Facilitation of Auditory Comprehension After Theta Burst Stimulation of Wernicke's Area in Stroke Patients: A Pilot Study

Abstract

Introduction: Single-pulse transcranial magnetic stimulation (TMS) and high-frequency repetitive TMS (rTMS) over Wernicke's area were found to facilitate language functions in right-handed healthy subjects. We aimed at investigating the effects of excitatory rTMS, given as intermittent theta burst stimulation (iTBS) over left Wernicke's area, on auditory comprehension in patients suffering from fluent aphasia after stroke of the left temporal lobe. Methods: We studied 13 patients with chronic fluent aphasia after an ischemic stroke involving Wernicke's area. iTBS was applied in random order to Wernicke's area, the right-hemisphere homologous of Wernicke's area, and the primary visual cortex. Auditory comprehension was blind assessed using the Token test before (T0), 5 (T1), and 40 min (T2) after a single session of iTBS. Results: At the first evaluation (T1) after iTBS on left Wernike's area, but not on the contralateral homologous area nor on the primary visual cortex, the scores on the Token test were significantly increased. No significant effects were observed at T2. Conclusion: We demonstrated that a single session of excitatory iTBS over Wernicke's area was safe and led to a transient facilitation of auditory comprehension in chronic stroke patients with lesions in the same area. Further studies are needed to establish whether TBS-induced modulation can be enhanced and transformed into longer-lasting effects by means of repeated TBS sessions and by combining TBS with speech and language therapy.

Capturing Neuroplastic Changes after iTBS in Patients with Post-Stroke Aphasia: A Pilot fMRI Study

“…To the best of our knowledge, iTBS can modulate cortical excitability and may serve as a potential tool for neuroplasticity of impaired motor, language, and cognition brain areas [ 48 , 49 , 50 , 51 ]. This study focused on immediate effects and changes of brain activity in patients with PSA, modulated by iTBS.…”

Continuous theta burst stimulation-induced suppression of the right fronto-thalamic-cerebellar circuit accompanies improvement in language performance in poststroke aphasia: A resting-state fMRI study

“…Moreover, significant activations of the left and right temporal gyrus, left posterior cingulate gyrus, and left thalamus during a language task following rTMS over the pSTG were observed by functional magnetic resonance imaging (fMRI; Kawamura et al, 2019 ). A pilot study by Versace demonstrated that excitatory intermittent TBS (iTBS) over Wernicke’s area led to transient facilitation of auditory comprehension in patients with chronic fluent aphasia ( Versace et al, 2019 ). However, these studies have several limitations, including the lack of exploration of underlying mechanisms and insufficient sample size.…”