A pilot study verifying the effectiveness of high-frequency repetitive transcranial magnetic stimulation in combination with intensive speech-language-hearing therapy in patients with chronic aphasia

Abstract

BACKGROUND:

A lot of research on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in patients with aphasia in the chronic stage deals with low-frequency stimulation, and reports on high-frequency stimulation (HF-rTMS) are scarce.

OBJECTIVE:

The purpose of this study was to evaluate retrospectively the effectiveness of high-frequency rTMS in combination with intensive speech-language-hearing therapy (ST) following the identification of the stimulation site using functional magnetic resonance imaging (fMRI) before, after the procedure and at 3 months in patients with aphasia in the chronic stage.

METHODS:

20 patients with aphasia in the chronic stage who met the eligibility criteria for rTMS therapy and who underwent HF-rTMS for the first time were included in the present study. All patients received fMRI before hospitalization, and the stimulation site was decided accordingly.

RESULTS:

There was a significant improvement in all patients, rTMS to the left hemisphere, fluent and non-fluent groups by the evaluation of pre- and post- treatment by hospitalization. All groups had a significant improvement in total Standard Language Test of Aphasia score at 3 months when compared with the time of hospitalization.

CONCLUSIONS:

The current study indicates that HF-rTMS in combination with intensive ST is an effective therapeutic approach for patients with aphasia in the chronic stage.

Keywords

rTMS aphasia fMRI speech-language-hearing therapy high-frequency stroke

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References

Abo,

, Kakuda,

, Watanabe,

, Morooka,

, Kawakami,

, & Senoo,

(2012). Effectiveness of low-frequency rTMS and intensive speech therapy in poststroke patients with aphasia: a pilot study based on evaluation by fMRI in relation to type of aphasia. Eur Neurol, 68(4), 199–208. doi: 10.1159/000338773.

Al-Janabi,

, Nickels,

L. A.

, Sowman,

P. F.

, Burianová,

, Merrett,

D. L.

, & Thompson,

W. F.

(2014). Augmenting melodic intonation therapy with non-invasive brain stimulation to treat impaired left-hemisphere function: two case studies. Front Psychol, 5, 37. doi: 10.3389/fpsyg.2014.00037.

Engelter,

S. T.

, Gostynski,

, Papa,

, Frei,

, Born,

, Ajdacic-Gross,

,. . . & Lyrer,

P. A.

(2006). Epidemiology of Aphasia Attributable to First Ischemic Stroke: Incidence, Severity, Fluency, Etiology, and Thrombolysis. Stroke, 37(6), 1379–1384. doi: 10.1161/01.STR.0000221815.64093.8c.

Hara,

, Abo,

, Kakita,

, Mori,

, Yoshida,

, & Sasaki,

(2017). The Effect of Selective Transcranial Magnetic Stimulation With Functional Near-Infrared Spectroscopy and Intensive Speech Therapy on Individuals With Post-Stroke Aphasia. Eur Neurol, 77(3-4), 186–194. doi: 10.1159/000457901.

Heikkinen,

P. H.

, Pulvermüller,

, Mäkelä,

J. P.

, Ilmoniemi,

R. J.

, Lioumis,

, Kujala,

, . . . & Klippi,

(2019). Combining rTMS With Intensive Language-Action Therapy in Chronic Aphasia: A Randomized Controlled Trial. Front Neurosci, 12, 1036. doi: 10.3389/fnins.2018.01036.

Holland,

, Fromm,

, Forbes,

, & MacWhinney,

(2017). Long-term Recovery in Stroke Accompanied by Aphasia: A Reconsideration. Aphasiology, 31(2), 152–165. doi: 10.1080/02687038.2016.1184221.

Hu,

X. Y.

, Zhang,

, Rajah,

G. B.

, Stone,

, Liu,

L. X.

, He,

J. J.

, . . . & Chen,

Y. D.

(2018). Effects of different frequencies of repetitive transcranial magnetic stimulation in stroke patients with non-fluent aphasia: a randomized, sham-controlled study. Neurol Res, 40(6), 459–465. doi: 10.1080/01616412.2018.1453980.

Kakuda,

, Abo,

, Uruma,

, Kaito,

, & Watanabe,

(2010). Low-frequency rTMS with language therapy over a -month period for sensory-dominant aphasia: case series of two post-stroke Japanese patients. Brain Injury, 24(9), 1113–1117. doi: 10.3109/02699052.2010.494587.

Kusano,

, Haruhara,

, Watanabe,

, Momosaki,

, & Abo,

(2012). The efficacy of short period intensive speech therapy for chronic aphasic patients. Higher Brain Function Research, 32, 601–608.

10.

Lefaucheur,

J. P.

, Aleman,

, Baeken,

, Benninger,

D. H.

, Brunelin,

, Di, Lazzaro,

, . . . & Ziemann,

(2020). Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Clin Neurophysiol, 131(5), 1168–1169. doi: 10.1016/j.clinph.2020.02.003.

11.

Naeser,

M. A.

, Martn,

P. I.

, Nicholas,

, Baker,

E. H.

, Seekins,

, Kobatashi, , . . . & Pascual-Leone,

(2005). Improved picture naming in chronic aphasia after TMS to part of right Broca’s area: an open-protocol study. Brain Lang, 93(1), 95–105. doi: 10.1016/j.bandl.2004.08.004.

12.

Tsai,

P-Y.

, Wang,

C-P.

, Ko,

J. S.

, Chung,

T-M.

, Chang,

Y. W.

, & Wang,

J. X.

(2014). The persistent and broadly modulating effect of inhibitory rTMS in nonfluent aphasic patients: a sham-controlled, double-blind study. Neurorehabil Neural Repair, 28(8), 779–787. doi: 10.1177/1545968314522710.

13.

Turkeltaub,

P. E.

, Coslett,

H. B.

, Thoma,s

A. L.

, Faseyitan,

, Benson,

, Norise,

, & Hamilton,

R. H.

(2012). The right hemisphere is not unitary in its role in aphasia recovery. Cortex, 48(9), 1179–1186. doi: 10.1016/j.cortex.2011.06.010.

14.

Wang,

C. P.

, Hsieh,

C. Y.

, Tsai,

P. Y.

, Wang,

C. T.

, Lin,

F. G.

, & Chan,

R. C.

(2014). Efficacy of synchronous verbal training during repetitive transcranial magnetic stimulation in patients with chronic aphasia. Stroke, 45(12), 3656–3662. doi: 10.1161/STROKEAHA.114.007058.

15.

Winhuisen,

, Thiel,

, Schumacher,

, Kessler,

, Rudolf,

, Haupt,

W. F.

, & Heiss,

W. D.

(2005). Role of the contralateral inferior frontal gyrus in recovery of language function in poststroke aphasia: a combined repetitive transcranial magnetic stimulation and positron emission tomography study. Stroke. Stroke, 36(8), 1759–1763. doi: 10.1161/01.STR.0000174487.81126.

16.

Yoon,

T. H.

, Han,

S. J.

, Yoon,

T. S.

, Kim,

J. S.

, & Yi,

T. I.

(2015). Therapeutic effect of repetitive magnetic stimulation combined with speech and language therapy in post-stroke non-fluent aphasia. Neuro Rehabilitation, 36(1), 107–114. doi: 10.3233/NRE-141198.