Aphasia, AcquiredNCT03292471
Effects of rTMS on Brain Activation in Aphasia
A study testing Transcranial Magnetic Stimulation in people with Aphasia, Acquired, run by VA Office of Research and Development at 1 site in United States.
Trial summary
This study will investigate the use of repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation method, to improve word-finding abilities in Veterans and non-Veterans with chronic language problems following stroke (aphasia). Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Aphasia, Acquired
- What is being tested?
- Transcranial Magnetic Stimulation
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 16 participants
- Where
- 1 siteUnited States
- Study dates
- 1 Jan 2018to 31 Dec 2019
- Phase
- Interventional
- Are there results?
- Yes, posted in the registrySummary in the doctors' view
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Aphasia due to unilateral left-hemisphere stroke
- Greater than 6 months post aphasia onset
- English as a first language
- No contraindications to MRI or TMS including:
- pregnancy
- presence of ferromagnetic substances in the head with the exception of dental fillings, stents or aneurysm clips documented to be MRI compatible
Show all 9Show fewer
- presence of any implanted devices including cardiac pacemaker, implanted cardiac defibrillator, insulin pump, cochlear implant, or drug infusion device
- history of epilepsy; use of medications that are known to lower seizure threshold
- severe claustrophobia
Who cannot join
- History for progressive neurological disease or premorbid language disorder
- Presence of severe motor speech disorder
- Drug or alcohol dependence, or significant mood or behavioral disorder that is not currently stable or medically managed
Trial locations and contacts
1 site in 1 country.
United States1 site
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
Pittsburgh, Pennsylvania, 15240
About this study
Official title: Immediate and Cumulative Effects of rTMS on Brain Activation in Chronic Aphasia
This study will investigate the use of repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation method, to improve word-finding abilities in Veterans and non-Veterans with chronic language problems following stroke (aphasia). Improving word-finding is important because word-finding difficulties are among the most common and debilitating consequences of aphasia. Although rTMS has shown promise as a treatment approach, not all individuals with aphasia show the same level of benefit. Specifically, this study will use functional magnetic resonance imaging (fMRI) to examine whether the likelihood of improved word-finding abilities following rTMS depends on pre-intervention language-related brain activity and will examine changes in brain activity in response to stimulation. A better understanding of how and for whom rTMS works will 1) help to identify the best candidates for rTMS treatment, 2) optimize rTMS treatment protocols to improve patient outcomes, and 3) improve the investigators' understanding of how the brain re-organizes language functions following stroke.
Read the detailed description
Aphasia, an acquired communication disorder, is a common consequence of left-hemisphere stroke. Persisting, or chronic, aphasia negatively impacts not only interpersonal communication but participation in activities of daily living, independence, and autonomy. It is also associated with higher rates of depression and lower quality of life. Therefore, examining factors and treatments that result in the best possible recovery of language function for individuals with chronic aphasia is of paramount importance.
An intervention approach that has shown promise in early-phase research on treatment of chronic aphasia is repetitive transcranial magnetic stimulation (rTMS). rTMS is a non-invasive brain stimulation technique that can be used to focally modulate activity in targeted brain regions. Studies have shown that multiple sessions of 1Hz inhibitory rTMS applied to the right hemisphere Pars Triangularis (PTr) of people with chronic aphasia results in improved naming abilities. These improvements accrue over time, and may persist even after rTMS has ended. It has been proposed that rTMS induces this improvement by reducing the disruptive influence of compensatory activity in the right hemisphere PTr, allowing for recruitment of more efficient left hemisphere peri-lesional brain areas. However, existing neuroimaging evidence to support this hypothesis is insufficient.
The goal of the proposed study is to investigate the neurological mechanisms underlying the effect of rTMS on naming performance in chronic aphasia. This will extend existing knowledge regarding hemispheric contributions to language recovery following stroke and elucidate how rTMS-induced neuroplasticity can be co-opted to encourage optimal reorganization. The study will also investigate a potential source of individual response variability to rTMS, one which can inform both candidate selection and optimal stimulation parameters. Sixteen participants will be enrolled, yielding a significantly larger sample size than previous studies that have examined changes in functional brain activation in response to rTMS (n = 1, 2).
All participants will receive a sequence of 1200 pulses of 1 Hz rTMS to right hemisphere PTr across 10 daily sessions. Half of the participants will also receive a 6 Hz rTMS excitatory priming pulse sequence immediately prior to the 1 Hz sequence. This priming sequence ensures a consistent inhibitory response to the subsequent 1Hz rTMS and will permit an examination of state-dependent individual response variability.
To evaluate the effect of rTMS over time, participants will undergo functional magnetic resonance (fMRI) scans at four time points: prior to initiation of rTMS ("baseline"), immediately following the first rTMS session ("post-rTMS"), following the conclusion of the rTMS series ("post-treatment") and at a 2-month follow-up visit. During the scans, participants will be asked to name pictures, and both patterns of regional naming-related activation and effective connectivity (directional causal influence between activated brain regions) will be evaluated at each time point. In addition, naming performance will be measured via standardized assessments at baseline, post-treatment, and follow-up.
Changes in naming performance will be assessed over time, as a measure of rTMS effectiveness overall and between groups (priming sequence vs no priming sequence). In addition, changes in activation and effective connectivity will be correlated with naming improvement to assess the relative effectiveness of right hemisphere recruitment compared to left hemisphere peri-lesional recruitment. Overall increases in left hemisphere recruitment are hypothesized to result in greater improvements. However, the magnitude of left hemisphere recruitment due to rTMS is expected to depend on baseline levels of right hemisphere PTr activity.
Results from this study will significantly improve the investigator's understanding of the effects of rTMS on stroke recovery. The results will also inform future studies evaluating rTMS as an adjunct to behavioral speech-language intervention, augmenting therapeutic gains from traditional aphasia treatment.
- Conditions
- Aphasia, Acquired
- Being tested
- Transcranial Magnetic Stimulation
- Keywords
- Aphasia, Rehabilitation, Stroke
- Medical subject headings
- Aphasia, Stroke
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Transcranial Magnetic StimulationDevice
Also called rTMS
rTMS is a non-invasive brain stimulation technique in which a focal, time-varying magnetic field is applied to a specific brain area to induce neuronal depolarization. rTMS can be used to selectively target a given brain region with a resolution as focal as 0.5 cm3 .Typically, administering a slow (1 Hz) sequence of magnetic pulses via rTMS temporarily reduces cortical excitability in the targeted brain region.
| Study group | Role | What they receive |
|---|---|---|
| Inhibitory only | Experimental | Inhibitory 1Hz rTMS will be applied continuously for 1200 pulses (20 minutes) 5 days per week across 2 weeks (10 sessions total). Receives: Device: Transcranial Magnetic Stimulation |
| Excitatory primed | Experimental | The inhibitory sequence described above will be preceded for each session by priming stimulation which will consist of intermittent 6-Hz rTMS applied in 5 second trains with 25 second intervals between trains for a total 600 pulses (10 minutes). Receives: Device: Transcranial Magnetic Stimulation |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Philadelphia Naming Test (PNT) Performance
The Philadelphia Naming Test is a performance-based measure commonly used to assess naming (word production) ability among adults with aphasia. The minimum raw score is 0 and the maximum is 175 (higher scores reflect more accurate naming/better naming ability).
Measured: Pre- to post treatment (an average of 3 weeks), and at 2 month follow-up
Secondary outcomes (1)
Change in Comprehensive Aphasia Test (CAT) Performance
The Comprehensive Aphasia Test is a performance-based measure of language processing across multiple language domains commonly used to assess language-processing ability among adults with aphasia. CAT mean modality T-Score (average of all language subscale T-scores of the Comprehensive Aphasia Test) is a measure of overall aphasia severity. A T-score of 50 reflects mean performance for the CAT normative sample of individuals with aphasia, with a standard deviation of 10 (higher scores reflect better performance/less severe aphasia).
Measured: Pre- to post treatment (an average of 3 weeks), and at 2 month follow-up
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted25 Sep 2017
- Study start1 Jan 2018
- Primary completion31 Dec 2019
- Study completion31 Dec 2019
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Posted resultsParticipant flow, outcome measures and adverse events reported by the sponsor.
- Other trials for Aphasia, AcquiredStudies of the same condition, open and under way.
- More trials run by VA Office of Research and DevelopmentThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants will be assigned to receive 10 sessions of inhibitory rTMS to right hemisphere pars triangularis (RH PTr), either preceded by a 6 Hz priming rTMS stimulation sequence or not.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 16 participants (actual)
Sponsor and investigators
- Lead sponsor
- VA Office of Research and Development
- Sponsor type
- US federal agency
- Responsible party
- Sponsor
- Investigators
- Michelle L. Gravier, PhD, Principal investigator, VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT03292471
- Sponsor's protocol ID
- B2566-P
- Other IDs
- I21RX002566-01A1
- Status last verified
- Dec 2022
- First submitted
- 8 Sep 2017
- Last updated
- 20 Dec 2022
- Results posted
- Yes, on ClinicalTrials.gov
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- Yes
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 20 Dec 2022. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Immediate and Cumulative Effects of rTMS on Brain Activation in Chronic Aphasia
- ClinicalTrials.gov ID
- NCT03292471
- Acronym / sponsor ID
- B2566-P
- Conditions
- Aphasia, Acquired
- Keywords
- Aphasia, Rehabilitation, Stroke
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 16 participants (actual)
- Lead sponsor
- VA Office of Research and DevelopmentUS federal agency
- Study start
- 1 Jan 2018 (actual)
- Primary completion
- 31 Dec 2019 (actual)
- Study completion
- 31 Dec 2019 (actual)
- First posted
- 25 Sep 2017 (actual)
- Results
- Posted 21 Jan 2022
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study will investigate the use of repetitive transcranial magnetic stimulation (rTMS), a non-invasive brain stimulation method, to improve word-finding abilities in Veterans and non-Veterans with chronic language problems following stroke (aphasia). Improving word-finding is important because word-finding difficulties are among the most common and debilitating consequences of aphasia. Although rTMS has shown promise as a treatment approach, not all individuals with aphasia show the same level of benefit. Specifically, this study will use functional magnetic resonance imaging (fMRI) to examine whether the likelihood of improved word-finding abilities following rTMS depends on pre-intervention language-related brain activity and will examine changes in brain activity in response to stimulation. A better understanding of how and for whom rTMS works will 1) help to identify the best candidates for rTMS treatment, 2) optimize rTMS treatment protocols to improve patient outcomes, and 3) improve the investigators' understanding of how the brain re-organizes language functions following stroke.
Detailed description
Aphasia, an acquired communication disorder, is a common consequence of left-hemisphere stroke. Persisting, or chronic, aphasia negatively impacts not only interpersonal communication but participation in activities of daily living, independence, and autonomy. It is also associated with higher rates of depression and lower quality of life. Therefore, examining factors and treatments that result in the best possible recovery of language function for individuals with chronic aphasia is of paramount importance.
An intervention approach that has shown promise in early-phase research on treatment of chronic aphasia is repetitive transcranial magnetic stimulation (rTMS). rTMS is a non-invasive brain stimulation technique that can be used to focally modulate activity in targeted brain regions. Studies have shown that multiple sessions of 1Hz inhibitory rTMS applied to the right hemisphere Pars Triangularis (PTr) of people with chronic aphasia results in improved naming abilities. These improvements accrue over time, and may persist even after rTMS has ended. It has been proposed that rTMS induces this improvement by reducing the disruptive influence of compensatory activity in the right hemisphere PTr, allowing for recruitment of more efficient left hemisphere peri-lesional brain areas. However, existing neuroimaging evidence to support this hypothesis is insufficient.
The goal of the proposed study is to investigate the neurological mechanisms underlying the effect of rTMS on naming performance in chronic aphasia. This will extend existing knowledge regarding hemispheric contributions to language recovery following stroke and elucidate how rTMS-induced neuroplasticity can be co-opted to encourage optimal reorganization. The study will also investigate a potential source of individual response variability to rTMS, one which can inform both candidate selection and optimal stimulation parameters. Sixteen participants will be enrolled, yielding a significantly larger sample size than previous studies that have examined changes in functional brain activation in response to rTMS (n = 1, 2).
All participants will receive a sequence of 1200 pulses of 1 Hz rTMS to right hemisphere PTr across 10 daily sessions. Half of the participants will also receive a 6 Hz rTMS excitatory priming pulse sequence immediately prior to the 1 Hz sequence. This priming sequence ensures a consistent inhibitory response to the subsequent 1Hz rTMS and will permit an examination of state-dependent individual response variability.
To evaluate the effect of rTMS over time, participants will undergo functional magnetic resonance (fMRI) scans at four time points: prior to initiation of rTMS ("baseline"), immediately following the first rTMS session ("post-rTMS"), following the conclusion of the rTMS series ("post-treatment") and at a 2-month follow-up visit. During the scans, participants will be asked to name pictures, and both patterns of regional naming-related activation and effective connectivity (directional causal influence between activated brain regions) will be evaluated at each time point. In addition, naming performance will be measured via standardized assessments at baseline, post-treatment, and follow-up.
Changes in naming performance will be assessed over time, as a measure of rTMS effectiveness overall and between groups (priming sequence vs no priming sequence). In addition, changes in activation and effective connectivity will be correlated with naming improvement to assess the relative effectiveness of right hemisphere recruitment compared to left hemisphere peri-lesional recruitment. Overall increases in left hemisphere recruitment are hypothesized to result in greater improvements. However, the magnitude of left hemisphere recruitment due to rTMS is expected to depend on baseline levels of right hemisphere PTr activity.
Results from this study will significantly improve the investigator's understanding of the effects of rTMS on stroke recovery. The results will also inform future studies evaluating rTMS as an adjunct to behavioral speech-language intervention, augmenting therapeutic gains from traditional aphasia treatment.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- Participants will be assigned to receive 10 sessions of inhibitory rTMS to right hemisphere pars triangularis (RH PTr), either preceded by a 6 Hz priming rTMS stimulation sequence or not.
| Arm | Type | Receives |
|---|---|---|
| Inhibitory only | Experimental | Device: Transcranial Magnetic StimulationInhibitory 1Hz rTMS will be applied continuously for 1200 pulses (20 minutes) 5 days per week across 2 weeks (10 sessions total). |
| Excitatory primed | Experimental | Device: Transcranial Magnetic StimulationThe inhibitory sequence described above will be preceded for each session by priming stimulation which will consist of intermittent 6-Hz rTMS applied in 5 second trains with 25 second intervals between trains for a total 600 pulses (10 minutes). |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (9 listed)
- Aphasia due to unilateral left-hemisphere stroke
- Greater than 6 months post aphasia onset
- English as a first language
- No contraindications to MRI or TMS including:
Key exclusion criteria (3 listed)
- History for progressive neurological disease or premorbid language disorder
- Presence of severe motor speech disorder
- Drug or alcohol dependence, or significant mood or behavioral disorder that is not currently stable or medically managed
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Transcranial Magnetic StimulationAlso: rTMSrTMS is a non-invasive brain stimulation technique in which a focal, time-varying magnetic field is applied to a specific brain area to induce neuronal depolarization. rTMS can be used to selectively target a given brain region with a resolution as focal as 0.5 cm3 .Typically, administering a slow (1 Hz) sequence of magnetic pulses via rTMS temporarily reduces cortical excitability in the targeted brain region. | Device | Excitatory primed, Inhibitory only |
Primary outcome
Change in Philadelphia Naming Test (PNT) Performance
Time frame: Pre- to post treatment (an average of 3 weeks), and at 2 month follow-up
The Philadelphia Naming Test is a performance-based measure commonly used to assess naming (word production) ability among adults with aphasia. The minimum raw score is 0 and the maximum is 175 (higher scores reflect more accurate naming/better naming ability).
1 secondary outcome
Change in Comprehensive Aphasia Test (CAT) Performance
Time frame: Pre- to post treatment (an average of 3 weeks), and at 2 month follow-up
Results and safety
Loading the posted results from ClinicalTrials.gov…
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 20 Dec 2022.
- Posted resultsParticipant flow, baseline, all outcome measures and adverse events.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Michelle L. Gravier, PhD principal investigator
VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Transcranial Magnetic Stimulation in people with Aphasia, Acquired, run by VA Office of Research and Development at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 9 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 20 Dec 2022. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Yes. Results are posted in the registry (first posted 21 Jan 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Philadelphia Naming Test (PNT) Performance (time frame: Pre- to post treatment (an average of 3 weeks), and at 2 month follow-up). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Dec 2022.