The Effectiveness of Transcranial Magnetic Stimulation (TMS) Paradigms as Treatment Options for Recovery of Language Deficits in Chronic Poststroke Aphasia

Abstract

Background. In an effort to boost aphasia recovery, modern rehabilitation, in addition to speech and language therapy (SALT), is increasingly incorporating noninvasive methods of brain stimulation. The present study is aimed at investigating the effectiveness of two paradigms of neuronavigated repetitive transcranial magnetic stimulation (rTMS): (i) 1 Hz rTMS and (ii) continuous theta burst stimulation (cTBS) each as a standalone treatment for chronic aphasia poststroke. Methods. A single subject experimental design (SSED) trial was carried out in which six people with aphasia (PWA) were recruited, following a single left hemispheric stroke more than six months prior to the study. Three individuals were treated with 1 Hz rTMS, and the remaining three were treated with cTBS. In all cases, TMS was applied over the right pars triangularis (pTr). Language assessment, with standardized and functional measures, and cognitive evaluations were carried out at four time points: twice prior to treatment (baseline), one day immediately posttreatment, and at follow-up two months after treatment was terminated. Quality of life (QoL) was also assessed at baseline and two months posttreatment. In addition, one of the participants with severe global aphasia was followed up again one and two years posttherapy. Results. For all participants, both rTMS paradigms (1 Hz rTMS and cTBS) generated trends towards improvement in several language skills (i.e., verbal receptive language, expressive language, and naming and reading) one day after treatment and/or two months after therapy. Rated QoL remained stable in three individuals, but for the other three, the communication scores of the QoL were reduced, while two of them also showed a decline in the psychological scores. The participant that was treated with cTBS and followed for up to two years showed that the significant improvement she had initially exhibited in comprehension and reading skills two months after TMS (1st follow-up) was sustained for at least up to two years. Conclusion. From the current findings, it is suggested that inhibitory TMS over the right pTr has the potential to drive neuroplastic changes as a standalone treatment that facilitates language recovery in poststroke aphasia.

Comparative efficacy of different noninvasive brain stimulation therapies for recovery of global cognitive function, attention, memory, and executive function after stroke: a network meta-analysis of randomized controlled trials

“…Three studies 56–58 with no more than five sessions of stimulation were removed. We also excluded three trials for data unextractable 59–61 and one 62 without details about tDCS protocol, to which we contacted the corresponding authors without reply. The quantitative meta-analysis included 20 trials 13,24,35–37,63–77 with 840 participants (see Figure 1(a), Table 1).…”

“…In the sham rTMS group, one patient reported an increase in tiredness and one patient reported a mild headache. The rest of the five RCTs 61,70,71,75,76 reported no adverse effects. These articles did not observe severe side effect, such as seizes.…”

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

“…Approximately 38% of adult stroke victims are subsequently diagnosed with aphasia ( 3 , 4 ), which further worsens the prognosis for these patients. The severity of aphasia is useful in predicting the functional autonomy of patients, as well as their short-term and long-term recovery outcomes following a stroke ( 5 , 6 ). Patients suffering from post-stroke aphasia (PSA) exhibit significantly elevated mortality rates and poorer functional outcomes compared to those without the condition ( 7 ).…”

“…An important consideration is whether SLT should be paired with rTMS. Several studies suggested that when employed as a standalone therapy, rTMS holds promise in producing language improvements in PSA ( 6 , 18 – 20 ). On the contrary, the suggestion that rTMS could prime the brain for behavioral therapy, implying that it should be integrated with SLT, is met with challenges.…”

Therapeutic mechanism of transcranial iTBS on nerve regeneration and functional recovery in rats with complete spinal cord transection

“…As a non-invasive, safe, and easily accepted treatment technique, transcranial magnetic stimulation (TMS) has a wide effect on neural networks in the brain by altering the excitability of neurons [3][4][5][6][7] .…”