TMS as a Biomarker of Plasticity in Aphasia Recovery

TMS 作为失语症恢复可塑性的生物标志物

• 批准号: 9304199
• 负责人: Roy H Hamilton
• 金额: $ 32.44万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9304199
• 关键词: Achievement; Affect; Aphasia; Attenuated; Behavior; Behavioral; Biological Markers; Brain; Brain Injuries; Brain-Derived Neurotrophic Factor; Broca Aphasia; Chronic; Clinical; Development; Equipment; Exhibits; Foundations; Future; Genetic Polymorphism; Goals; Individual; Individual Differences; Intervention; Investigation; Knowledge; Language; Language Disorders; Language Therapy; Lead; Lesion; Location; Magnetism; Matched Group; Measures; Mediating; Methods; Middle Inferior Frontal Convolution; Modeling; Motor; Motor Cortex; Motor Evoked Potentials; Names; Nature; Neuronal Plasticity; Neurons; Neurophysiology - biologic function; Outcome; Patients; Performance; Phase; Physiological; Physiology; Plasticizers; Positioning Attribute; Property; Protocols documentation; Recovery; Recovery of Function; Rehabilitation therapy; Severities; Source; Statistical Models; Stratification; Stroke; System; Technology; Testing; Therapeutic; Time; Transcranial magnetic stimulation; Treatment outcome; Work; acute stroke; aphasia recovery; aphasic; base; cognitive function; disability; experience; follow-up; improved; indexing; language processing; nervous system disorder; neurophysiology; outcome prediction; patient population; post stroke; predictive marker; predictive modeling; prognostic; public health relevance; relating to nervous system; response; stroke recovery; success; therapy development; therapy outcome; tool

DESCRIPTION (provided by applicant): The central objective of this application is to explore trans- cranial magnetic stimulation (TMS) as a potential tool for assessing neuroplasticity in the language system, and to explore the utility of this technology as a biomarker for functional recovery in patients with aphasia after stroke. Aphasia affects approximately one third of acute stroke patients and is a common and often devastating source of persistent disability. Long-term aphasia recovery is highly variable and is understood to depend largely on the brain's potential for plastic reorganization of language processing. However, to date, no physiologic measures of neuroplasticity have been incorporated into the assessment of patients with post- stroke aphasia. TMS is a form of noninvasive brain stimulation that has been used to induce focal reversible changes in neural function, including language processing. The behavioral and neurophysiologic effects of TMS reflect the responsiveness of the cortex and are driven by well-recognized mechanisms of plasticity. These effects could therefore potentially be employed as indices of the neuroplastic capacity in the brain. The first specific aim of the proposed project i to determine whether TMS-induced changes in naming performance correlate with long-term recovery from chronic aphasia. Having developed a statistical model that predicts chronic aphasia severity, we will operationally define differences in language plasticity in terms of whether patients perform better than accounted for by the model (high plasticity) or worse (low plasticity). Using a TMS protocol similar to one that we have already shown can transiently facilitate naming ability in patients with chronic nonfluent aphasia; we predict that the degree of transient TMS-induced enhancement in naming will be greater in the high plasticity group of subjects than in the low plasticity group. The second specific aim of the proposed project is to determine whether a sensitive TMS measure of motor physiology can be employed to assess plasticity in patients with chronic nonfluent aphasia. To achieve this aim, we will again employ our statistical model of aphasia recovery to determine whether patients with high language plasticity exhibit a greater effect of TMS on measures of motor physiology than low plasticity patients. The final aim will explore of the feasibility of employing these TMS measures in patients with sub-acute stroke and aphasia, and will determine whether these measures are robust and reliable in this patient population. Achievement of the aims of this project will greatl expand knowledge about the nature of plasticity in language systems. Importantly, development of a marker of language plasticity will also lay the foundation for improved prognostication of aphasia outcomes, more appropriate stratification of therapeutic language interventions, and the further development of treatments aimed at facilitating adaptive change in language systems.

描述（由申请人提供）：本申请的主要目的是探索经颅磁刺激（TMS）作为评估语言系统神经可塑性的潜在工具，并探索该技术作为卒中后失语症患者功能恢复的生物标志物的效用。失语症影响约三分之一的急性中风患者，是一种常见的，往往是毁灭性的持续性残疾的来源。长期失语症的恢复是高度可变的，并且被理解为在很大程度上取决于大脑对语言处理的可塑性重组的潜力。然而，到目前为止，还没有神经可塑性的生理指标被纳入中风后失语症患者的评估。经颅磁刺激是一种非侵入性脑刺激，已被用于诱导神经功能的局灶性可逆变化，包括语言处理。经颅磁刺激的行为和神经生理效应反映了皮层的反应性，并由公认的可塑性机制驱动。因此，这些影响可能被用作大脑神经可塑性能力的指标。该项目的第一个具体目标是确定TMS诱导的命名能力的变化是否与慢性失语症的长期恢复相关。在建立了一个预测慢性失语症严重程度的统计模型后，我们将从操作上定义语言可塑性的差异，即患者的表现是否优于模型（高可塑性）或更差（低可塑性）。使用类似于我们已经证明的TMS方案可以短暂促进慢性非流利性失语症患者的命名能力;我们预测， 在高可塑性组的受试者中，瞬时TMS诱导的命名增强将大于低可塑性组。该项目的第二个具体目标是确定是否可以采用敏感的TMS运动生理学测量来评估慢性非流利性失语症患者的可塑性。为了实现这一目标，我们将再次采用我们的统计模型失语症恢复，以确定是否具有高语言可塑性的患者表现出更大的影响TMS运动生理学的措施比低可塑性的患者。最终目的是探索在亚急性卒中和失语症患者中采用这些TMS措施的可行性，并确定这些措施在该患者人群中是否稳健可靠。该项目目标的实现将大大扩展对语言系统可塑性本质的认识。重要的是，语言可塑性标志物的开发也将为改善失语症结局的预测、更适当的语言治疗干预分层以及进一步开发旨在促进语言系统适应性变化的治疗奠定基础。

项目成果

Fields or flows? A comparative metaanalysis of transcranial magnetic and direct current stimulation to treat post-stroke aphasia.

• DOI: 10.3233/rnn-150616
• 发表时间: 2016
• 期刊: Restorative neurology and neuroscience
• 影响因子: 2.8
• 作者: P. Shah-Basak;R. Wurzman;Juliann B. Purcell;Felix Gervits;R. Hamilton