V5/MT Stimulation on Reading and Reading-related Measures in Developmental Dyslexia

Developmental Dyslexia Clinical Trial

Official title:

Probing the Efficacy of V5/MT Stimulation on Reading and Reading-related Measures in Children and Adolescents With Developmental Dyslexia

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05972200
• Other study ID #: 3073_OPBG_2023
• Status: Recruiting
• Phase: N/A
• Start date: September 1, 2023
• Est. completion date: August 31, 2026

Study information

• Verified date: August 2023
• Source: Bambino Gesù Hospital and Research Institute
• Contact: Deny Menghini
• Phone: 06.6859.2875
• Email: deny.menghini[@]opbg.net
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The present study grounds on the absence of evidence-based treatment in individuals with developmental dyslexia (DD). At this topic, the present study will explore the potential effect of transcranial direct current stimulation (tDCS) over left hemispheric direct Lateral Geniculate Nucleus (LGN)-V5/MT pathway, cerebral areas usually disrupted in individuals with DD. The investigators hypothesized that active tDCS over V5/MT will boost reading skills in children and adolescents with DD. On the contrary, sham (placebo condition) tDCS over V5/MT or active (control condition) tDCS over V1 will not have significant effect in improving reading skills. Further, both active and sham tDCS will be safe and well tolerated.

Description:

Over the last few decades, a huge number of studies has revealed that Developmental Dyslexia (DD), a brain-based neurodevelopmental disorder characterized by a severe and persistent impairment in the acquisition of reading skills may depend on multiple neurocognitive impairments, ranging from language-specific to cognitive-general deficits. Besides the most influential hypothesis of a phonological core deficit, there is also evidence for difficulties in low-level visual-temporal information processing, as the magnocellular deficit theory supports, as well as for visual-spatial attentional deficits, visual-perceptual impairments, and rapid automatized naming (RAN)-speed deficits. Replicated structural/functional neuroimaging studies have demonstrated a DD hypoactivation relative to typical readers in the left temporo-occipital regions-critical for the automatic visual processing of word strings or print-and in the left temporo-parietal regions-important for grapheme-to-phoneme mapping. Moreover, findings from animal models and post mortem studies in humans suggest that DD might also be associated with structural alterations in subcortical sensory pathways, particularly in visual and auditory thalamic nuclei and in their connections with high-order sensory cortices (i.e., the left hemispheric direct Lateral Geniculate Nucleus (LGN)-V5/MT pathway and the left hemispheric direct Medial Geniculate Body (MGB)-mPT pathway). In addition, in adults with DD, left V5/MT-LGN connectivity strength correlated with RAN abilities - a key deficit in DD. A number of studies have demonstrated the positive effect of transcranial direct current stimulation (tDCS), a non-invasive brain stimulation used for transiently modifying neural activity of target areas, on reading and, particularly, in DD. However, the few non-invasive brain stimulation studies on improving reading in DD yielded heterogeneous results and this variability might be partly due to the lack of neurobiological understanding of the underlying DD mechanism or to the use of traditional tDCS rather than a more focal technique such as the high-definition tDCS (HD-tDCS). Starting from this, the aim of the current study is testing the effectiveness of a cutting-edge stimulation technique (i.e., HD-tDCS) in a within-subject experiment involving children and adolescents with DD. Especially, we will work to test i) the specific effect of HD-tDCS over high-order sensory cortices (i.e., V5/MT vs V1) on reading in children with DD; ii) the preconditions and neurobiological mechanisms that lead to high treatment outcomes. If the stimulation over V5/MT is effective and specifically related to reading improvement, our results could help to i) understand the contribution and neurobiological mechanism of V5/MT in reading of children and adolescents with DD; ii) select criteria for potential responders to non-invasive brain stimulation; iii) develop evidence-based interventions in DD.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 36
• Est. completion date: August 31, 2026
• Est. primary completion date: August 31, 2026
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 8 Years to 13 Years

Eligibility

Inclusion Criteria:

• Italian speakers right-handed children and adolescents with dyslexia (DSM-5, APA 2013);
• Word/nonword/text reading accuracy and/or speed at least 2 Standard Deviations below the mean for school-age;
• nv IQ = 85;
• normal hearing and normal or corrected-to-normal vision.

Exclusion Criteria:

• Having a comorbidity with other primary psychiatric/neurological diagnosis (e.g., depression, anxiety, autism, ADHD);
• Having a personal history of neurological/medical/genetic diseases;
• Having ongoing drug treatment influencing brain function;
• Having epilepsy o family history of epilepsy.

Related Conditions & MeSH terms

• Developmental Dyslexia
• Dyslexia

Intervention

Device:
• Active HD-tDCS over V5/MT
For HD-tDCS a 4 × 1 montage (Kessler et al., 2013), small circular electrodes (diameter 1 cm) will be used with the anode placed centrally with a current intensity of 1 mA for a total of 20 minutes (30 s ramp up/down). Hereby, the anodal electrode modulates the excitability of the targeted area left V5/MT, whereas the other 4 electrodes return electrical currents that flow away from that area. V5/MT will be localised via published procedures and electrode's placement will be done according to the 10-20 International EEG 10-20 System for electrode placement.
• Active HD-tDCS over V1
For HD-tDCS a 4 × 1 montage (Kessler et al., 2013), small circular electrodes (diameter 1 cm) will be used with the anode placed centrally with a current intensity of 1 mA for a total of 20 minutes (30 s ramp up/down). Hereby, the anodal electrode modulates the excitability of the targeted area left V1, whereas the other 4 electrodes return electrical currents that flow away from that area. V1 will be localised via published procedures and electrode's placement will be done according to the 10-20 International EEG 10-20 System for electrode placement.
• Sham HD-tDCS over V5/MT or V1
Sham HD-tDCS will be delivered over left V5/MT or left V1. The same electrodes placement as well as the stimulation set-up will be used as in the active stimulation conditions, but the current will be applied for 30 s and will be ramped down (0 mA) during the rest of the session without the participants awareness. .

Locations

Country	Name	City	State
Italy	Bambino Gesù Hospital and Research Institute	Roma

Sponsors (1)

Lead Sponsor	Collaborator
Bambino Gesù Hospital and Research Institute

Country where clinical trial is conducted

Italy, 

References & Publications (33)

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.): DSM 5. Washington, DC: American Psychiatric Association. 2013.

Battisti A, Lazzaro G, Costanzo F, Varuzza C, Rossi S, Vicari S, Menghini D. Effects of a short and intensive transcranial direct current stimulation treatment in children and adolescents with developmental dyslexia: A crossover clinical trial. Front Psyc — View Citation

Bosse ML, Tainturier MJ, Valdois S. Developmental dyslexia: the visual attention span deficit hypothesis. Cognition. 2007 Aug;104(2):198-230. doi: 10.1016/j.cognition.2006.05.009. Epub 2006 Jul 21. — View Citation

Bowers PG, Wolf, M. Theoretical links among naming speed, precise timing mechanisms and orthographic skill in dyslexia. Reading and Writing.1993; 51: 69-85.

Costanzo F, Rossi S, Varuzza C, Varvara P, Vicari S, Menghini D. Long-lasting improvement following tDCS treatment combined with a training for reading in children and adolescents with dyslexia. Neuropsychologia. 2019 Jul;130:38-43. doi: 10.1016/j.neurops — View Citation

Costanzo F, Varuzza C, Rossi S, Sdoia S, Varvara P, Oliveri M, Giacomo K, Vicari S, Menghini D. Evidence for reading improvement following tDCS treatment in children and adolescents with Dyslexia. Restor Neurol Neurosci. 2016;34(2):215-26. doi: 10.3233/RN — View Citation

Costanzo F, Varuzza C, Rossi S, Sdoia S, Varvara P, Oliveri M, Koch G, Vicari S, Menghini D. Reading changes in children and adolescents with dyslexia after transcranial direct current stimulation. Neuroreport. 2016 Mar 23;27(5):295-300. doi: 10.1097/WNR. — View Citation

Franceschini S, Gori S, Ruffino M, Pedrolli K, Facoetti A. A causal link between visual spatial attention and reading acquisition. Curr Biol. 2012 May 8;22(9):814-9. doi: 10.1016/j.cub.2012.03.013. Epub 2012 Apr 5. — View Citation

Galaburda AM, Menard MT, Rosen GD. Evidence for aberrant auditory anatomy in developmental dyslexia. Proc Natl Acad Sci U S A. 1994 Aug 16;91(17):8010-3. doi: 10.1073/pnas.91.17.8010. — View Citation

Giovagnoli G, Vicari S, Tomassetti S, Menghini D. The Role of Visual-Spatial Abilities in Dyslexia: Age Differences in Children's Reading? Front Psychol. 2016 Dec 21;7:1997. doi: 10.3389/fpsyg.2016.01997. eCollection 2016. — View Citation

Giraldo-Chica M, Hegarty JP 2nd, Schneider KA. Morphological differences in the lateral geniculate nucleus associated with dyslexia. Neuroimage Clin. 2015 Mar 20;7:830-6. doi: 10.1016/j.nicl.2015.03.011. eCollection 2015. — View Citation

Heth I, Lavidor M. Improved reading measures in adults with dyslexia following transcranial direct current stimulation treatment. Neuropsychologia. 2015 Apr;70:107-13. doi: 10.1016/j.neuropsychologia.2015.02.022. Epub 2015 Feb 19. — View Citation

Kirimoto H, Ogata K, Onishi H, Oyama M, Goto Y, Tobimatsu S. Transcranial direct current stimulation over the motor association cortex induces plastic changes in ipsilateral primary motor and somatosensory cortices. Clin Neurophysiol. 2011 Apr;122(4):777- — View Citation

Lazzaro G, Costanzo F, Varuzza C, Rossi S, De Matteis ME, Vicari S, Menghini D. Individual differences modulate the effects of tDCS on reading in children and adolescents with dyslexia. Scientific Studies of Reading. 2021; 25(6): 1-17.

Lazzaro G, Costanzo F, Varuzza C, Rossi S, Vicari S, Menghini D. Effects of a short, intensive, multi-session tDCS treatment in developmental dyslexia: Preliminary results of a sham-controlled randomized clinical trial. Prog Brain Res. 2021;264:191-210. d — View Citation

Livingstone MS, Rosen GD, Drislane FW, Galaburda AM. Physiological and anatomical evidence for a magnocellular defect in developmental dyslexia. Proc Natl Acad Sci U S A. 1991 Sep 15;88(18):7943-7. doi: 10.1073/pnas.88.18.7943. Erratum In: Proc Natl Acad — View Citation

Melby-Lervag M, Lyster SA, Hulme C. Phonological skills and their role in learning to read: a meta-analytic review. Psychol Bull. 2012 Mar;138(2):322-52. doi: 10.1037/a0026744. Epub 2012 Jan 16. — View Citation

Menghini D, Finzi A, Benassi M, Bolzani R, Facoetti A, Giovagnoli S, Ruffino M, Vicari S. Different underlying neurocognitive deficits in developmental dyslexia: a comparative study. Neuropsychologia. 2010 Mar;48(4):863-72. doi: 10.1016/j.neuropsychologia — View Citation

Muller-Axt C, Anwander A, von Kriegstein K. Altered Structural Connectivity of the Left Visual Thalamus in Developmental Dyslexia. Curr Biol. 2017 Dec 4;27(23):3692-3698.e4. doi: 10.1016/j.cub.2017.10.034. Epub 2017 Nov 16. — View Citation

Richlan F, Kronbichler M, Wimmer H. Meta-analyzing brain dysfunctions in dyslexic children and adults. Neuroimage. 2011 Jun 1;56(3):1735-42. doi: 10.1016/j.neuroimage.2011.02.040. Epub 2011 Feb 19. — View Citation

Richlan F. Developmental dyslexia: dysfunction of a left hemisphere reading network. Front Hum Neurosci. 2012 May 1;6:120. doi: 10.3389/fnhum.2012.00120. eCollection 2012. — View Citation

Rios DM, Correia Rios M, Bandeira ID, Queiros Campbell F, de Carvalho Vaz D, Lucena R. Impact of Transcranial Direct Current Stimulation on Reading Skills of Children and Adolescents With Dyslexia. Child Neurol Open. 2018 Oct 4;5:2329048X18798255. doi: 10 — View Citation

Schulte-Korne G, Bruder J. Clinical neurophysiology of visual and auditory processing in dyslexia: a review. Clin Neurophysiol. 2010 Nov;121(11):1794-809. doi: 10.1016/j.clinph.2010.04.028. Epub 2010 May 31. — View Citation

Snowling, M. Dyslexia, 2nd ed.; Blackwell Publishing: Oxford, UK. 2000.

Stenneken P, Egetemeir J, Schulte-Korne G, Muller HJ, Schneider WX, Finke K. Slow perceptual processing at the core of developmental dyslexia: a parameter-based assessment of visual attention. Neuropsychologia. 2011 Oct;49(12):3454-65. doi: 10.1016/j.neur — View Citation

Tschentscher N, Ruisinger A, Blank H, Diaz B, von Kriegstein K. Reduced Structural Connectivity Between Left Auditory Thalamus and the Motion-Sensitive Planum Temporale in Developmental Dyslexia. J Neurosci. 2019 Feb 27;39(9):1720-1732. doi: 10.1523/JNEUR — View Citation

Turkeltaub PE, Benson J, Hamilton RH, Datta A, Bikson M, Coslett HB. Left lateralizing transcranial direct current stimulation improves reading efficiency. Brain Stimul. 2012 Jul;5(3):201-207. doi: 10.1016/j.brs.2011.04.002. Epub 2011 May 5. — View Citation

Vellutino FR, Fletcher JM, Snowling MJ, Scanlon DM. Specific reading disability (dyslexia): what have we learned in the past four decades? J Child Psychol Psychiatry. 2004 Jan;45(1):2-40. doi: 10.1046/j.0021-9630.2003.00305.x. — View Citation

Vidyasagar TR, Pammer K. Dyslexia: a deficit in visuo-spatial attention, not in phonological processing. Trends Cogn Sci. 2010 Feb;14(2):57-63. doi: 10.1016/j.tics.2009.12.003. Epub 2010 Jan 14. — View Citation

Wang Z, Cheng-Lai A, Song Y, Cutting L, Jiang Y, Lin O, Meng X, Zhou X. A perceptual learning deficit in Chinese developmental dyslexia as revealed by visual texture discrimination training. Dyslexia. 2014 Aug;20(3):280-96. doi: 10.1002/dys.1475. Epub 201 — View Citation

Wolf M, Bowers PG. The double-deficit hypothesis for the developmental dyslexias. Journal of Educational Psychology. 1999; 91(3): 415-438.

Younger JW, Booth JR. Parietotemporal Stimulation Affects Acquisition of Novel Grapheme-Phoneme Mappings in Adult Readers. Front Hum Neurosci. 2018 Mar 23;12:109. doi: 10.3389/fnhum.2018.00109. eCollection 2018. — View Citation

Younger JW, Randazzo Wagner M, Booth JR. Weighing the Cost and Benefit of Transcranial Direct Current Stimulation on Different Reading Subskills. Front Neurosci. 2016 Jun 7;10:262. doi: 10.3389/fnins.2016.00262. eCollection 2016. — View Citation

* Note: There are 33 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Text reading accuracy (Experimental reading task)	Change in text reading accuracy from baseline compared after to Active HD-tDCS over V5/MT sessions than after Active HD-tDCS over V1 and Sham sessions. Text reading accuracy is considered as the percentage (%) of accuracy and computed as the ratio between the number of correctly read stimuli and the total number of stimuli presented multiplied by 100.; The time points will be pre- (baseline) vs post-stimulation session.	during procedure
Primary	Text reading speed (Experimental reading task)	Change in text reading speed from baseline compared to after Active HD-tDCS over V5/MT sessions than after Active HD-tDCS over V1 and Sham sessions. Text reading speed is considered as the syllables/seconds ratio and calculated dividing the total number of syllables pronounced by the total time spent to complete the reading (in seconds).; The time points will be pre- (baseline) vs post-stimulation session.	during procedure
Secondary	Word reading accuracy (Experimental reading task)	Change in word reading accuracy from baseline compared to after Active HD-tDCS over V5/MT sessions than after Active HD-tDCS over V1 and Sham sessions. Word reading accuracy is considered as the percentage (%) of accuracy and computed as the ratio between the number of correctly read stimuli and the total number of stimuli presented multiplied by 100.; The time points will be pre- (baseline) vs post-stimulation session.	during procedure
Secondary	Word reading speed (Experimental reading task)	Change in word reading speed from baseline compared to after Active HD-tDCS over V5/MT sessions than during Active HD-tDCS over V1 and Sham sessions. Word reading speed is considered as the syllables/seconds ratio and calculated dividing the total number of syllables pronounced by the total time spent to complete the reading (in seconds).; The time points will be pre- (baseline) vs post-stimulation session.	during procedure
Secondary	Non-word reading accuracy (Experimental reading task)	Change in non-word reading accuracy from baseline compared to after Active HD-tDCS over V5/MT sessions than after Active HD-tDCS over V1 and Sham sessions. Non-word reading accuracy is considered as the percentage (%) of accuracy and computed as the ratio between the number of correctly read stimuli and the total number of stimuli presented multiplied by 100.; The time points will be pre- (baseline) vs post-stimulation session.	during procedure
Secondary	Non-word reading speed (Experimental reading task)	Change in non-word reading speed from baseline compared to after Active HD-tDCS over V5/MT sessions than after Active HD-tDCS over V1 and Sham sessions. Non-word reading speed is considered as the syllables/seconds ratio and calculated dividing the total number of syllables pronounced by the total time spent to complete the reading (in seconds).; The time points will be pre- (baseline) vs post-stimulation session.	during procedure
Secondary	Right visual hemisphere-motion perception (Experimental reading task)	Change in right visual hemisphere-motion perception from baseline compared to after Active HD-tDCS over V5/MT sessions than after Active HD-tDCS over V1 and Sham sessions. Right visual hemisphere-motion perception is considered as the number of correct saccades.; The time points will be pre- (baseline) vs post-stimulation session.	during procedure
Secondary	Rapid automatized naming letter and number (Experimental reading task)	Change in rapid automatized naming letter and number from baseline compared to after Active HD-tDCS over V5/MT sessions than after Active HD-tDCS over V1 and Sham sessions. Rapid automatized naming letter and number is considered as the total time spent (in seconds) to complete the task.; The time points will be pre- (baseline) vs post-stimulation session.	during procedure
Secondary	Phoneme blending (Experimental reading task)	Change in phoneme blending from baseline compared to after Active HD-tDCS over V5/MT sessions than after Active HD-tDCS over V1 and Sham sessions. Phoneme blending is considered as the number of correctly blended phonemes.; The time points will be pre- (baseline) vs post-stimulation session.	during procedure
Secondary	Eye-movements during reading (Experimental reading task)	Change in eye-movements from baseline compared to after reading during Active HD-tDCS over V5/MT sessions than after Active HD-tDCS over V1 and Sham sessions. Eye-movements during reading is considered as the number of saccades and the number of dwells.; The time points will be pre- (baseline) vs post-stimulation session.	during procedure
Secondary	Spontaneous EEG (Experimental reading task)	Change in spontaneous EEG from baseline compared to after Active HD-tDCS over V5/MT sessions than after Active HD-tDCS over V1 and Sham sessions. Spontaneous EEG is considered as the individual alpha-peak frequency and the beta and theta/gamma oscillations.; The time points will be pre- (baseline) vs post-stimulation session.	during procedure