We report improved ability to name pictures at 2 and 8 months after repetitive transcranial magnetic stimulation (rTMS) treatments to the pars triangularis portion of right Broca's homologue in a 57 year-old woman with severe nonfluent/global aphasia (6.5 years post left basal ganglia bleed, subcortical lesion). TMS was applied at 1 Hz, 20 minutes a day, 10 days, over a two-week period. She received no speech therapy during the study. One year after her TMS treatments, she entered speech therapy with continued improvement. TMS may have modulated activity in the remaining left and right hemisphere neural network for naming.

Fifty years ago Gazzaniga and coworkers published a seminal article that discussed the separate roles of the cerebral hemispheres in humans. Today, the study of interhemispheric communication is facilitated by a battery of novel data analysis techniques drawn from across disciplinary boundaries, including dynamic systems theory and network theory. These techniques enable the characterization of dynamic changes in the brain's functional connectivity, thereby providing an unprecedented means of decoding interhemispheric communication. Here, we illustrate the use of these techniques to examine interhemispheric coordination in healthy human participants performing a split visual field experiment in which they process lexical stimuli. We find that interhemispheric coordination is greater when lexical information is introduced to the right hemisphere and must subsequently be transferred to the left hemisphere for language processing than when it is directly introduced to the language-dominant (left) hemisphere. Further, we find that putative functional modules defined by coherent interhemispheric coordination come online in a transient manner, highlighting the underlying dynamic nature of brain communication. Our work illustrates that recently developed dynamic, network-based analysis techniques can provide novel and previously unapproachable insights into the role of interhemispheric coordination in cognition.T he field of split-brain research began several decades ago with the use of a drastic surgical solution for intractable epilepsy (1-3): the severing of the corpus callosum. This procedure significantly decreased the connectivity between the hemispheres, thereby irrevocably altering interhemispheric communication. Although a few interhemispheric pathways remained through subcortical structures and the anterior commissure, examination of callosal function using split visual field experiments clearly demonstrated its role in interhemispheric communication (2). The callosal projection plays a particularly crucial role in a variety of sensory-motor integrative functions of the two hemispheres (4), shows changes with age, and demonstrates the potential for dynamic changes with training (5). In fact, experiments in patients with severance of the callosum revealed that it subserves a large range of behaviors and cognitive functions that underlie the varied workings of the mind.Interhemispheric communication has been studied using two basic approaches. The first uses behavioral experiments to examine cognitive phenotypes, and the second uses neuroscientific experiments to examine brain phenotypes. Split-brain research initially focused on the former: Patients demonstrated striking behavioral phenotypes that provided clues regarding the underlying mechanics of brain communication. For example, although most perceptual processing appears to be isolated in each hemisphere following surgery, some attentional and emotional mechanisms initiated in one hemisphere can still be communicated to the other, cortically disconnected,...

Functional brain imaging with nonfluent aphasia patients has shown increased cortical activation (perhaps "overactivation") in right (R) hemisphere language homologues. These areas of overactivation may represent a maladaptive strategy that interferes with, rather than promotes, aphasia recovery. Repetitive transcranial magnetic stimulation (rTMS) is a painless, noninvasive procedure that utilizes magnetic fields to create electric currents in discrete brain areas affecting about a 1-cm square area of cortex. Slow frequency, 1 Hz rTMS reduces cortical excitability. When rTMS is applied to an appropriate cortical region, it may suppress the possible overactivation and thus modulate a distributed neural network for language. We provide information on rTMS and report preliminary results following rTMS application to R Broca's area (posterior, R pars triangularis) in four stroke patients with nonfluent aphasia (5-11 years after left hemisphere stroke). Following 10 rTMS treatments, significant improvement in naming pictures was observed. This form of rTMS may provide a novel, complementary treatment for aphasia.