Treatment of dysphasia with rTMS and language therapy after childhood stroke: Multimodal imaging of plastic change

Carlson, Helen L.; Jadavji, Zeanna; Mineyko, Aleksandra; Damji, Omar; Hodge, Jacquie; Saunders, Jenny; Hererro, Mia; Nowak, Michele; Patzelt, Rebecca; Mazur-Mosiewicz, Anya; MacMaster, Frank P.; Kirton, Adam

doi:10.1016/j.bandl.2016.05.008

Cited by 26 publications

(6 citation statements)

References 84 publications

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“…6 Improvement in the motor function of patients with stroke due to rTMS was first reported in 2005. 7 The efficacy of using rTMS to treat various stroke symptoms, such as dysphagia, 8 depression, 9 aphasia, 10 and motor dysfunction, has also been evaluated. 1,3,[11][12][13][14][15][16][17] In 2017, a systemic review and meta-analysis conducted by Zhang et al 18 revealed the positive effects of rTMS on upper limb motor function in patients with stroke.…”

Section: Introductionmentioning

confidence: 99%

Repetitive transcranial magnetic stimulation of lower limb motor function in patients with stroke: a systematic review and meta-analysis of randomized controlled trials

et al. 2019

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Objective: The aim of this study was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on the post-stroke recovery of lower limb motor function. Data sources: We searched the databases of PubMed, Cochrane Library, and Embase. The randomized controlled trials were published by 25 January 2019. Review methods: We included randomized controlled trials that evaluated the effects of rTMS on lower limb motor recovery in patients with stroke. Two reviewers independently screened the searched records, extracted data, and assessed the risk of bias. The treatment effect sizes were pooled in a meta-analysis by using the RevMan 5.3 software. The internal validity was assessed using topics suggested by the Physiotherapy Evidence Database (PEDro). Results: Eight studies with 169 participants were included in the meta-analysis. Pooled estimates demonstrated that rTMS significantly improved the body function of the lower limbs (standardized mean difference (SMD) = 0.66; P < 0.01), lower limb activity (SMD = 0.66; P < 0.01), and motor-evoked potential (SMD = 1.13; P < 0.01). The subgroup analyses results also revealed that rTMS improved walking speed (SMD = 1.13) and lower limb scores on the Fugl-Meyer Assessment scale (SMD = 0.63). We found no significant differences between the groups in different mean post-stroke time or stimulation mode over lower limb motor recovery. Only one study reported mild adverse effects. Conclusion: rTMS may have short-term therapeutic effects on the lower limbs of patients with stroke. Furthermore, the application of rTMS is safe. However, this evidence is limited by a potential risk of bias.

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Section: Introductionmentioning

confidence: 99%

Repetitive transcranial magnetic stimulation of lower limb motor function in patients with stroke: a systematic review and meta-analysis of randomized controlled trials

et al. 2019

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“…Taking “timed” components out of tasks may help with deficits in processing speed. Further, language studies involving children who incur a stroke later in childhood during the more critical language development phases might combine investigations of clinical outcomes and functional imaging to better understand interventions in related pediatric populations (such as intensive speech therapy and non-invasive brain stimulation) (Barwood et al, 2011; Carlson et al, 2016; Hamilton et al, 2011; Mylius et al, 2012; Naeser et al, 2012; Torres et al, 2013; Zumbansen and Thiel, 2014) to maximize compensatory plasticity.…”

Section: Discussionmentioning

confidence: 99%

“…This is presumably because lateralization of language has not yet started at the time of injury whereby developmental plasticity can then result in effective bilateral or right hemispheric language organization (Ballantyne et al, 2007; Lidzba et al, 2017; Schlaug, 2018; Westmacott et al, 2010). Accordingly, age is also related to post-stroke lateralization and subsequent function for children incurring stroke after the perinatal period (Carlson et al, 2016; Ilves et al, 2014; Szaflarski et al, 2014). While task functional MRI has helped characterize such developmental language organization, understanding of the integrated language network is limited.…”

Section: Introductionmentioning

confidence: 99%

Functional connectivity of language networks after perinatal stroke

Carlson

Sugden

Brooks

et al. 2019

NeuroImage: Clinical

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Successful language acquisition during development is imperative for lifelong function. Complex language networks develop throughout childhood. Perinatal stroke may cause significant language disabilities but function can also be remarkably normal. Studying such very early brain injury populations may inform developmental plasticity models of language networks. We examined functional connectivity (FC) of language networks in children with arterial and venous perinatal stroke and typically developing controls (TDC) in a population-based, controlled, cohort study. Resting state functional MRI was performed at 3 T (TR/TE = 2000/30 ms, 150 volumes, 3.6mm 3 voxels). Seed-based analyses used bilateral inferior frontal and superior temporal gyri. A subset of stroke participants completed clinical language testing. Sixty-six children participated (median age: 12.85±3.8y, range 6–19; arterial N = 17; venous N = 15; TDC N = 34]. Children with left hemisphere strokes had comparable FC in their right hemispheres compared to TDC. Inter- and intra-hemispheric connectivity strengths were similar between TDC and PVI but lower for AIS. Reduced FC was associated with poorer language comprehension. Language networks can be estimated using resting-state fMRI in children with perinatal stroke. Altered connectivity may occur in both hemispheres, is more pronounced with arterial lesions, and is associated with clinical function. Our results have implications for therapeutic language interventions after early stroke.

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“…A resulting challenge is to then integrate these biomarkers with other measures of both white matter (as described above) but also grey matter where FreeSurfer can already segment and quantify regional cortical thickness, volume and surface area. Such anatomical approaches are further complemented by other advanced imaging approaches including MR spectroscopy and functional connectivity, which are demonstrating early evidence of applicability in perinatal stroke ( Carlson et al, 2016 ; Ilvesmäki et al, 2017 ). Such personalized models are increasingly clinically relevant with recent translation into non-invasive neuromodulation clinical trials that suggest efficacy for improving function in hemiparetic children ( Gillick et al, 2014 ; Kirton et al, 2016a , Kirton et al, 2016b ; Kirton et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Bihemispheric alterations in myelination in children following unilateral perinatal stroke

Carlson

Mineyko

et al. 2018

NeuroImage: Clinical

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BackgroundStroke is a leading cause of perinatal brain injury with variable outcomes including cerebral palsy and epilepsy. The biological processes that underlie these heterogeneous outcomes are poorly understood. Alterations in developmental myelination are recognized as a major determinant of outcome in preterm brain injury but have not been explored in perinatal stroke. We aimed to characterize myelination in hemiparetic children after arterial perinatal stroke, hypothesizing that ipsilesional myelination would be impaired, the degree of which would correlate with poor outcome.MethodsRetrospective, controlled cohort study. Participants were identified through the Alberta Perinatal Stroke Project (APSP), a population-based research cohort (n > 400). Inclusion criteria were: 1) MRI-confirmed, unilateral arterial perinatal stroke, 2) T1-weighted MRI after 6 months of age, 3) absence of other neurological disorders, 4) neurological outcome that included at least one of the following tests - Pediatric Stroke Outcome Measure (PSOM), Assisting Hand Assessment (AHA), Melbourne Assessment (MA), neuropsychological evaluation (NPE), and robotic sensorimotor measurements. FreeSurfer software measured hemispheric asymmetry in myelination intensity (primary outcome). A second method using ImageJ software validated the detection of myelination asymmetry. A repeated measures ANOVA was used to compare perilesional, ipsilesional remote, and contralesional homologous region myelination between stroke cases and typically developing controls. Myelination metrics were compared to clinical outcome measures (t-test, Pearson's correlation).ResultsTwenty youth with arterial stroke (mean age: 13.4 ± 4.2yo) and 27 typically developing controls (mean age: 12.5 ± 3.7yo) were studied in FreeSurfer. Participants with stroke demonstrated lower myelination in the ipsilesional hemisphere (p < 0.0001). Myelination in perilesional regions had lower intensity compared to ipsilesional remote areas (p < .00001) and contralesional homologous areas (p < 0.00001). Ipsilesional remote regions had decreased myelination compared to homologous regions on the contralesional hemisphere (p = 0.016). Contralesional myelination was decreased compared to controls (p < 0.00001). Myelination metrics were not strongly associated with clinical motor, robotic sensorimotor, or neuropsychological outcomes though some complex tests requiring speeded responses had moderate effect sizes.ConclusionMyelination of apparently uninjured brain in both the ipsilesional and contralesional hemispheres is decreased after perinatal stroke. Differences appear to radiate outward from the lesion. Further study is needed to determine clinical significance.

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Treatment of dysphasia with rTMS and language therapy after childhood stroke: Multimodal imaging of plastic change

Cited by 26 publications

References 84 publications

Repetitive transcranial magnetic stimulation of lower limb motor function in patients with stroke: a systematic review and meta-analysis of randomized controlled trials

Repetitive transcranial magnetic stimulation of lower limb motor function in patients with stroke: a systematic review and meta-analysis of randomized controlled trials

Functional connectivity of language networks after perinatal stroke

Bihemispheric alterations in myelination in children following unilateral perinatal stroke

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