Cerebellar Theta-Burst Stimulation Induces Distinct Functional Connectivity Patterns in Post-Stroke Aphasia: A Randomized Controlled Trial.
Recent studies have identified the right cerebellar Crus I (rCrus I) as a promising target for rTMS in improving language rehabilitation. However, it remains unclear whether continuous theta burst stimulation (cTBS) over the rCrus I improves language outcomes in patients with subacute post-stroke aphasia (PSA).
To determine whether inhibitory cTBS over rCrus I improves language recovery in PSA and to explore underlying functional connectivity (FC) mechanisms.
Fifty-one PSA patients were randomized to receive either real cTBS (n = 25) or sham stimulation (n = 26) over rCrus I (10 sessions, 2 weeks) combined with speech-language therapy (SLT). Language assessments (WAB-AQ, BNT, BDAE) and resting-state fMRI were conducted before and after the intervention.
Both groups showed significant language improvement post-intervention. No significant interaction was found for WAB-AQ (P = .058), but a significant interaction was observed for repetition (P = .034), favoring cTBS. Resting-state fMRI showed altered connectivity between rCrus I and right temporo-occipital regions, with FC changes negatively correlated with language gains in the cTBS group. Exploratory subgroup analyses identified 2 distinct FC response patterns (FC-increase and FC-decrease), indicating heterogeneous cerebello-cortical and intra-cerebellar connectivity modulation across participants.
Cerebellar cTBS did not confer a significant overall benefit on language recovery in PSA, but selectively improved repetition performance, suggesting domain-specific effects. Functional imaging indicated that rCrus I-centered connectivity changes were associated with behavioral outcomes, with marked inter-individual variability. These findings support a modulatory role of cerebellar cTBS on language networks, warranting further validation in larger, well-powered studies.
This trial was registered under the China Clinical Trial Registry (Registration No. ChiCTR2100049828).
To determine whether inhibitory cTBS over rCrus I improves language recovery in PSA and to explore underlying functional connectivity (FC) mechanisms.
Fifty-one PSA patients were randomized to receive either real cTBS (n = 25) or sham stimulation (n = 26) over rCrus I (10 sessions, 2 weeks) combined with speech-language therapy (SLT). Language assessments (WAB-AQ, BNT, BDAE) and resting-state fMRI were conducted before and after the intervention.
Both groups showed significant language improvement post-intervention. No significant interaction was found for WAB-AQ (P = .058), but a significant interaction was observed for repetition (P = .034), favoring cTBS. Resting-state fMRI showed altered connectivity between rCrus I and right temporo-occipital regions, with FC changes negatively correlated with language gains in the cTBS group. Exploratory subgroup analyses identified 2 distinct FC response patterns (FC-increase and FC-decrease), indicating heterogeneous cerebello-cortical and intra-cerebellar connectivity modulation across participants.
Cerebellar cTBS did not confer a significant overall benefit on language recovery in PSA, but selectively improved repetition performance, suggesting domain-specific effects. Functional imaging indicated that rCrus I-centered connectivity changes were associated with behavioral outcomes, with marked inter-individual variability. These findings support a modulatory role of cerebellar cTBS on language networks, warranting further validation in larger, well-powered studies.
This trial was registered under the China Clinical Trial Registry (Registration No. ChiCTR2100049828).
Authors
Wang Wang, Xu Xu, Wang Wang, Huang Huang, Zheng Zheng, Chen Chen, Jiang Jiang, Gao Gao, Ren Ren, Zhao Zhao
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