome measure. A secondary aim is to identify anatomic and behavioral predictors of response to treatment. Finally, a third aim is to identify the mechanism underlying the beneficial effect of the treatment using a variety of imaging techniques. Subjects who have no contraindication to the MRI will undergo fMRI imaging prior to and at 6 months after therapy. Using modern network analyses and robust machine learning techniques we will identify changes in the strengths of connections between nodes in the language network to address specific hypotheses regarding the effects of TMS and CILT on brain organization that are associated with beneficial response to treatment.