{"title":"Cerebellar Theta-Burst Stimulation Induces Distinct Functional Connectivity Patterns in Post-Stroke Aphasia: A Randomized Controlled Trial.","authors":"Xin Wang, Xinlei Xu, Daoran Wang, Guilan Huang, Kai Zheng, Chengchen Chen, Dongdong Jiang, Fanglan Gao, Caili Ren, Zhiyong Zhao","doi":"10.1177/15459683261479722","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Objective: </strong>To determine whether inhibitory cTBS over rCrus I improves language recovery in PSA and to explore underlying functional connectivity (FC) mechanisms.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Both groups showed significant language improvement post-intervention. No significant interaction was found for WAB-AQ (<i>P</i> = .058), but a significant interaction was observed for repetition (<i>P</i> = .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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Trial registration: </strong>This trial was registered under the China Clinical Trial Registry (Registration No. ChiCTR2100049828).</p>","PeriodicalId":94158,"journal":{"name":"Neurorehabilitation and neural repair","volume":" ","pages":"15459683261479722"},"PeriodicalIF":3.7000,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurorehabilitation and neural repair","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15459683261479722","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Background: 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).
Objective: To determine whether inhibitory cTBS over rCrus I improves language recovery in PSA and to explore underlying functional connectivity (FC) mechanisms.
Methods: 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.
Results: 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.
Conclusions: 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.
Trial registration: This trial was registered under the China Clinical Trial Registry (Registration No. ChiCTR2100049828).
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