Functional Network Changes After High-Frequency rTMS Over the Most Activated Speech-Related Area Combined With Speech Therapy in Chronic Stroke With Non-fluent Aphasia

Abstract

ObjectiveHigh-frequency repetitive transcranial magnetic stimulation (HF-rTMS) to the lesional hemisphere requires prudence in selecting the appropriate stimulation spot. Functional near-IR spectroscopy (fNIRS) can be used in both selecting the stimulation spot and assessing the changes of the brain network. This study aimed to evaluate the effect of HF-rTMS on the most activated spot identified with fNIRS and assess the changes of brain functional network in the patients with poststroke aphasia.MethodsA total of five patients received HF-rTMS to the most activated area on the lesional hemisphere, followed by 30 min of speech therapy for 10 days. The Korean version of the Western aphasia battery (K-WAB) and fNIRS evaluation were done 1 day before the treatment, 1 day and 1 month after the last treatment session. Changes of K-WAB and paired cortical interaction and brain network analysis using graph theory were assessed.ResultsAphasia quotient in K-WAB significantly increased after the treatment (P = 0.043). The correlation analysis of cortical interactions showed increased connectivity between language production and processing areas. Clustering coefficients of the left hemisphere were increased over a sparsity range between 0.45 and 0.58 (0.015 < p < 0.031), whereas the clustering coefficients of the right hemisphere, decreased over a sparsity range 0.15–0.87 (0.063 < p < 0.095). The global efficiency became lower over a network sparsity range between 0.47 and 0.75 (0.015 < p < 0.063).ConclusionImprovement of language function and changes of corticocortical interaction between language-related cortical areas were observed after HF-rTMS on the most activated area identified by fNIRS with combined speech therapy in the patients with poststroke aphasia.

Does SLT combined with NIBS enhance naming recovery in post-stroke aphasia? A meta-analysis and systematic review

“…Conversely, Hara et al (2017) applied HF-rTMS to the lesioned hemisphere, resulting in increased activity in the contralateral hemisphere. Recently, Chang et al's (2022) study confirmed that in poststroke stable aphasia patients, language function improves and cortical-cortical interactions change when HF-rTMS is used to target the most active language-related area identified in advance by functional near-infrared spectroscopy (fNIRS). This suggests that HF-rTMS may have promising therapeutic effects on chronic aphasia patients.…”

Repetitive transcranial magnetic stimulation for post-stroke non-fluent aphasia: a systematic review and meta-analysis of randomized controlled trials

“…Both HF-rTMS and LF-rTMS applied to one hemisphere, have demonstrated effectiveness in treating NFA ( 13 ). HF-rTMS enhances cerebral cortex excitability and revives bilateral cerebral hemisphere function by stimulating local neurons in the language center ( 98 ). However, HF-rTMS can cause intracranial hemorrhage and epilepsy, leading to its limited use in clinical and research settings.…”

Feasibility of Simultaneous Transcranial Direct Current Stimulation During Gait Training in Chronic Stroke Patients: A Randomized Double-blind Pilot Clinical Trial

“…In the domain of another non-invasive brain stimulation technique, repetitive TMS, a recent development involves the use of a navigation method by functional near-infrared spectroscopy (fNIRS) [11]. The fNIRSaided navigation method exhibits excellent sensitivity and topographical resolution compared with the conventional MEP-guided method [12].…”