# Effects and mechanisms of theta burst stimulation targeting individualized pre-supplementary motor area for post-stroke aphasia: study protocol for a randomized controlled trial

## TL;DR

This study tests if personalized brain stimulation targeting a specific brain area improves language recovery after stroke.

## Contribution

The study introduces individualized theta burst stimulation targeting the pre-SMA for aphasia rehabilitation.

## Key findings

- Personalized pre-SMA stimulation may enhance language recovery in post-stroke aphasia.
- The study will identify neuroplastic changes linked to treatment response.
- Functional connectivity analysis will reveal brain network changes post-intervention.

## Abstract

Recent functional magnetic resonance imaging (fMRI) evidence suggests that pre-supplementary motor area (pre-SMA) activity supports language recovery in post-stroke aphasia (PSA). As a key hub within domain-general cognitive networks, the pre-SMA represents a promising target for individualized neuromodulation. While intermittent theta burst stimulation (iTBS) can enhance language recovery, its efficacy may be limited by generalized targeting strategies.

This study aims to investigate the efficacy of fMRI-guided, neuronavigated iTBS targeting the individualized pre-SMA for promoting language recovery in subacute PSA and to elucidate its underlying neural mechanisms via functional connectivity (FC) analysis.

In this single-center, randomized, double-blind, sham-controlled trial, 40 participants with early subacute PSA (1–3 months post-stroke) are allocated to receive either active or sham iTBS targeting the left or right pre-SMA, localized via individualized MRI mapping. Participants will undergo a 2-week intervention, with language and neuroimaging assessments conducted at baseline, immediately post-intervention, and at a 1-month follow-up. Primary outcome measures are the Western Aphasia Battery (WAB). Second outcomes measures will be including the Boston Naming Test (BNT), the Boston Diagnostic Aphasia Examination (BDAE), non-language cognitive assessment (NLCA), alongside functional connectivity analysis from resting-state fMRI.

We anticipate that this trial demonstrates the efficacy of individualized pre-SMA iTBS in improving language recovery in PSA. Furthermore, we expect to identify treatment-induced neuroplastic changes in functional and structural brain connectivity. The findings could establish a novel precision neuromodulation approach for aphasia rehabilitation by identifying patient-specific biomarkers of treatment response.

https://www.chictr.org.cn/, ChiCTR2500108996.