Targeted Transcranial Magnetic Stimulation to Improve Language and Speech in Patients With Primary Progressive Aphasia

"The SLT will consist of an online intervention performed through a web-based platform.~The SLT training of the SLT group will consist of 2 cycles of training lasting 1 (rest) + 5 (training) weeks, 3 times per week, 1 hour each session, separated by a 12-week washout period."

Stimulation of DLPFC; rTMS will be administered as high-frequency (20Hz) in 2 second trains (40 pulses per train) with an inter-train interval of 22 seconds for a total of 50 trains (2000 pulses per session) at 120% of the patient's resting motor threshold. Patients will undergo an induction with 20-minutes rTMS protocol for 5 consecutive days, then they will start a maintenance phase where rTMS will be performed 3 days a week per 20 minutes preceding the SLT session, for a total of 20 sessions (of whom 15 combined with SLT).

The protocol will be the same as standard STIM. The site of stimulation will be defined using EEG/fMRI recordings of language tasks (syntax production for nfvPPA; silent naming for svPPA and lvPPA) to evidence the areas of higher activation/connectivity of the language network. We will define the area of higher fMRI activation; then, we will use fMRI-EEG connectivity and spectral activity to select the site of stimulation, among the areas with the highest fMRI activation and the highest Beta/Gamma frequencies.

Patients of the SLT + STIM (standard rTMS + targeted rTMS) will firstly undergo the standard rTMS in the first 6 week of training after the baseline visit

Patients of the SLT + STIM (targeted rTMS + standard rTMS) will secondly undergo the standard rTMS after 12 week washout period

Patients of the SLT + STIM (targeted rTMS + standardTMS) will firstly undergo the targeted rTMS in the first 6 weeks of training after the baseline visit

Patients of the SLT + STIM (standard rTMS + targeted rTMS) will secondly undergo the targeted rTMS after 12 week washout period