Transcranial Magnetic Stimulation for Aphasia: Efficacy and Neural Basis

项目总结 经颅磁刺激(TMS)已被证明可以改善语言功能 在慢性失语症受试者中进行了一些小型研究，其中许多研究没有包括 对照组。尽管这种治疗方法看起来很有希望，但到目前为止的数据还不允许 对该技术的实用性进行充分的评估。我们建议研究TMS的影响 联合强迫诱导语言疗法治疗慢性阻塞性肺疾病75例 失语症。受试者将以2：1的比例随机分为TMS加CILT组或假TMS加CILT组。 一次90%运动阈值的HzTMS将被送到右额下回20次 为期两周的10个疗程中的10分钟；将提供一小时的语言治疗 在每一次TMS会议结束后立即举行会议。改变西区的基线 失语症电池失语商在TMS治疗结束后6个月将作为 主要结果衡量标准。第二个目标是确定解剖学和行为学预测因素 对治疗的反应。最后，第三个目标是确定利益背后的机制 治疗效果采用多种影像技术。受试者没有 MRI禁忌症在治疗前和治疗后6个月进行功能磁共振成像。 使用现代网络分析和稳健的机器学习技术，我们将识别 语言网络中节点之间的连接强度的变化以解决 关于TMS和CILT对大脑组织影响的具体假设是 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.