Randomized controlled trial of theta burst stimulation modalities in severe post-stroke aphasia: examining the right...

This randomized controlled trial explores the therapeutic potential of theta burst stimulation, a form of transcranial magnetic stimulation, in treating severe post-stroke non-fluent aphasia, with a focus on the role of the right hemisphere. While traditional TMS protocols often target the left hemisphere or suppress the right hemisphere, emerging evidence suggests variability in treatment efficacy. Theta burst stimulation, a distinctive protocol within transcranial magnetic stimulation modalities. We compared intermittent theta burst stimulation (an excitatory protocol) and continuous theta burst stimulation (an inhibitory protocol) applied to the triangular region of the right inferior frontal gyrus against sham stimulation. All participants received daily personalized speech training alongside stimulation. Language function and quality of life were assessed using the Western Aphasia Battery and Stroke and Aphasia Quality of Life Scale, respectively. Results indicated that all groups showed improvements in language function and quality of life, but the intermittent theta burst stimulation group exhibited significantly greater gains in spontaneous speech, repetition, naming, and overall aphasia severity compared to both continuous theta burst stimulation and sham groups. No significant differences were observed between continuous theta burst stimulation and sham groups. These findings suggest that excitatory stimulation of the right inferior frontal gyrus may enhance language recovery in severe non-fluent aphasia, potentially through compensatory mechanisms of the right hemisphere. This study contributes to refining neuromodulation strategies for post-stroke aphasia rehabilitation.