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Cheng J, Jiang Y, Rao T, Yang Y, Liu Y, Zhan Y, Yang S. Repetitive transcranial magnetic stimulation for post-stroke non-fluent aphasia: a systematic review and meta-analysis of randomized controlled trials. Front Neurol 2024; 15:1348695. [PMID: 38751884 PMCID: PMC11094331 DOI: 10.3389/fneur.2024.1348695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Objective To systematically evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) on language function in patients with non-fluent aphasia post-stroke. Methods We selected randomized clinical trials (RCT) that involved stroke patients with non-fluent aphasia, whose intervention was rTMS vs. no therapy or other therapy. Two researchers autonomously reviewed the literature based on the specified criteria for inclusion and exclusion and completed the process of data extraction, data verification, and quality evaluation. Meta-analysis was performed using RevMan 5.4 and Stata MP 17, while the assessment of risk of bias was carried out utilizing the Risk of Bias version 2 tool (RoB2). Results The meta-analysis involved 47 RCTs, encompassing 2,190 patients overall. The indexes indicated that rTMS has the potential to decrease the severity of non-fluent aphasia in stroke patients, including improvement of the capability of repetition, naming, and spontaneous language. The determination of BDNF in the serum of patients was also increased. In addition, rTMS reduced the likelihood of depression in stroke patients. Conclusion To summarize the relevant studies, rTMS has significant effects on improving the language abilities of stroke patients suffering from non-fluent aphasia, including the abilities of repetition, naming, and spontaneous language.
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Affiliation(s)
- Jing Cheng
- First School of Clinical Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yijing Jiang
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ting Rao
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yihan Yang
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yanping Liu
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ying Zhan
- School of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shanli Yang
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Chen S, Zhang S, Yang W, Chen Y, Wang B, Chen J, Li X, Xie L, Huang H, Zeng Y, Tian L, Ji W, Wei X, Lan Y, Li H. The effectiveness of intermittent theta burst stimulation for upper limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials. Front Neurosci 2023; 17:1272003. [PMID: 37901439 PMCID: PMC10602812 DOI: 10.3389/fnins.2023.1272003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Background Intermittent theta burst stimulation (iTBS) is a promising noninvasive therapy to restore the excitability of the cortex, and subsequently improve the function of the upper extremities. Several studies have demonstrated the effectiveness of iTBS in restoring upper limb function and modulating cortical excitability. We aimed to evaluate the effects of iTBS on upper limb motor recovery after stroke. Objective The purpose of this article is to evaluate the influence of intermittent theta-burst stimulation on upper limb motor recovery and improve the quality of life. Method A literature search was conducted using PubMed, EMBASE, MEDLINE, The Cochrane Library, Web of Science, and CBM, including only English studies, to identify studies that investigated the effects of iTBS on upper limb recovery, compared with sham iTBS used in control groups. Effect size was reported as standardized mean difference (SMD) or weighted mean difference (WMD). Results Ten studies were included in the meta-analysis. The results of the meta-analysis indicated that when compared to the control group, the iTBS group had a significant difference in the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) (WMD: 3.20, 95% CI: 1.42 to 4.97; WMD: 3.72, 95% CI: 2.13 to 5.30, respectively). In addition, there was also a significant improvement in the modified Ashworth scale (MAS) compared to the sham group (WMD: -0.56; 95% CI: -0.85 to -0.28). More evidence is still needed to confirm the effect of Barthel Index (BI) scores after interventions. However, no significant effect was found for the assessment of Motor Evoked Potential (MEP) amplitude and MEP latency (SMD: 0.35; 95% CI: -0.21 to 0.90; SMD: 0.35, 95% CI: -0.18 to 0.87; SMD: 0.03, 95% CI: -0.49 to 0.55; respectively). Conclusion Our results showed that iTBS significantly improved motor impairment, functional activities, and reduced muscle tone of upper limbs, thereby increasing the ability to perform Activities of Daily Living (ADL) in stroke patients, while there were no significant differences in MEPs. In conclusion, iTBS is a promising non-invasive brain stimulation as an adjunct to therapy and enhances the therapeutic effect of conventional physical therapy. In the future, more randomized controlled trials with large sample sizes, high quality, and follow-up are necessary to explore the neurophysiological effects. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023392739.
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Affiliation(s)
- Songbin Chen
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Shunxi Zhang
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wenqing Yang
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yujie Chen
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Bingshui Wang
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Jixiang Chen
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaotong Li
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Lanfang Xie
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Huangjie Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yangkang Zeng
- Department of Rehabilitation Medicine, Shenzhen University General Hospital, Shenzhen, China
| | - Lingling Tian
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Wenxue Ji
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xijun Wei
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hai Li
- Department of Rehabilitation Medicine, Shenzhen Hospital, Southern Medical University, Shenzhen, China
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Ntasiopoulou C, Nasios G, Messinis L, Nousia A, Siokas V, Dardiotis E. Repetitive Transcranial Magnetic Stimulation in Post-stroke Aphasia: Comparative Evaluation of Inhibitory and Excitatory Therapeutic Protocols: Narrative Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:619-628. [PMID: 37581835 DOI: 10.1007/978-3-031-31986-0_60] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
OBJECTIVE Aphasia is a serious consequence of stroke resulting in difficulties in using language for communication with negative effects on patients' quality of life. The use of non-invasive repetitive transcranial magnetic stimulation (rTMS) is a novel approach in aphasia therapy, based on the knowledge gained by functional imaging technics of the brain. AIM This review evaluates the effectiveness of rTMS on aphasia therapy according to the results of English language studies that have been published in the databases PubMed/Medline, Scopus, and Web of Science from 2011 to 2021. RESULTS Twenty-seven studies were included in the review with 672 participants. The studies mainly concern the application of inhibitory rTMS on the right inferior frontal gyrus (rIFG) in the subacute and chronic phase, as well as excitatory rTMS of the unaffected language areas of the left cerebral hemisphere in the chronic phase after stroke. Most of the studies concluded that there was statistically significant improvement in various parameters of language including confrontation naming, repetition, and aphasia quotient. Three studies published results that doubt the effectiveness of rTMS. CONCLUSION rTMS is a safe therapeutic method for aphasia treatment in the subacute and chronic phases after stroke. Its effectiveness is immediate as well as distant with a gradually decreasing therapeutic effect. Moreover, rTMS may supplement speech and language therapy as a priming factor. The most recognized method at this point in time is the application of suppressive rTMS on the right inferior frontal gyrus in combination with speech and language therapy.
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Affiliation(s)
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Lambros Messinis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Nousia
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Vasileios Siokas
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
| | - Efthimios Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, University of Thessaly, Larissa, Greece
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Huang W, Chen J, Zheng Y, Zhang J, Li X, Su L, Li Y, Dou Z. The Effectiveness of Intermittent Theta Burst Stimulation for Stroke Patients With Upper Limb Impairments: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:896651. [PMID: 35873775 PMCID: PMC9298981 DOI: 10.3389/fneur.2022.896651] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Upper limb impairments are one of the most common health problems of stroke, affecting both motor function and independence in daily life. It has been demonstrated that intermittent theta burst stimulation (iTBS) increases brain excitability and improves upper limb function. Our study sought to determine the role of iTBS in stroke recovery. Objective The purpose of this study was to determine the efficacy of iTBS in individuals with upper limb impairments following stroke. Methods The databases used included Cumulative Index to PubMed, EMBASE, ESCBOhost, The Cochrane Library, Chinese Biomedical Database, Web of Science, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), Technology Periodical Database (VIP), and WanFang Database. Studies published before November 2021 were included. Each participant received an iTBS-based intervention aimed at improving activity levels or impairment, which was compared to usual care, a sham intervention, or another intervention. The primary outcome measure was a change in upper limb function assessment. Secondary outcomes included impairment, participation, and quality of life measures. Result A total of 18 studies (n = 401 participants) that met the inclusion criteria were included in this study. There was a slight change in the upper limb function of the iTBS group compared with the control group, as measured by the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score (mean difference 2.70, 95% CI −0.02 to 5.42, p = 0.05). Significant improvement in resting motor threshold (RMT) and motor-evoked potential (MEP) was also observed in the meta-analysis of iTBS (MD 3.46, 95% CI 2.63 to 4.28, p < 0.00001); (MD 1.34, 95% CI 1.17 to 1.51, P < 0.00001). In addition, we got similar results when the studies were using the Modified Barthel Index (MBI) assessment (mean difference of 7.34, 95% CI 0.47 to 14.21, p = 0.04). Conclusion Our study established the efficacy of iTBS in improving motor cortical plasticity, motor function, and daily functioning in stroke patients. However, the review requires evidence from additional randomized controlled trials and high-quality research. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/
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Affiliation(s)
- Wenhao Huang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiayi Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yadan Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jin Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liujie Su
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yinying Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Stefaniak JD, Geranmayeh F, Lambon Ralph MA. The multidimensional nature of aphasia recovery post-stroke. Brain 2022; 145:1354-1367. [PMID: 35265968 PMCID: PMC9128817 DOI: 10.1093/brain/awab377] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/20/2021] [Accepted: 09/18/2021] [Indexed: 12/28/2022] Open
Abstract
Language is not a single function, but instead results from interactions between neural representations and computations that can be damaged independently of each other. Although there is now clear evidence that the language profile in post-stroke aphasia reflects graded variations along multiple underlying dimensions ('components'), it is still entirely unknown if these distinct language components have different recovery trajectories and rely on the same, or different, neural regions during aphasia recovery. Accordingly, this study examined whether language components in the subacute stage: (i) mirror those observed in the chronic stage; (ii) recover together in a homogeneous manner; and (iii) have recovery trajectories that relate to changing activation in distinct or overlapping underlying brain regions. We analysed longitudinal data from 26 individuals with mild-moderate aphasia following left hemispheric infarct who underwent functional MRI and behavioural testing at ∼2 weeks and ∼4 months post-stroke. The language profiles in early post-stroke aphasia reflected three orthogonal principal components consisting of fluency, semantic/executive function and phonology. These components did not recover in a singular, homogeneous manner; rather, their longitudinal trajectories were uncorrelated, suggesting that aphasia recovery is heterogeneous and multidimensional. Mean regional brain activation during overt speech production in unlesioned areas was compared with patient scores on the three principal components of language at both the early and late time points. In addition, the change in brain activation over time was compared with the change on each of the principal component scores, both before and after controlling for baseline scores. We found that different language components were associated with changing activation in multiple, non-overlapping bilateral brain regions during aphasia recovery. Specifically, fluency recovery was associated with increasing activation in bilateral middle frontal gyri and right temporo-occipital middle temporal gyrus; semantic/executive recovery was associated with reducing activation in bilateral anterior temporal lobes; while phonology recovery was associated with reducing activation in bilateral precentral gyri, dorso-medial frontal poles and the precuneus. Overlapping clusters in the ventromedial prefrontal cortex were positively associated with fluency recovery but negatively associated with semantic/executive and phonology recovery. This combination of detailed behavioural and functional MRI data provides novel insights into the neural basis of aphasia recovery. Because different aspects of language seem to rely on different neural regions for recovery, treatment strategies that target the same neural region in all stroke survivors with aphasia might be entirely ineffective or even impair recovery, depending on the specific language profile of each individual patient.
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Affiliation(s)
- James D Stefaniak
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9GB, UK
| | - Fatemeh Geranmayeh
- Computational Cognitive and Clinical Neuroimaging Laboratory, Department of Brain Sciences, Imperial College London, Hammersmith Hospital Campus, London W12 0NN, UK
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Starosta M, Cichoń N, Saluk-Bijak J, Miller E. Benefits from Repetitive Transcranial Magnetic Stimulation in Post-Stroke Rehabilitation. J Clin Med 2022; 11:jcm11082149. [PMID: 35456245 PMCID: PMC9030945 DOI: 10.3390/jcm11082149] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023] Open
Abstract
Stroke is an acute neurovascular central nervous system (CNS) injury and one of the main causes of long-term disability and mortality. Post-stroke rehabilitation as part of recovery is focused on relearning lost skills and regaining independence as much as possible. Many novel strategies in neurorehabilitation have been introduced. This review focuses on current evidence of the effectiveness of repetitive transcranial magnetic stimulation (rTMS), a noninvasive brain stimulation (NIBS), in post-stroke rehabilitation. Moreover, we present the effects of specific interventions, such as low-frequency or high-frequency rTMS therapy, on motor function, cognitive function, depression, and aphasia in post-stroke patients. Collected data suggest that high-frequency stimulation (5 Hz and beyond) produces an increase in cortical excitability, whereas low-frequency stimulation (≤1 Hz) decreases cortical excitability. Accumulated data suggest that rTMS is safe and can be used to modulate cortical excitability, which may improve overall performance. Side effects such as tingling sensation on the skin of the skull or headache are possible. Serious side effects such as epileptic seizures can be avoided by adhering to international safety guidelines. We reviewed clinical studies that present promising results in general recovery and stimulating neuroplasticity. This article is an overview of the current rTMS state of knowledge related to benefits in stroke, as well as its cellular and molecular mechanisms. In the stroke rehabilitation literature, there is a key methodological problem of creating double-blinding studies, which are very often impossible to conduct.
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Affiliation(s)
- Michał Starosta
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland;
- Correspondence:
| | - Natalia Cichoń
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland;
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland;
| | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland;
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Lin BF, Yeh SC, Kao YCJ, Lu CF, Tsai PY. Functional Remodeling Associated With Language Recovery After Repetitive Transcranial Magnetic Stimulation in Chronic Aphasic Stroke. Front Neurol 2022; 13:809843. [PMID: 35330805 PMCID: PMC8940300 DOI: 10.3389/fneur.2022.809843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) has shown promising efficacy in improving the language functions in poststroke aphasia. However, randomized controlled trials were lacking to investigate the rTMS-related neuroimaging changes underlying the therapeutic effects on language improvement in chronic aphasia. Objective In this study, we aimed to evaluate the effects of low-frequency rTMS (LF-rTMS) on chronic poststroke aphasia. We hypothesized that the deactivation of the right pars triangularis could restore the balance of interhemispheric inhibition and, hence, facilitated the functional remodeling of language networks in both the hemispheres. Furthermore, the rTMS-induced functional reorganization should underpin the language recovery after rTMS. Methods A total of 33 patients (22 males; age: 58.70 ± 13.77 years) with chronic stroke in the left hemisphere and nonfluent aphasia were recruited in this randomized double-blinded study. The ratio of randomization between the rTMS and sham groups is 17:16. All the patients received real 1-Hz rTMS or sham stimulation (placebo coil delivered < 5% of magnetic output with similar audible click-on discharge) at the right posterior pars triangularis for 10 consecutive weekdays (stroke onset to the first stimulation: 10.97 ± 10.35 months). Functional connectivity of language networks measured by resting-state fMRI was calculated and correlated to the scores of the Concise Chinese Aphasia Test by using the stepwise regression analysis. Results After LF-rTMS intervention, significant improvement in language functions in terms of comprehension and expression abilities was observed compared with the sham group. The rTMS group showed a significant decrease of coupling strength between right pars triangularis and pars opercularis with a strengthened connection between right pars orbitalis and angular gyrus. Furthermore, the LF-rTMS significantly enhanced the coupling strength associated with left Wernicke area. Results of regression analysis showed that the identified functional remodeling involving both the hemispheres could support and predict the language recovery after LF-rTMS treatment. Conclusion We reported the therapeutic effects of LF-rTMS and corresponding functional remodeling in chronic poststroke aphasia. Our results provided neuroimage evidence reflecting the rebalance of interhemispheric inhibition induced by LF-rTMS, which could facilitate future research in the refinement of rTMS protocol to optimize the neuromodulation efficacy and benefit the clinical management of patients with stroke.
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Affiliation(s)
- Bing-Fong Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Ching Yeh
- Department of Computer Science and Information Engineering, National Central University, Taoyuan, Taiwan
| | - Yu-Chieh Jill Kao
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Yi Tsai
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Chou TY, Wang JC, Lin MY, Tsai PY. Low-Frequency vs. Theta Burst Transcranial Magnetic Stimulation for the Treatment of Chronic Non-fluent Aphasia in Stroke: A Proof-of-Concept Study. Front Aging Neurosci 2022; 13:800377. [PMID: 35095477 PMCID: PMC8795082 DOI: 10.3389/fnagi.2021.800377] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/27/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Although low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) has shown promise in the treatment of poststroke aphasia, the efficacy of high-frequency rTMS (HF-rTMS) has yet to be determined. PURPOSE We investigated the efficacy of intermittent theta burst stimulation (iTBS) in ameliorating chronic non-fluent aphasia and compared it with that of LF-rTMS. METHODS We randomly assigned patients with poststroke non-fluent aphasia to an ipsilesional iTBS (n = 29), contralesional 1-Hz rTMS (n = 27), or sham (n = 29) group. Each group received the rTMS protocol executed in 10 daily sessions over 2 weeks. We evaluated language function before and after the intervention by using the Concise Chinese Aphasia Test (CCAT). RESULTS Compared with the sham group, the iTBS group exhibited significant improvements in conversation, description, and expression scores (P = 0.0004-0.031), which characterize verbal production, as well as in auditory comprehension, reading comprehension, and matching scores (P < 0.01), which characterize language perception. The 1-Hz group exhibited superior improvements in expression, reading comprehension, and imitation writing scores compared with the sham group (P < 0.05). The iTBS group had significantly superior results in CCAT total score, matching and auditory comprehension (P < 0.05) relative to the 1-Hz group. CONCLUSION Our study findings contribute to a growing body of evidence that ipsilesional iTBS enhances the language recovery of patients with non-fluent aphasia after a chronic stroke. Auditory comprehension was more preferentially enhanced by iTBS compared with the 1-Hz protocol. Our findings highlight the importance of ipsilesional modulation through excitatory rTMS for the recovery of non-fluent aphasia in patients with chronic stroke. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT03059225].
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Affiliation(s)
- Ting-Yu Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jia-Chi Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mu-Yun Lin
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Yi Tsai
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Brisson V, Tremblay P. Improving speech perception in noise in young and older adults using transcranial magnetic stimulation. BRAIN AND LANGUAGE 2021; 222:105009. [PMID: 34425411 DOI: 10.1016/j.bandl.2021.105009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
UNLABELLED Normal aging is associated with speech perception in noise (SPiN) difficulties. The objective of this study was to determine if SPiN performance can be enhanced by intermittent theta-burst stimulation (iTBS) in young and older adults. METHOD We developed a sub-lexical SPiN test to evaluate the contribution of age, hearing, and cognition to SPiN performance in young and older adults. iTBS was applied to the left posterior superior temporal sulcus (pSTS) and the left ventral premotor cortex (PMv) to examine its impact on SPiN performance. RESULTS Aging was associated with reduced SPiN accuracy. TMS-induced performance gain was greater after stimulation of the PMv compared to the pSTS. Participants with lower scores in the baseline condition improved the most. DISCUSSION SPiN difficulties can be reduced by enhancing activity within the left speech-processing network in adults. This study paves the way for the development of TMS-based interventions to reduce SPiN difficulties in adults.
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Affiliation(s)
- Valérie Brisson
- Département de réadaptation, Université Laval, Québec, Canada; Centre de recherche CERVO, Québec, Canada
| | - Pascale Tremblay
- Département de réadaptation, Université Laval, Québec, Canada; Centre de recherche CERVO, Québec, Canada.
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New Treatment Strategy Using Repetitive Transcranial Magnetic Stimulation for Post-Stroke Aphasia. Diagnostics (Basel) 2021; 11:diagnostics11101853. [PMID: 34679550 PMCID: PMC8534572 DOI: 10.3390/diagnostics11101853] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) for post-stroke aphasia (PSA) has been suggested to promote improvement of language function when used in combination with rehabilitation. However, many challenges remain. In some reports examined by category of language function, only naming has good evidence of improvement, and the improvement effect on other language modalities is low. Therefore, it is necessary to establish methods that contribute to the improvement of language functions other than naming. Therapeutic methods for PSA based on the mechanism of rTMS are mainly inhibitory stimulation methods for language homologous areas. However, the mechanisms of these methods are controversial when inferred from the process of recovery of language function. Low-frequency rTMS applied to the right hemisphere has been shown to be effective in the chronic phase of PSA, but recent studies of the recovery process of language function indicate that this method is unclear. Therefore, it has been suggested that evaluating brain activity using neuroimaging contributes to confirming the effect of rTMS on PSA and the elucidation of the mechanism of functional improvement. In addition, neuroimaging-based stimulation methods (imaging-based rTMS) may lead to further improvements in language function. Few studies have examined neuroimaging and imaging-based rTMS in PSA, and further research is required. In addition, the stimulation site and stimulation parameters of rTMS are likely to depend on the time from onset to intervention. However, there are no reports of studies in patients between 90 and 180 days after onset. Therefore, research during this period is required. New stimulation methods, such as multiple target methods and the latest neuroimaging methods, may contribute to the establishment of new knowledge and new treatment methods in this field.
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Cichon N, Wlodarczyk L, Saluk-Bijak J, Bijak M, Redlicka J, Gorniak L, Miller E. Novel Advances to Post-Stroke Aphasia Pharmacology and Rehabilitation. J Clin Med 2021; 10:jcm10173778. [PMID: 34501229 PMCID: PMC8432240 DOI: 10.3390/jcm10173778] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/07/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022] Open
Abstract
Aphasia is one of the most common clinical features of functional impairment after a stroke. Approximately 21–40% of stroke patients sustain permanent aphasia, which progressively worsens one’s quality of life and rehabilitation outcomes. Post-stroke aphasia treatment strategies include speech language therapies, cognitive neurorehabilitation, telerehabilitation, computer-based management, experimental pharmacotherapy, and physical medicine. This review focuses on current evidence of the effectiveness of impairment-based aphasia therapies and communication-based therapies (as well as the timing and optimal treatment intensities for these interventions). Moreover, we present specific interventions, such as constraint-induced aphasia therapy (CIAT) and melodic intonation therapy (MIT). Accumulated data suggest that using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) is safe and can be used to modulate cortical excitability. Therefore, we review clinical studies that present TMS and tDCS as (possible) promising therapies in speech and language recovery, stimulating neuroplasticity. Several drugs have been used in aphasia pharmacotherapy, but evidence from clinical studies suggest that only nootropic agents, donepezil and memantine, may improve the prognosis of aphasia. This article is an overview on the current state of knowledge related to post-stroke aphasia pharmacology, rehabilitation, and future trends.
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Affiliation(s)
- Natalia Cichon
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
- Correspondence:
| | - Lidia Wlodarczyk
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland;
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland;
| | - Michal Bijak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
| | - Justyna Redlicka
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa, 14, 93-113 Lodz, Poland; (J.R.); (E.M.)
| | - Leslaw Gorniak
- Biohazard Prevention Centre, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska, 141/143, 90-236 Lodz, Poland; (M.B.); (L.G.)
| | - Elzbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa, 14, 93-113 Lodz, Poland; (J.R.); (E.M.)
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Arheix-Parras S, Barrios C, Python G, Cogné M, Sibon I, Engelhardt M, Dehail P, Cassoudesalle H, Moucheboeuf G, Glize B. A systematic review of repetitive transcranial magnetic stimulation in aphasia rehabilitation: Leads for future studies. Neurosci Biobehav Rev 2021; 127:212-241. [PMID: 33862065 DOI: 10.1016/j.neubiorev.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool that induces neuromodulation in the brain. Several studies have shown that rTMS improves language recovery in patients with post-stroke aphasia. OBJECTIVE This systematic review summarizes the role of rTMS in aphasia rehabilitation. METHODS We searched MEDLINE via PubMed and Scopus on 30October, 2020, for English articles (1996-2020). Eligible studies involved post-stroke aphasia rehabilitation with rTMS. In some of these studies, rTMS was also combined with speech therapy. RESULTS In total, seven meta-analyses and 59studies (23randomized clinical trials) were included in this systematic review. The methods used in these studies were heterogeneous. Only six studies did not find that rTMS had a significant effect on language performance. CONCLUSIONS The evidence from the peer-reviewed literature suggests that rTMS is an effective tool in post-stroke aphasia rehabilitation. However, the precise mechanisms that underlie the effects of rTMS and the reorganization of language networks in patients who have had a stroke remain unclear. We discuss these crucial challenges in the context of future studies.
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Affiliation(s)
- Sophie Arheix-Parras
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Charline Barrios
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Grégoire Python
- Faculté de psychologie, Université de Genève, Geneva, Switzerland
| | - Mélanie Cogné
- Department of Physical Medicine and Rehabilitation, CHU de Rennes, Rennes, France
| | - Igor Sibon
- INCIA, CNRS, UMR5287, University of Bordeaux, F-33400, Talence, France; Stroke Unit, Clinical Neurosciences Department, CHU de Bordeaux, 33076, Bordeaux, France
| | - Mélanie Engelhardt
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Patrick Dehail
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Hélène Cassoudesalle
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Geoffroy Moucheboeuf
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France
| | - Bertrand Glize
- Handicap Activité Cognition Santé, BPH U1219 Inserm, Université de Bordeaux, F-33000, Bordeaux, France; Institut Universitaire des Sciences de la Réadaptation, Université de Bordeaux, F-33000, Bordeaux, France; Department of physical medicine and rehabilitation, CHU de Bordeaux, F-33000, Bordeaux, France; Faculté de psychologie, Université de Genève, Geneva, Switzerland; Institute of Neurodegenerative Diseases, CNRS UMR 5293, Université de Bordeaux, F-33000, Bordeaux, France.
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Zhang J, Zhong D, Xiao X, Yuan L, Li Y, Zheng Y, Li J, Liu T, Jin R. Effects of repetitive transcranial magnetic stimulation (rTMS) on aphasia in stroke patients: A systematic review and meta-analysis. Clin Rehabil 2021; 35:1103-1116. [PMID: 33706572 DOI: 10.1177/0269215521999554] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the effects and safety of repetitive transcranial magnetic stimulation (rTMS) on aphasia in stroke patients. METHODS We searched databases from inception to January 28, 2021. Randomized control trials investigating the effects and safety of rTMS for aphasia patients after stroke were included. Study screening, data extraction, and risk of bias assessment were performed independently by two reviewers. Meta-analysis was conducted with Review Manager 5.3 software. The quality of the evidence was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS Twenty-eight studies with 1287 patients were included. All studies were assessed at low or unclear risk of bias in one or more domains. The meta-analysis exhibited rTMS was better than sham rTMS and conventional rehabilitation in language recovery. Low-frequency rTMS showed greater improvement in language recovery except for comprehension than sham rTMS. Low-frequency and bilateral rTMS were superior to conventional rehabilitation in language recovery. High-frequency rTMS was no better than sham rTMS and conventional rehabilitation for improving aphasia. The rTMS had better effects in naming, comprehension and aphasia quotient at 20 sessions. Eleven studies reported rTMS was safe for aphasia patients after stroke. The quality of evidence for all outcomes was low or very low, and publication bias may exist. CONCLUSIONS rTMS may be relatively effective and safe for aphasia patients after stroke. However, these findings should be treated with caution due to high heterogeneity and potential biases.
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Affiliation(s)
- Jun Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xili Xiao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Li Yuan
- The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yuxi Li
- School of Acupuncture Moxibustion and Tuina/The Third Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yaling Zheng
- Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tianyu Liu
- School of Physical Education, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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