Intermittent Theta Burst Stimulation Tbs For Treatment Of Chronic Post-Stroke Aphasia: Results Of A Pilot Randomized, Double-Blind, Sham-Controlled Trial

Background: Research indicates intermittent theta burst stimulation (iTBS) is a potential treatment of post-stroke aphasia.Material/Methods: In this double-blind, sham-controlled trial (NCT 01512264) participants were randomized to receive 3 weeks of sham (G(0)), 1 week of iTBS/2 weeks of sham (G(1)), 2 weeks of iTBS/1 week of sham (G(2)), or 3 weeks of iTBS (G). FMRI localized residual language function in the left hemisphere; iTBS was applied to the maximum fMRI activation in the residual language cortex in the left frontal lobe. FMRI and aphasia testing were conducted pretreatment, at <= 1 week after completing treatment, and at 3 months follow-up.Results: 27/36 participants completed the trial. We compared G(0) to each of the individual treatment group and to all iTBS treatment groups combined (G(1-3)). In individual groups, participants gained (of moderate or large effect sizes; some significant at P<0.05) on the Boston Naming Test (BNT), the Semantic Fluency Test (SFT), and the Aphasia Quotient of the Western Aphasia Battery-Revised (WAB-R AQ). In G(1-3), BNT, and SFT improved immediately after treatment, while the WAB-R AQ improved at 3 months. Compared to G(0), the other groups showed greater fMRI activation in both hemispheres and non-significant increases in language lateralization to the left hemisphere. Changes in IFG connectivity were noted with iTBS, showing differences between time-points, with some of them correlating with the behavioral measures.Conclusions: The results of this pilot trial support the hypothesis that iTBS applied to the ipsilesional hemisphere can im- prove aphasia and result in cortical plasticity.