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Liu Y, Zhong Z, Chen J, Kuo H, Chen X, Wang P, Shi M, Yang M, Liu B, Liu G. Brain activation patterns in patients with post-stroke cognitive impairment during working memory task: a functional near-infrared spectroscopy study. Front Neurol 2024; 15:1419128. [PMID: 39188710 PMCID: PMC11346344 DOI: 10.3389/fneur.2024.1419128] [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: 04/17/2024] [Accepted: 07/25/2024] [Indexed: 08/28/2024] Open
Abstract
Objective To explore the activation patterns in the frontal cortex of patients with post-stroke cognitive impairment during the execution of working memory tasks. Methods 15 patients with post-stroke cognitive impairment, 17 patients without cognitive impairment, and 15 healthy controls of similar age and sex were included. All participants under-went immediate recall task testing and near-infrared spectroscopy imaging to measure frontal cortex activation during the task. Results The healthy control group performed the best in the immediate recall task, followed by the post-stroke non-cognitive impairment group. The post-stroke cognitive impairment group had the poorest performance. The near-infrared spectroscopy results revealed that during the immediate recall task, the healthy control group primarily activated the left frontal lobe region. In contrast, post-stroke patients exhibited reduced activation in the left frontal lobe and increased activation in the right frontal cortex, particularly in the right frontopolar and orbitofrontal regions, with the post-stroke cognitive impairment group displaying the most pronounced changes. Conclusion Patients with post-stroke cognitive impairment exhibit reduced activation in the left prefrontal cortex during the working memory tasks. They rely on compensatory activation in the right prefrontal cortex, particularly in the frontopolar and orbitofrontal cortex, to successfully complete the task.
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Affiliation(s)
- Yuanyuan Liu
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Geriatric Medical Center, Shanghai, China
- Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Zongye Zhong
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Jian Chen
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Hochieh Kuo
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Xiuli Chen
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Ping Wang
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Mingfang Shi
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Mingzhen Yang
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Bangzhong Liu
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
| | - Guanghua Liu
- Department of Rehabilitation Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Shanghai Institute of Rehabilitation with Integrated Western and Chinese Traditional Medicine, Shanghai, China
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Ramírez-Ferrer E, Aguilera-Pena MP, Duffau H. Functional and oncological outcomes after right hemisphere glioma resection in awake versus asleep patients: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:160. [PMID: 38625548 DOI: 10.1007/s10143-024-02370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/04/2024] [Accepted: 03/24/2024] [Indexed: 04/17/2024]
Abstract
The right hemisphere has been underestimated by being considered as the non-dominant hemisphere. However, it is involved in many functions, including movement, language, cognition, and emotion. Therefore, because lesions on this side are usually not resected under awake mapping, there is a risk of unfavorable neurological outcomes. The goal of this study is to compare the functional and oncological outcomes of awake surgery (AwS) versus surgery under general anesthesia (GA) in supratentorial right-sided gliomas. A systematic review of the literature according to PRISMA guidelines was performed up to March 2023. Four databases were screened. Primary outcome to assess was return to work (RTW). Secondary outcomes included the rate of postoperative neurological deficit, postoperative Karnofsky Performance Status (KPS) score and the extent of resection (EOR). A total of 32 articles were included with 543 patients who underwent right hemisphere tumor resection under awake surgery and 294 under general anesthesia. There were no significant differences between groups regarding age, gender, handedness, perioperative KPS, tumor location or preoperative seizures. Preoperative and long-term postoperative neurological deficits were statistically lower after AwS (p = 0.03 and p < 0.01, respectively), even though no difference was found regarding early postoperative course (p = 0.32). A subsequent analysis regarding type of postoperative impairment was performed. Severe postoperative language deficits were not different (p = 0.74), but there were fewer long-term mild motor and high-order cognitive deficits (p < 0.05) in AwS group. A higher rate of RTW (p < 0.05) was documented after AwS. The EOR was similar in both groups. Glioma resection of the right hemisphere under awake mapping is a safer procedure with a better preservation of high-order cognitive functions and a higher rate of RTW than resection under general anesthesia, despite similar EOR.
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Affiliation(s)
- Esteban Ramírez-Ferrer
- School of Medicine, Universidad del Rosario, Bogotá, Colombia.
- Department of Neurosurgery, Hospital Universitario La Samaritana, Bogotá, Colombia.
- Department of Neurosurgery, Hospital Universitario Mayor de Méderi, Bogotá, Colombia.
- Center of Research and Training in Neurosurgery (CIEN), Bogotá, Colombia.
| | - Maria Paula Aguilera-Pena
- Center of Research and Training in Neurosurgery (CIEN), Bogotá, Colombia
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Hugues Duffau
- Department of Neurosurgery, Gui De Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- U1191 Laboratory, Team "Brain Plasticity, Stem Cells and Glial Tumors", Institute of Functional Genomics of Montpellier, National Institute for Health and Medical Research (INSERM), University of Montpellier, Montpellier, France
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3
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López-Barroso D, Paredes-Pacheco J, Torres-Prioris MJ, Dávila G, Berthier ML. Brain structural and functional correlates of the heterogenous progression of mixed transcortical aphasia. Brain Struct Funct 2023:10.1007/s00429-023-02655-6. [PMID: 37256346 DOI: 10.1007/s00429-023-02655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
Mixed transcortical aphasia (MTCA) is characterized by non-fluent speech and comprehension deficits coexisting with preserved repetition. MTCA may evolve to less severe variants of aphasias or even to full language recovery. Mechanistically, MCTA has traditionally been attributed to a disconnection between the spared left perisylvian language network (PSLN) responsible for preserved verbal repetition, and damaged left extrasylvian networks, which are responsible for language production and comprehension impairments. However, despite significant advances in in vivo neuroimaging, the structural and functional status of the PSLN network in MTCA and its evolution has not been investigated. Thus, the aim of the present study is to examine the status of the PSLN, both in terms of its functional activity and structural integrity, in four cases who developed acute post-stroke MTCA and progressed to different types of aphasia. For it, we conducted a neuroimaging-behavioral study performed in the chronic stage of four patients. The behavioral profile of MTCA persisted in one patient, whereas the other three patients progressed to less severe types of aphasias. Neuroimaging findings suggest that preserved verbal repetition in MTCA does not always depend on the optimal status of the PSLN and its dorsal connections. Instead, the right hemisphere or the left ventral pathway may also play a role in supporting verbal repetition. The variability in the clinical evolution of MTCA may be explained by the varying degree of PSLN alteration and individual premorbid neuroanatomical language substrates. This study offers a fresh perspective of MTCA through the lens of modern neuroscience and unveils novel insights into the neural underpinnings of repetition.
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Affiliation(s)
- Diana López-Barroso
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain
- Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Malaga, Malaga, Spain
| | - José Paredes-Pacheco
- Radiology and Psychiatry Department, Faculty of Medicine, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias (CIMES), General Foundation of the University of Malaga, Malaga, Spain
| | - María José Torres-Prioris
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain
- Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Malaga, Malaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain
- Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain
- Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain
- Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of Malaga, Malaga, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain.
- Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain.
- Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain.
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Lee IT, Huang CC, Hsu PC, Lin CP, Tsai PY. Resting-State Network Changes Following Transcranial Magnetic Stimulation in Patients With Aphasia—A Randomized Controlled Study. Neuromodulation 2022; 25:528-537. [DOI: 10.1016/j.neurom.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022]
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Kristinsson S, den Ouden DB, Rorden C, Newman-Norlund R, Neils-Strunjas J, Fridriksson J. Predictors of Therapy Response in Chronic Aphasia: Building a Foundation for Personalized Aphasia Therapy. J Stroke 2022; 24:189-206. [PMID: 35677975 PMCID: PMC9194549 DOI: 10.5853/jos.2022.01102] [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: 05/31/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic aphasia, a devastating impairment of language, affects up to a third of stroke survivors. Speech and language therapy has consistently been shown to improve language function in prior clinical trials, but few clinicially applicable predictors of individual therapy response have been identified to date. Consequently, clinicians struggle substantially with prognostication in the clinical management of aphasia. A rising prevalence of aphasia, in particular in younger populations, has emphasized the increasing demand for a personalized approach to aphasia therapy, that is, therapy aimed at maximizing language recovery of each individual with reference to evidence-based clinical recommendations. In this narrative review, we discuss the current state of the literature with respect to commonly studied predictors of therapy response in aphasia. In particular, we focus our discussion on biographical, neuropsychological, and neurobiological predictors, and emphasize limitations of the literature, summarize consistent findings, and consider how the research field can better support the development of personalized aphasia therapy. In conclusion, a review of the literature indicates that future research efforts should aim to recruit larger samples of people with aphasia, including by establishing multisite aphasia research centers.
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Affiliation(s)
- Sigfus Kristinsson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Dirk B. den Ouden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Chris Rorden
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Roger Newman-Norlund
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Jean Neils-Strunjas
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Center for the Study of Aphasia Recovery, University of South Carolina, Columbia, SC, USA
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Truzman T, Rochon E, Meltzer J, Leonard C, Bitan T. Simultaneous Normalization and Compensatory Changes in Right Hemisphere Connectivity during Aphasia Therapy. Brain Sci 2021; 11:1330. [PMID: 34679395 PMCID: PMC8534113 DOI: 10.3390/brainsci11101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/01/2021] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
Changes in brain connectivity during language therapy were examined among participants with aphasia (PWA), aiming to shed light on neural reorganization in the language network. Four PWA with anomia following left hemisphere stroke and eight healthy controls (HC) participated in the study. Two fMRI scans were administered to all participants with a 3.5-month interval. The fMRI scans included phonological and semantic tasks, each consisting of linguistic and perceptual matching conditions. Between the two fMRI scans, PWA underwent Phonological Components Analysis treatment. Changes in effective connectivity during the treatment were examined within right hemisphere (RH) architecture. The results illustrate that following the treatment, the averaged connectivity of PWA across all perceptual and linguistic conditions in both tasks increased resemblance to HC, reflecting the normalization of neural processes associated with silent object name retrieval. In contrast, connections that were specifically enhanced by the phonological condition in PWA decreased in their resemblance to HC, reflecting emerging compensatory reorganization in RH connectivity to support phonological processing. These findings suggest that both normalization and compensation play a role in neural language reorganization at the chronic stage, occurring simultaneously in the same brain.
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Affiliation(s)
- Tammar Truzman
- Communication Sciences and Disorders Department and IIPDM, University of Haifa, Haifa 3498838, Israel
- The Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
| | - Elizabeth Rochon
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- KITE Research Institute, Toronto Rehab, University Health Network (UHN), Toronto, ON M5G 2A2, Canada
| | - Jed Meltzer
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- Psychology Department, University of Toronto, Toronto, ON M5S 1A1, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON M6A 2E1, Canada
| | - Carol Leonard
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Tali Bitan
- The Integrated Brain and Behavior Research Center, University of Haifa, Haifa 3498838, Israel
- Department of Speech Language Pathology and Rehabilitation Sciences Institute, University of Toronto, Toronto, ON M5G 1V7, Canada; (E.R.); (J.M.); (C.L.); (T.B.)
- Psychology Department and IIPDM, University of Haifa, Haifa 3498838, Israel
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7
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DeMarco AT, Dvorak E, Lacey E, Stoodley CJ, Turkeltaub PE. An Exploratory Study of Cerebellar Transcranial Direct Current Stimulation in Individuals With Chronic Stroke Aphasia. Cogn Behav Neurol 2021; 34:96-106. [PMID: 34074864 PMCID: PMC8186819 DOI: 10.1097/wnn.0000000000000270] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aphasia is a common, debilitating consequence of stroke, and speech therapy is often inadequate to achieve a satisfactory outcome. Neuromodulation techniques have emerged as a potential augmentative treatment for improving aphasia outcomes. Most studies have targeted the cerebrum, but there are theoretical and practical reasons that stimulation over the cerebral hemispheres might not be ideal. On the other hand, the right cerebellum is functionally and anatomically linked to major language areas in the left hemisphere, making it a promising alternative target site for stimulation. OBJECTIVE To provide preliminary effect sizes for the ability of a short course of anodal transcranial direct current stimulation (tDCS) targeted over the right cerebellum to enhance language processing in individuals with chronic poststroke aphasia. METHOD Ten individuals received five sessions of open-label anodal tDCS targeting the right cerebellum. The effects of the tDCS were compared with the effects of sham tDCS on 14 controls from a previous clinical trial. In total, 24 individuals with chronic poststroke aphasia participated in the study. Behavioral testing was conducted before treatment, immediately following treatment, and at the 3-month follow-up. RESULTS Cerebellar tDCS did not significantly enhance language processing measured either immediately following treatment or at the 3-month follow-up. The effect sizes of tDCS over sham treatment were generally nil or small, except for the mean length of utterance on the picture description task, for which medium to large effects were observed. CONCLUSION These results may provide guidance for investigators who are planning larger trials of tDCS for individuals with chronic poststroke aphasia.
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Affiliation(s)
- Andrew T DeMarco
- Departments of Rehabilitation Medicine
- Neurology, Georgetown University, Washington, DC
| | | | - Elizabeth Lacey
- Neurology, Georgetown University, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
| | | | - Peter E Turkeltaub
- Neurology, Georgetown University, Washington, DC
- MedStar National Rehabilitation Hospital, Washington, DC
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Wilson SM, Schneck SM. Neuroplasticity in post-stroke aphasia: A systematic review and meta-analysis of functional imaging studies of reorganization of language processing. NEUROBIOLOGY OF LANGUAGE (CAMBRIDGE, MASS.) 2020; 2:22-82. [PMID: 33884373 PMCID: PMC8057712 DOI: 10.1162/nol_a_00025] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 09/11/2020] [Indexed: 04/23/2023]
Abstract
Recovery from aphasia is thought to depend on neural plasticity, that is, functional reorganization of surviving brain regions such that they take on new or expanded roles in language processing. We carried out a systematic review and meta-analysis of all articles published between 1995 and early 2020 that have described functional imaging studies of six or more individuals with post-stroke aphasia, and have reported analyses bearing on neuroplasticity of language processing. Each study was characterized and appraised in detail, with particular attention to three critically important methodological issues: task performance confounds, contrast validity, and correction for multiple comparisons. We identified 86 studies describing a total of 561 relevant analyses. We found that methodological limitations related to task performance confounds, contrast validity, and correction for multiple comparisons have been pervasive. Only a few claims about language processing in individuals with aphasia are strongly supported by the extant literature: first, left hemisphere language regions are less activated in individuals with aphasia than neurologically normal controls, and second, in cohorts with aphasia, activity in left hemisphere language regions, and possibly a temporal lobe region in the right hemisphere, is positively correlated with language function. There is modest, equivocal evidence for the claim that individuals with aphasia differentially recruit right hemisphere homotopic regions, but no compelling evidence for differential recruitment of additional left hemisphere regions or domain-general networks. There is modest evidence that left hemisphere language regions return to function over time, but no compelling longitudinal evidence for dynamic reorganization of the language network.
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Affiliation(s)
- Stephen M. Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah M. Schneck
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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Weng YL, Lee CL. Reduced right-hemisphere ERP P600 grammaticality effect is associated with greater right-hemisphere inhibition: Evidence from right-handers with familial sinistrality. Brain Res 2020; 1738:146815. [PMID: 32243986 DOI: 10.1016/j.brainres.2020.146815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/29/2020] [Accepted: 03/29/2020] [Indexed: 11/18/2022]
Abstract
The present study examined the hypothesis that left hemisphere (LH) equivalent language capabilities in the right hemisphere (RH) are inhibited in neurologically intact individuals by testing healthy young right-handers with a history of familial sinistrality (FS+, i.e. with at least one left handed biological relative), a population documented to show greater variability for RH language processing. Event-Related Potential (ERP) and split visual field presentation techniques were combined to assess LH- and RH- biased responses to syntactic category violations. In addition, a bilateral flanker task was used to measure inter-hemispheric inhibition ability in the same set of participants. Replicating prior findings, in addition to the LH-biased P600 grammaticality effect previously seen for right-handers in general, a fair amount, though not all, of FS + right-handers showed RH-biased P600 responses, leading to a reliable RH P600 grammaticality effect at the group level. Capitalizing on the variability of RH P600 responses, our results further revealed that reduced RH-biased P600 effects were reliably correlated with more effective RH inhibition (indexed by smaller reaction time differences between incongruent and neutral flankers presented to the RH via the left visual field). These results corroborated previous findings that the RH is capable of processing syntactic information in a manner qualitatively similar to that in the LH and further demonstrated that LH-equivalent processing in the RH as indexed by the P600 responses is modulated by RH inhibition, contributing to inter-individual variability in syntactic lateralization.
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Affiliation(s)
- Yi-Lun Weng
- Department of Linguistics and Cognitive Science, University of Delaware, USA; Graduate Institute of Linguistics, National Taiwan University, Taiwan
| | - Chia-Lin Lee
- Graduate Institute of Linguistics, National Taiwan University, Taiwan; Department of Psychology, National Taiwan University, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University, Taiwan; Neurobiology and Cognitive Neuroscience Center, National Taiwan University, Taiwan.
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10
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Belopasova AV, Dobrynina LA, Kadykov AS, Berdnikovich ES, Bergelson TM, Tsypushtanova MM. [Noninvasive brain stimulation in the rehabilitation of patients with post-stroke aphasia]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:23-28. [PMID: 32307426 DOI: 10.17116/jnevro202012003223] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past decade, non-invasive brain stimulation, in particular transcranial stimulation by direct electric current (TES), has been increasingly included in the array of methods used for rehabilitation of patients with post-stroke impairments (motor, speech, cognitive). Development of stimulation protocols with determination of the zones of exposure, as well as better understanding of the patterns of restoration of functional systems, became possible due to basic research using functional MRI paradigm. However, the complexity of the organization of the speech system, the variety of forms of aphasia that occur when it is damaged, the individual variability of neuroplastic processes, motivated a search for optimal stimulation protocols that contribute to the personification of the rehabilitation process. Portability, low cost of equipment, a good safety and tolerance profile, as well as a proven effect on neuroplasticity processes, are the undoubted advantages of TES-therapy. There is reason to believe that further study and clinical testing of this technique will turn it into the promising tool for enhancing the effectiveness of classical speech therapy approaches in patients with post-stroke aphasia.
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Affiliation(s)
| | | | - A S Kadykov
- Research Center of Neurology, Moscow, Russia
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11
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Chu R, Meltzer JA, Bitan T. Interhemispheric interactions during sentence comprehension in patients with aphasia. Cortex 2018; 109:74-91. [PMID: 30312780 DOI: 10.1016/j.cortex.2018.08.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 05/03/2018] [Accepted: 08/28/2018] [Indexed: 02/06/2023]
Abstract
Right-hemisphere involvement in language processing following left-hemisphere damage may reflect either compensatory processes, or a release from homotopic transcallosal inhibition, resulting in excessive right-to-left suppression that is maladaptive for language performance. Using fMRI, we assessed inter-hemispheric effective connectivity in fifteen patients with post-stroke aphasia, along with age-matched and younger controls during a sentence comprehension task. Dynamic Causal Modeling was used with four bilateral regions including inferior frontal gyri (IFG) and primary auditory cortices (A1). Despite the presence of lesions, satisfactory model fit was obtained in 9/15 patients. In young controls, the only significant homotopic connection (RA1-LA1), was excitatory, while inhibitory connections emanated from LIFG to both left and right A1's. Interestingly, these connections were also correlated with language comprehension scores in patients. The results for homotopic connections show that excitatory connectivity from RA1-to-LA1 and inhibitory connectivity from LA1-to-RA1 are associated with general auditory verbal comprehension. Moreover, negative correlations were found between sentence comprehension and top-down coupling for both heterotopic (LIFG-to-RA1) and intra-hemispheric (LIFG-to-LA1) connections. These results do not show an emergence of a new compensatory right to left excitation in patients nor do they support the existence of left to right transcallosal suppression in controls. Nevertheless, the correlations with performance in patients are consistent with some aspects of both the compensation model, and the transcallosal suppression account for the role of the RH. Altogether our results suggest that changes to both excitatory and inhibitory homotopic and heterotopic connections due to LH damage may be maladaptive, as they disrupt the normal inter-hemispheric coordination and communication.
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Affiliation(s)
- Ronald Chu
- Baycrest Health Sciences, Rotman Research Institute, Toronto, ON, Canada; University of Toronto, Department of Psychology, Toronto, ON, Canada.
| | - Jed A Meltzer
- Baycrest Health Sciences, Rotman Research Institute, Toronto, ON, Canada; University of Toronto, Department of Psychology, Toronto, ON, Canada; University of Toronto, Department of Speech-Language Pathology, Toronto, ON, Canada; Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada
| | - Tali Bitan
- University of Toronto, Department of Speech-Language Pathology, Toronto, ON, Canada; University of Haifa, Department of Psychology and IIPDM, Haifa, Israel
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12
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Forkel SJ, Catani M. Lesion mapping in acute stroke aphasia and its implications for recovery. Neuropsychologia 2018; 115:88-100. [PMID: 29605593 PMCID: PMC6018610 DOI: 10.1016/j.neuropsychologia.2018.03.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 03/21/2018] [Accepted: 03/27/2018] [Indexed: 12/24/2022]
Abstract
Patients with stroke offer a unique window into understanding human brain function. Mapping stroke lesions poses several challenges due to the complexity of the lesion anatomy and the mechanisms causing local and remote disruption on brain networks. In this prospective longitudinal study, we compare standard and advanced approaches to white matter lesion mapping applied to acute stroke patients with aphasia. Eighteen patients with acute left hemisphere stroke were recruited and scanned within two weeks from symptom onset. Aphasia assessment was performed at baseline and six-month follow-up. Structural and diffusion MRI contrasts indicated an area of maximum overlap in the anterior external/extreme capsule with diffusion images showing a larger overlap extending into posterior perisylvian regions. Anatomical predictors of recovery included damage to ipsilesional tracts (as shown by both structural and diffusion images) and contralesional tracts (as shown by diffusion images only). These findings indicate converging results from structural and diffusion lesion mapping methods but also clear differences between the two approaches in their ability to identify predictors of recovery outside the lesioned regions.
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Affiliation(s)
- Stephanie J Forkel
- Natbrainlab, King's College London, Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), De Crespigny Park, London SE5 8AF, United Kingdom; Natbrainlab, Department of Forensic and Neurodevelopmental Sciences and Sackler Institute of Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London De Crespigny Park, London SE5 8AF, United Kingdom.
| | - Marco Catani
- Natbrainlab, King's College London, Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), De Crespigny Park, London SE5 8AF, United Kingdom; Natbrainlab, Department of Forensic and Neurodevelopmental Sciences and Sackler Institute of Translational Neurodevelopment, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London De Crespigny Park, London SE5 8AF, United Kingdom.
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13
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Lukic S, Barbieri E, Wang X, Caplan D, Kiran S, Rapp B, Parrish TB, Thompson CK. Right Hemisphere Grey Matter Volume and Language Functions in Stroke Aphasia. Neural Plast 2017; 2017:5601509. [PMID: 28573050 PMCID: PMC5441122 DOI: 10.1155/2017/5601509] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/09/2017] [Accepted: 03/21/2017] [Indexed: 11/17/2022] Open
Abstract
The role of the right hemisphere (RH) in recovery from aphasia is incompletely understood. The present study quantified RH grey matter (GM) volume in individuals with chronic stroke-induced aphasia and cognitively healthy people using voxel-based morphometry. We compared group differences in GM volume in the entire RH and in RH regions-of-interest. Given that lesion site is a critical source of heterogeneity associated with poststroke language ability, we used voxel-based lesion symptom mapping (VLSM) to examine the relation between lesion site and language performance in the aphasic participants. Finally, using results derived from the VLSM as a covariate, we evaluated the relation between GM volume in the RH and language ability across domains, including comprehension and production processes both at the word and sentence levels and across spoken and written modalities. Between-subject comparisons showed that GM volume in the RH SMA was reduced in the aphasic group compared to the healthy controls. We also found that, for the aphasic group, increased RH volume in the MTG and the SMA was associated with better language comprehension and production scores, respectively. These data suggest that the RH may support functions previously performed by LH regions and have important implications for understanding poststroke reorganization.
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Affiliation(s)
- Sladjana Lukic
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Elena Barbieri
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Xue Wang
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David Caplan
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Swathi Kiran
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Speech, Language, and Hearing, College of Health & Rehabilitation, Boston University, Boston, MA, USA
| | - Brenda Rapp
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Cognitive Science, Krieger School of Arts & Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Todd B. Parrish
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Cynthia K. Thompson
- Center for the Neurobiology of Language Recovery, Northwestern University, Evanston, IL, USA
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
- Department of Neurology, Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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14
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Hara T, Abo M, Kakita K, Mori Y, Yoshida M, Sasaki N. The Effect of Selective Transcranial Magnetic Stimulation with Functional Near-Infrared Spectroscopy and Intensive Speech Therapy on Individuals with Post-Stroke Aphasia. Eur Neurol 2017; 77:186-194. [DOI: 10.1159/000457901] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/22/2017] [Indexed: 11/19/2022]
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15
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Shah-Basak PP, Wurzman R, Purcell JB, Gervits F, Hamilton R. Fields or flows? A comparative metaanalysis of transcranial magnetic and direct current stimulation to treat post-stroke aphasia. Restor Neurol Neurosci 2016; 34:537-58. [PMID: 27163249 DOI: 10.3233/rnn-150616] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Rachel Wurzman
- Laboratory for Cognition and Neural Stimulation, University of Pennsylvania, Philadelphia, PA, USA
| | - Juliann B. Purcell
- Laboratory for Cognition and Neural Stimulation, University of Pennsylvania, Philadelphia, PA, USA
| | - Felix Gervits
- Laboratory for Cognition and Neural Stimulation, University of Pennsylvania, Philadelphia, PA, USA
| | - Roy Hamilton
- Laboratory for Cognition and Neural Stimulation, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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16
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Marini A, Galetto V, Tatu K, Duca S, Geminiani G, Sacco K, Zettin M. Recovering two languages with the right hemisphere. BRAIN AND LANGUAGE 2016; 159:35-44. [PMID: 27289209 DOI: 10.1016/j.bandl.2016.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 02/26/2016] [Accepted: 05/28/2016] [Indexed: 06/06/2023]
Abstract
Converging evidence suggests that the right hemisphere (RH) plays an important role in language recovery from aphasia after a left hemisphere (LH) lesion. In this longitudinal study we describe the neurological, cognitive, and linguistic profile of A.C., a bilingual who, after a severe traumatic brain injury, developed a form of fluent aphasia that affected his two languages (i.e., Romanian and Italian). The trauma-induced parenchymal atrophy led to an exceptional ventricular dilation that, gradually, affected the whole left hemisphere. A.C. is now recovering both languages relying only on his right hemisphere. An fMRI experiment employing a bilingual covert verb generation task documented the involvement of the right middle temporal gyrus in processes of lexical selection and access. This case supports the hypothesis that the RH plays a role in language recovery from aphasia when the LH has suffered massive lesions.
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Affiliation(s)
- Andrea Marini
- Dipartimento di Lingue e Letterature, Comunicazione, Formazione e Società, University of Udine, Udine, Italy; Scientific Institute, IRCCS Eugenio Medea, San Vito al Tagliamento, Pordenone, Italy; Claudiana - Landesfachhochschule für Gesundheitsberufe, Bolzano, Italy.
| | - Valentina Galetto
- Centro Puzzle, Torino, Italy; Center for Cognitive Science, Università degli Studi di Torino, Italy
| | - Karina Tatu
- Dipartimento di Psicologia, Università di Torino, Italy; Koelliker Hospital, Turin, Italy
| | | | - Giuliano Geminiani
- Center for Cognitive Science, Università degli Studi di Torino, Italy; Dipartimento di Psicologia, Università di Torino, Italy; Koelliker Hospital, Turin, Italy; Neuroscience Institute of Turin, Italy
| | - Katiuscia Sacco
- Center for Cognitive Science, Università degli Studi di Torino, Italy; Dipartimento di Psicologia, Università di Torino, Italy; Koelliker Hospital, Turin, Italy; Neuroscience Institute of Turin, Italy
| | - Marina Zettin
- Centro Puzzle, Torino, Italy; Center for Cognitive Science, Università degli Studi di Torino, Italy; Dipartimento di Psicologia, Università di Torino, Italy.
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17
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Marangolo P, Fiori V, Sabatini U, De Pasquale G, Razzano C, Caltagirone C, Gili T. Bilateral Transcranial Direct Current Stimulation Language Treatment Enhances Functional Connectivity in the Left Hemisphere: Preliminary Data from Aphasia. J Cogn Neurosci 2016; 28:724-38. [DOI: 10.1162/jocn_a_00927] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract
Several studies have already shown that transcranial direct current stimulation (tDCS) is a useful tool for enhancing recovery in aphasia. However, no reports to date have investigated functional connectivity changes on cortical activity because of tDCS language treatment. Here, nine aphasic persons with articulatory disorders underwent an intensive language therapy in two different conditions: bilateral anodic stimulation over the left Broca's area and cathodic contralesional stimulation over the right homologue of Broca's area and a sham condition. The language treatment lasted 3 weeks (Monday to Friday, 15 sessions). In all patients, language measures were collected before (T0) and at the end of treatment (T15). Before and after each treatment condition (real vs. sham), each participant underwent a resting-state fMRI study. Results showed that, after real stimulation, patients exhibited the greatest recovery not only in terms of better accuracy in articulating the treated stimuli but also for untreated items on different tasks of the language test. Moreover, although after the sham condition connectivity changes were confined to the right brain hemisphere, real stimulation yielded to stronger functional connectivity increase in the left hemisphere. In conclusion, our data provide converging evidence from behavioral and functional imaging data that bilateral tDCS determines functional connectivity changes within the lesioned hemisphere, enhancing the language recovery process in stroke patients.
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Affiliation(s)
- Paola Marangolo
- 1IRCCS Fondazione Santa Lucia, Rome, Italy
- 2Università Federico II, Naples, Italy
| | - Valentina Fiori
- 1IRCCS Fondazione Santa Lucia, Rome, Italy
- 3Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Umberto Sabatini
- 1IRCCS Fondazione Santa Lucia, Rome, Italy
- 4University of Magna Grecia, Catanzaro, Italy
| | | | | | - Carlo Caltagirone
- 1IRCCS Fondazione Santa Lucia, Rome, Italy
- 3Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Tommaso Gili
- 1IRCCS Fondazione Santa Lucia, Rome, Italy
- 5Museo Storico della Fiscia e Ricerche “Enrico Fermi”, Rome, Italy
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18
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Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation Combined with Intensive Speech Therapy on Cerebral Blood Flow in Post-Stroke Aphasia. Transl Stroke Res 2015; 6:365-74. [DOI: 10.1007/s12975-015-0417-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 06/08/2015] [Accepted: 07/12/2015] [Indexed: 10/23/2022]
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19
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Brain plasticity in aphasic patients: intra- and inter-hemispheric reorganisation of the whole linguistic network probed by N150 and N350 components. Sci Rep 2015. [PMID: 26217919 PMCID: PMC4649892 DOI: 10.1038/srep12541] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The present study examined linguistic plastic reorganization of language through Evoked Potentials in a group of 17 non-fluent aphasic patients who had suffered left perisylvian focal lesions, and showed a good linguistic recovery. Language reorganisation was probed with three linguistic tasks (Phonological, Semantic, Orthographic), the early word recognition potential (N150) and the later phonological-related component (N350). Results showed the typical left-lateralised posterior N150 in healthy controls (source: left Fusiform Gyrus), that was bilateral (Semantic) or right sided (Phonological task) in patients (sources: right Inferior/Middle Temporal and Fusiform Gyri). As regards N350, controls revealed different intra- and inter-hemispheric linguistic activation across linguistic tasks, whereas patients exhibited greater activity in left intact sites, anterior and posterior to the damaged area, in all tasks (sources: Superior Frontal Gyri). A comprehensive neurofunctional model is presented, describing how complete intra- and inter-hemispheric reorganisation of the linguistic networks occurs after aphasic damage in the strategically dominant left perisylvian linguistic centres.
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20
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Abstract
Traumatic brain injury (TBI) remains a significant public health problem and is a leading cause of death and disability in many countries. Durable treatments for neurological function deficits following TBI have been elusive, as there are currently no FDA-approved therapeutic modalities for mitigating the consequences of TBI. Neurostimulation strategies using various forms of electrical stimulation have recently been applied to treat functional deficits in animal models and clinical stroke trials. The results from these studies suggest that neurostimulation may augment improvements in both motor and cognitive deficits after brain injury. Several studies have taken this approach in animal models of TBI, showing both behavioral enhancement and biological evidence of recovery. There have been only a few studies using deep brain stimulation (DBS) in human TBI patients, and future studies are warranted to validate the feasibility of this technique in the clinical treatment of TBI. In this review, the authors summarize insights from studies employing neurostimulation techniques in the setting of brain injury. Moreover, they relate these findings to the future prospect of using DBS to ameliorate motor and cognitive deficits following TBI.
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Affiliation(s)
- Samuel S Shin
- Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
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21
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Forkel SJ, Thiebaut de Schotten M, Dell'Acqua F, Kalra L, Murphy DGM, Williams SCR, Catani M. Anatomical predictors of aphasia recovery: a tractography study of bilateral perisylvian language networks. ACTA ACUST UNITED AC 2014; 137:2027-39. [PMID: 24951631 DOI: 10.1093/brain/awu113] [Citation(s) in RCA: 192] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Stroke-induced aphasia is associated with adverse effects on quality of life and the ability to return to work. For patients and clinicians the possibility of relying on valid predictors of recovery is an important asset in the clinical management of stroke-related impairment. Age, level of education, type and severity of initial symptoms are established predictors of recovery. However, anatomical predictors are still poorly understood. In this prospective longitudinal study, we intended to assess anatomical predictors of recovery derived from diffusion tractography of the perisylvian language networks. Our study focused on the arcuate fasciculus, a language pathway composed of three segments connecting Wernicke's to Broca's region (i.e. long segment), Wernicke's to Geschwind's region (i.e. posterior segment) and Broca's to Geschwind's region (i.e. anterior segment). In our study we were particularly interested in understanding how lateralization of the arcuate fasciculus impacts on severity of symptoms and their recovery. Sixteen patients (10 males; mean age 60 ± 17 years, range 28-87 years) underwent post stroke language assessment with the Revised Western Aphasia Battery and neuroimaging scanning within a fortnight from symptoms onset. Language assessment was repeated at 6 months. Backward elimination analysis identified a subset of predictor variables (age, sex, lesion size) to be introduced to further regression analyses. A hierarchical regression was conducted with the longitudinal aphasia severity as the dependent variable. The first model included the subset of variables as previously defined. The second model additionally introduced the left and right arcuate fasciculus (separate analysis for each segment). Lesion size was identified as the only independent predictor of longitudinal aphasia severity in the left hemisphere [beta = -0.630, t(-3.129), P = 0.011]. For the right hemisphere, age [beta = -0.678, t(-3.087), P = 0.010] and volume of the long segment of the arcuate fasciculus [beta = 0.730, t(2.732), P = 0.020] were predictors of longitudinal aphasia severity. Adding the volume of the right long segment to the first-level model increased the overall predictive power of the model from 28% to 57% [F(1,11) = 7.46, P = 0.02]. These findings suggest that different predictors of recovery are at play in the left and right hemisphere. The right hemisphere language network seems to be important in aphasia recovery after left hemispheric stroke.
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Affiliation(s)
- Stephanie J Forkel
- 1 Research Department of Clinical, Educational, and Health Psychology (RDCEHP), Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, UK2 Natbrainlab, Department of Neuroimaging, Institute of Psychiatry, King's College London, UK
| | - Michel Thiebaut de Schotten
- 3 Natbrainlab, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK4 Inserm U1127; UPMC-Paris6, UMR_S 1127; CNRS UMR 7225, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - Flavio Dell'Acqua
- 2 Natbrainlab, Department of Neuroimaging, Institute of Psychiatry, King's College London, UK5 NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Lalit Kalra
- 6 Department of Clinical Neuroscience, Institute of Psychiatry, King's College London, London, UK
| | - Declan G M Murphy
- 7 Sackler Institute for Translational Neurodevelopment and Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, UK
| | - Steven C R Williams
- 2 Natbrainlab, Department of Neuroimaging, Institute of Psychiatry, King's College London, UK5 NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Marco Catani
- 3 Natbrainlab, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, London, UK
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22
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Tsai PY, Wang CP, Ko JS, Chung YM, Chang YW, Wang JX. The Persistent and Broadly Modulating Effect of Inhibitory rTMS in Nonfluent Aphasic Patients. Neurorehabil Neural Repair 2014; 28:779-87. [DOI: 10.1177/1545968314522710] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. While prior preliminary studies have broadened our understanding of how repetitive transcranial magnetic stimulation (rTMS) improves language outcomes in stroke patients with nonfluent aphasia, the evidence base of the effectiveness of this method remains inadequate. Objective. In this study, we aimed to strengthen the evidence that this approach improves language performance and to identify characteristics of patients predisposed to benefit most from this treatment. Methods. Fifty-six stroke patients with nonfluent aphasia were randomly allocated to a real or a sham stimulation group: Group A (n = 33), who underwent 10 sessions of 1-Hz rTMS over the contralesional pars triangularis (PTr), and Group B (n = 23), who received sham 1-Hz stimulation. We performed the Picture Naming Test and the Concise Chinese Aphasia Test (CCAT) at the baseline, post-rTMS intervention, and at 3-month follow-up. Results. Group A showed significantly greater improvement than Group B in CCAT scoring ( P < .001), object-naming accuracy ( P = .01), and naming reaction time ( P = .004). The CCAT scoring and naming testing changes for Group A were persistent at 3 months following intervention ( P = .008). Patients who had a lower contralesional rest motor threshold (rMT) were predisposed to a favorable therapeutic outcome ( P = .006), independent of aphasia type, severity, and duration. Conclusions. The results of this study provide evidence that inhibitory rTMS, through downregulating the circuitry of the right pars triangularis (PTr), achieves a persistent and broadly modulating effect, irrespective of aphasia severity and subtype. Patients who show lower rMT in the right motor system would seem to benefit the most from inhibitory rTMS.
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Affiliation(s)
- Po-Yi Tsai
- Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | | | - James S. Ko
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Ya-Wen Chang
- Taipei Veterans General Hospital, Taipei, Taiwan
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23
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Chen HI, Attiah M, Baltuch G, Smith DH, Hamilton RH, Lucas TH. Harnessing plasticity for the treatment of neurosurgical disorders: an overview. World Neurosurg 2014; 82:648-59. [PMID: 24518888 DOI: 10.1016/j.wneu.2014.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 11/30/2013] [Accepted: 02/06/2014] [Indexed: 12/11/2022]
Abstract
Plasticity is fundamental to normal central nervous system function and its response to injury. Understanding this adaptive capacity is central to the development of novel surgical approaches to neurologic disease. These innovative interventions offer the promise of maximizing functional recovery for patients by harnessing targeted plasticity. Developing novel therapies will require the unprecedented integration of neuroscience, bioengineering, molecular biology, and physiology. Such synergistic approaches will create therapeutic options for patients previously outside of the scope of neurosurgery, such as those with permanent disability after traumatic brain injury or stroke. In this review, we synthesize the rapidly evolving field of plasticity and explore ways that neurosurgeons may enhance functional recovery in the future. We conclude that understanding plasticity is fundamental to modern neurosurgical education and practice.
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Affiliation(s)
- H Isaac Chen
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Mark Attiah
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gordon Baltuch
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Douglas H Smith
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy H Lucas
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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24
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Jarso S, Li M, Faria A, Davis C, Leigh R, Sebastian R, Tsapkini K, Mori S, Hillis AE. Distinct mechanisms and timing of language recovery after stroke. Cogn Neuropsychol 2014; 30:454-75. [PMID: 24472056 PMCID: PMC3979443 DOI: 10.1080/02643294.2013.875467] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The "language network" is remarkably stable across language tasks but changes in response to injury to specific components or in response to "disconnection" of input to one component. We investigated network changes during language recovery, hypothesizing that language recovery takes place through distinct mechanisms: (a) reperfusion; (b) recovery from diaschisis; (c) recovery from structural disconnection; and (d) "reorganization" of language, whereby various components assume function of a damaged component. We also tested the hypothesis that "reorganization" depends on: the language task, level of performance, size and site of stroke, and time post onset. We tested these hypotheses in five participants who had structural, perfusion, and functional imaging utilizing spelling, reading, word generation, and picture naming tasks at acute and subsequent stages after ischaemic stroke. These cases illustrate different mechanisms of aphasia recovery or illustrate that reorganization of language acutely depends on individual variables in addition to size and site of stroke.
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Affiliation(s)
- Samson Jarso
- a Russell H. Morgan Department of Radiology and Radiological Science , The Johns Hopkins University School of Medicine , Baltimore , MA , USA
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25
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Shah PP, Szaflarski JP, Allendorfer J, Hamilton RH. Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation. Front Hum Neurosci 2013; 7:888. [PMID: 24399952 PMCID: PMC3870921 DOI: 10.3389/fnhum.2013.00888] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 12/05/2013] [Indexed: 11/13/2022] Open
Abstract
Stroke victims tend to prioritize speaking, writing, and walking as the three most important rehabilitation goals. Of note is that two of these goals involve communication. This underscores the significance of developing successful approaches to aphasia treatment for the several hundred thousand new aphasia patients each year and over 1 million stroke survivors with chronic aphasia in the U.S. alone. After several years of growth as a research tool, non-invasive brain stimulation (NBS) is gradually entering the arena of clinical aphasiology. In this review, we first examine the current state of knowledge of post-stroke language recovery including the contributions from the dominant and non-dominant hemispheres. Next, we briefly discuss the methods and the physiologic basis of the use of inhibitory and excitatory repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) as research tools in patients who experience post-stroke aphasia. Finally, we provide a critical review of the most influential evidence behind the potential use of these two brain stimulation methods as clinical rehabilitative tools.
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Affiliation(s)
- Priyanka P Shah
- Department of Neurology, University of Pennsylvania Philadelphia, PA, USA ; Laboratory for Cognition and Neural Stimulation, Center for Cognitive Neuroscience, University of Pennsylvania Philadelphia, PA, USA
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Jane Allendorfer
- Department of Neurology, University of Alabama at Birmingham Birmingham, AL, USA
| | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania Philadelphia, PA, USA ; Laboratory for Cognition and Neural Stimulation, Center for Cognitive Neuroscience, University of Pennsylvania Philadelphia, PA, USA
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26
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Tuomiranta LM, Càmara E, Froudist Walsh S, Ripollés P, Saunavaara JP, Parkkola R, Martin N, Rodríguez-Fornells A, Laine M. Hidden word learning capacity through orthography in aphasia. Cortex 2013; 50:174-91. [PMID: 24262200 DOI: 10.1016/j.cortex.2013.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/14/2013] [Accepted: 10/14/2013] [Indexed: 11/17/2022]
Abstract
The ability to learn to use new words is thought to depend on the integrity of the left dorsal temporo-frontal speech processing pathway. We tested this assumption in a chronic aphasic individual (AA) with an extensive left temporal lesion using a new-word learning paradigm. She exhibited severe phonological problems and Magnetic Resonance Imaging (MRI) suggested a complete disconnection of this left-sided white-matter pathway comprising the arcuate fasciculus (AF). Diffusion imaging tractography confirmed the disconnection of the direct segment and the posterior indirect segment of her left AF, essential components of the left dorsal speech processing pathway. Despite her left-hemispheric damage and moderate aphasia, AA learned to name and maintain the novel words in her active vocabulary on par with healthy controls up to 6 months after learning. This exceeds previous demonstrations of word learning ability in aphasia. Interestingly, AA's preserved word learning ability was modality-specific as it was observed exclusively for written words. Functional magnetic resonance imaging (fMRI) revealed that in contrast to normals, AA showed a significantly right-lateralized activation pattern in the temporal and parietal regions when engaged in reading. Moreover, learning of visually presented novel word-picture pairs also activated the right temporal lobe in AA. Both AA and the controls showed increased activation during learning of novel versus familiar word-picture pairs in the hippocampus, an area critical for associative learning. AA's structural and functional imaging results suggest that in a literate person, a right-hemispheric network can provide an effective alternative route for learning of novel active vocabulary. Importantly, AA's previously undetected word learning ability translated directly into therapy, as she could use written input also to successfully re-learn and maintain familiar words that she had lost due to her left hemisphere lesion.
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Affiliation(s)
- Leena M Tuomiranta
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland
| | - Estela Càmara
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Seán Froudist Walsh
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College, London, UK
| | - Pablo Ripollés
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Basic Psychology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Nadine Martin
- Department of Communication Sciences and Disorders, Eleanor M. Saffran Center for Cognitive Neuroscience, Temple University, Philadelphia, PA, USA
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Basic Psychology, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Matti Laine
- Department of Psychology and Logopedics, Abo Akademi University, Turku, Finland.
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De-Torres I, Dávila G, Berthier ML, Walsh SF, Moreno-Torres I, Ruiz-Cruces R. Repeating with the right hemisphere: reduced interactions between phonological and lexical-semantic systems in crossed aphasia? Front Hum Neurosci 2013; 7:675. [PMID: 24151460 PMCID: PMC3798981 DOI: 10.3389/fnhum.2013.00675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 09/26/2013] [Indexed: 11/13/2022] Open
Abstract
Knowledge on the patterns of repetition amongst individuals who develop language deficits in association with right hemisphere lesions (crossed aphasia) is very limited. Available data indicate that repetition in some crossed aphasics experiencing phonological processing deficits is not heavily influenced by lexical-semantic variables (lexicality, imageability, and frequency) as is regularly reported in phonologically-impaired cases with left hemisphere damage. Moreover, in view of the fact that crossed aphasia is rare, information on the role of right cortical areas and white matter tracts underpinning language repetition deficits is scarce. In this study, repetition performance was assessed in two patients with crossed conduction aphasia and striatal/capsular vascular lesions encompassing the right arcuate fasciculus (AF) and inferior frontal-occipital fasciculus (IFOF), the temporal stem and the white matter underneath the supramarginal gyrus. Both patients showed lexicality effects repeating better words than non-words, but manipulation of other lexical-semantic variables exerted less influence on repetition performance. Imageability and frequency effects, production of meaning-based paraphrases during sentence repetition, or better performance on repeating novel sentences than overlearned clichés were hardly ever observed in these two patients. In one patient, diffusion tensor imaging disclosed damage to the right long direct segment of the AF and IFOF with relative sparing of the anterior indirect and posterior segments of the AF, together with fully developed left perisylvian white matter pathways. These findings suggest that striatal/capsular lesions extending into the right AF and IFOF in some individuals with right hemisphere language dominance are associated with atypical repetition patterns which might reflect reduced interactions between phonological and lexical-semantic processes.
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Affiliation(s)
- Irene De-Torres
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones, Médico-Sanitarias, University of MálagaMalaga, Spain
- Unit of Physical Medicine and Rehabilitation, Carlos Haya University HospitalMalaga, Spain
| | - Guadalupe Dávila
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones, Médico-Sanitarias, University of MálagaMalaga, Spain
- Psychobiology Area, Faculty of Psychology, University of MálagaMalaga, Spain
| | - Marcelo L. Berthier
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones, Médico-Sanitarias, University of MálagaMalaga, Spain
| | - Seán Froudist Walsh
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones, Médico-Sanitarias, University of MálagaMalaga, Spain
- Department of Psychosis Studies, Institute of Psychiatry, King's Health PartnersKing's College London, UK
| | | | - Rafael Ruiz-Cruces
- Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones, Médico-Sanitarias, University of MálagaMalaga, Spain
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Meltzer JA, Wagage S, Ryder J, Solomon B, Braun AR. Adaptive significance of right hemisphere activation in aphasic language comprehension. Neuropsychologia 2013; 51:1248-59. [PMID: 23566891 PMCID: PMC3821997 DOI: 10.1016/j.neuropsychologia.2013.03.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 02/25/2013] [Accepted: 03/19/2013] [Indexed: 10/27/2022]
Abstract
Aphasic patients often exhibit increased right hemisphere activity during language tasks. This may represent takeover of function by regions homologous to the left-hemisphere language networks, maladaptive interference, or adaptation of alternate compensatory strategies. To distinguish between these accounts, we tested language comprehension in 25 aphasic patients using an online sentence-picture matching paradigm while measuring brain activation with MEG. Linguistic conditions included semantically irreversible ("The boy is eating the apple") and reversible ("The boy is pushing the girl") sentences at three levels of syntactic complexity. As expected, patients performed well above chance on irreversible sentences, and at chance on reversible sentences of high complexity. Comprehension of reversible non-complex sentences ranged from nearly perfect to chance, and was highly correlated with offline measures of language comprehension. Lesion analysis revealed that comprehension deficits for reversible sentences were predicted by damage to the left temporal lobe. Although aphasic patients activated homologous areas in the right temporal lobe, such activation was not correlated with comprehension performance. Rather, patients with better comprehension exhibited increased activity in dorsal fronto-parietal regions. Correlations between performance and dorsal network activity occurred bilaterally during perception of sentences, and in the right hemisphere during a post-sentence memory delay. These results suggest that effortful reprocessing of perceived sentences in short-term memory can support improved comprehension in aphasia, and that strategic recruitment of alternative networks, rather than homologous takeover, may account for some findings of right hemisphere language activation in aphasia.
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Affiliation(s)
- Jed A Meltzer
- Rotman Research Institute, Baycrest Centre, 3560 Bathurst Street, Toronto, ON, Canada.
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29
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Abstract
Stroke and cerebrovascular diseases are major causes of mortality, morbidity, and disability. Nuclear Medicine, primarily via tomographic methods, has made significant contributions to the understanding of the hemodynamic and metabolic consequences of cerebrovascular diseases. In this review, the findings in acute, subacute, and chronic cerebrovascular diseases are described. Many of the pathophysiologic processes and consequences that follow stroke, including completed infarct core, adjacent penumbra, and diaschisis, have been investigated with Nuclear Medicine, and stroke outcome may be related to these phenomena. Additional topics included in this review are cerebrovascular reserve tests and multi-infarct dementia. Finally, Nuclear Medicine investigations of stroke recovery and cerebral plasticity appear to indicate that enhanced activity of preexisting networks, rather than substitution of function, represents the most important mechanism of improvement in chronic stroke rehabilitation.
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Affiliation(s)
- David H Lewis
- Division of Nuclear Medicine, Department of Radiology, University of Washington School of Medicine, Seattle, WA 98104, USA.
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Waldowski K, Seniów J, Leśniak M, Iwański S, Członkowska A. Effect of low-frequency repetitive transcranial magnetic stimulation on naming abilities in early-stroke aphasic patients: a prospective, randomized, double-blind sham-controlled study. ScientificWorldJournal 2012; 2012:518568. [PMID: 23213288 PMCID: PMC3508571 DOI: 10.1100/2012/518568] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/14/2012] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose. Functional brain imaging studies with aphasia patients have shown increased cortical activation in the right hemisphere language homologues, which hypothetically may represent a maladaptive strategy that interferes with aphasia recovery. The aim of this study was to investigate whether low-frequency repetitive transcranial magnetic stimulation (rTMS) over the Broca's homologues in combination with speech/language therapy improves naming in early-stroke aphasia patients. Methods. 26 right-handed aphasic patients in the early stage (up to 12 weeks) of a first-ever left hemisphere ischemic stroke were randomized to receive speech and language therapy combined with real or sham rTMS. Prior to each 45-minute therapeutic session (15 sessions, 5 days a week), 30 minutes of 1-Hz rTMS was applied. Outcome measures were obtained at baseline, immediately after 3 weeks of experimental treatment and 15 weeks; posttreatment using the Computerized Picture Naming Test. Results. Although both groups significantly improved their naming abilities after treatment, no significant differences were noted between the rTMS and sham stimulation groups. The additional analyses have revealed that the rTMS subgroup with a lesion including the anterior part of language area showed greater improvement primarily in naming reaction time 15 weeks after completion of the therapeutic treatment. Improvement was also demonstrated in functional communication abilities. Conclusions. Inhibitory rTMS of the unaffected right inferior frontal gyrus area in combination with speech and language therapy cannot be assumed as an effective method for all poststroke aphasia patients. The treatment seems to be beneficial for patients with frontal language area damage, mostly in the distant time after finishing rTMS procedure.
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Affiliation(s)
- Konrad Waldowski
- Second Department of Neurology, Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02-957 Warsaw, Poland.
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31
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Rapp B, Caplan D, Edwards S, Visch-Brink E, Thompson CK. Neuroimaging in aphasia treatment research: issues of experimental design for relating cognitive to neural changes. Neuroimage 2012; 73:200-7. [PMID: 22974976 DOI: 10.1016/j.neuroimage.2012.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 07/31/2012] [Accepted: 09/05/2012] [Indexed: 11/16/2022] Open
Abstract
The design of functional neuroimaging studies investigating the neural changes that support treatment-based recovery of targeted language functions in acquired aphasia faces a number of challenges. In this paper, we discuss these challenges and focus on experimental tasks and experimental designs that can be used to address the challenges, facilitate the interpretation of results and promote integration of findings across studies.
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Affiliation(s)
- Brenda Rapp
- Johns Hopkins University, Department of Cognitive Science, Baltimore, MD, USA.
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32
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Berthier ML, Lambon Ralph MA, Pujol J, Green C. Arcuate fasciculus variability and repetition: The left sometimes can be right. Cortex 2012; 48:133-43. [DOI: 10.1016/j.cortex.2011.06.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 06/01/2011] [Accepted: 06/14/2011] [Indexed: 11/24/2022]
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Abo M, Kakuda W, Watanabe M, Morooka A, Kawakami K, Senoo A. Effectiveness of Low-Frequency rTMS and Intensive Speech Therapy in Poststroke Patients with Aphasia: A Pilot Study Based on Evaluation by fMRI in Relation to Type of Aphasia. Eur Neurol 2012; 68:199-208. [PMID: 22948550 DOI: 10.1159/000338773] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 04/09/2012] [Indexed: 11/19/2022]
Affiliation(s)
- Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.
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Turkeltaub PE, Messing S, Norise C, Hamilton RH. Are networks for residual language function and recovery consistent across aphasic patients? Neurology 2011; 76:1726-34. [PMID: 21576689 DOI: 10.1212/wnl.0b013e31821a44c1] [Citation(s) in RCA: 187] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES If neuroplastic changes in aphasia are consistent across studies, this would imply relatively stereotyped mechanisms of recovery which could guide the design of more efficient noninvasive brain stimulation treatments. To address this question, we performed a meta-analysis of functional neuroimaging studies of chronic aphasia after stroke. METHODS Functional neuroimaging articles using language tasks in patients with chronic aphasia after stroke (n = 105) and control subjects (n = 129) were collected. Activation likelihood estimation meta-analysis determined areas of consistent activity in each group. Functional homology between areas recruited by aphasic patients and controls was assessed by determining whether they activated under the same experimental conditions. RESULTS Controls consistently activated a network of left hemisphere language areas. Aphasic patients consistently activated some spared left hemisphere language nodes, new left hemisphere areas, and right hemisphere areas homotopic to the control subjects' language network. Patients with left inferior frontal lesions recruited right inferior frontal gyrus more reliably than those without. Some areas, including right dorsal pars opercularis, were functionally homologous with corresponding control areas, while others, including right pars triangularis, were not. CONCLUSIONS The network of brain areas aphasic patients recruit for language functions is largely consistent across studies. Several recruitment mechanisms occur, including persistent function in spared nodes, compensatory recruitment of alternate nodes, and recruitment of areas that may hinder recovery. These findings may guide development of brain stimulation protocols that can be applied across populations of aphasic patients who share common attributes.
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Affiliation(s)
- Peter E Turkeltaub
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania Health System, 3400 Spruce Street, 3W Gates Building, Philadelphia, PA 19104, USA.
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35
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Hamilton RH, Chrysikou EG, Coslett B. Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation. BRAIN AND LANGUAGE 2011; 118:40-50. [PMID: 21459427 PMCID: PMC3109088 DOI: 10.1016/j.bandl.2011.02.005] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 01/12/2011] [Accepted: 02/27/2011] [Indexed: 05/12/2023]
Abstract
One of the most frequent symptoms of unilateral stroke is aphasia, the impairment or loss of language functions. Over the past few years, behavioral and neuroimaging studies have shown that rehabilitation interventions can promote neuroplastic changes in aphasic patients that may be associated with the improvement of language functions. Following left hemisphere strokes, the functional reorganization of language in aphasic patients has been proposed to involve both intrahemispheric interactions between damaged left hemisphere and perilesional sites and transcallosal interhemispheric interactions between the lesioned left hemisphere language areas and homotopic regions in the right hemisphere. A growing body of evidence for such reorganization comes from studies using transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), two safe and noninvasive procedures that can be applied clinically to modulate cortical excitability during post-stroke language recovery. We discuss a hierarchical model for the plastic changes in language representation that occur in the setting of dominant hemisphere stroke and aphasia. We further argue that TMS and tDCS are potentially promising tools for enhancing functional recovery of language and for further elucidating mechanisms of plasticity in patients with aphasia.
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Affiliation(s)
- Roy H Hamilton
- University of Pennsylvania, Department of Neurology, Center for Cognitive Neuroscience, Philadelphia, United States.
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36
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Turkeltaub PE, Coslett HB, Thomas AL, Faseyitan O, Benson J, Norise C, Hamilton RH. The right hemisphere is not unitary in its role in aphasia recovery. Cortex 2011; 48:1179-86. [PMID: 21794852 DOI: 10.1016/j.cortex.2011.06.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 05/19/2011] [Accepted: 06/10/2011] [Indexed: 11/16/2022]
Abstract
Neurologists and aphasiologists have debated for over a century whether right hemisphere recruitment facilitates or impedes recovery from aphasia. Here we present a well-characterized patient with sequential left and right hemisphere strokes whose case substantially informs this debate. A 72-year-old woman with chronic nonfluent aphasia was enrolled in a trial of transcranial magnetic stimulation (TMS). She underwent 10 daily sessions of inhibitory TMS to the right pars triangularis. Brain activity was measured during picture naming using functional magnetic resonance imaging (fMRI) prior to TMS exposure and before and after TMS on the first day of treatment. Language and cognition were tested behaviorally three times prior to treatment, and at 2 and 6 months afterward. Inhibitory TMS to the right pars triangularis induced immediate improvement in naming, which was sustained 2 months later. fMRI confirmed a local reduction in activity at the TMS target, without expected increased activity in corresponding left hemisphere areas. Three months after TMS, the patient suffered a right hemisphere ischemic stroke, resulting in worsening of aphasia without other clinical deficits. Behavioral testing 3 months later confirmed that language function was impacted more than other cognitive domains. The paradoxical effects of inhibitory TMS and the stroke to the right hemisphere demonstrate that even within a single patient, involvement of some right hemisphere areas may support recovery, while others interfere. The behavioral evidence confirms that compensatory reorganization occurred within the right hemisphere after the original stroke. No support is found for interhemispheric inhibition, the theoretical framework on which most therapeutic brain stimulation protocols for aphasia are based.
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Affiliation(s)
- Peter E Turkeltaub
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
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Gorbet DJ, Staines WR. Inhibition of contralateral premotor cortex delays visually guided reaching movements in men but not in women. Exp Brain Res 2011; 212:315-25. [PMID: 21607701 DOI: 10.1007/s00221-011-2731-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 05/09/2011] [Indexed: 11/24/2022]
Abstract
The premotor-parietal network for preparation of visually guided reaching demonstrates activity mainly contralateral to the reaching arm in men but bilaterally in women. These sex differences are most prominent in the dorsal premotor cortex (PMd); however, the functional implications of these differences remain unclear. Therefore, in the experiments described here, we used continuous theta burst stimulation (cTBS) to test hypotheses regarding the roles of PMd both contralateral and ipsilateral to the reaching arm in men and in women. Inhibitory cTBS of the ipsilateral PMd did not have a significant effect on reaction time in either men or women. However, cTBS of the contralateral PMd resulted in a slowed mean reaction time in men but not in women. Movement times were unaffected by stimulation applied to either hemisphere. These results suggest the presence of sex differences in processing within the left PMd during visually guided reaching movements using the right arm. Further, when taken together, the results suggest that ipsilateral PMd activity in women may not be functionally necessary for reaching movements. Rather, this ipsilateral activity may provide a protective redundancy that can compensate for decreased activity from the contralateral PMd. The observation of sex differences in reaction times but not in movement times following cTBS to the contralateral hemisphere suggests that these sex differences are more strongly associated with movement planning than with motor execution.
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Affiliation(s)
- Diana J Gorbet
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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Güngör L, Terzi M, Onar MK. Does long term use of piracetam improve speech disturbances due to ischemic cerebrovascular diseases? BRAIN AND LANGUAGE 2011; 117:23-27. [PMID: 21227483 DOI: 10.1016/j.bandl.2010.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 09/27/2010] [Accepted: 11/25/2010] [Indexed: 05/30/2023]
Abstract
Aphasia causes significant disability and handicap among stroke survivors. Language therapy is recommended for aphasic patients, but not always available. Piracetam, an old drug with novel properties, has been shown to have mild beneficial effects on post-stroke aphasia. In the current study, we investigated the effects of 6 months treatment with piracetam on aphasia following stroke. Thirty patients with first-ever ischemic strokes and related aphasia were enrolled in the study. The scores for the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), modified Rankin Scale (mRS), and Gülhane Aphasia Test were recorded. The patients were scheduled randomly to receive either 4.8 g piracetam daily or placebo treatment for 6 months. At the end of 24 weeks, clinical assessments and aphasia tests were repeated. The level of improvement in the clinical parameters and aphasia scores was compared between the two groups. All patients had large lesions and severe aphasia. No significant difference was observed between the piracetam and placebo groups regarding the improvements in the NIHSS, BI and mRS scores at the end of the treatment. The improvements observed in spontaneous speech, reading fluency, auditory comprehension, reading comprehension, repetition, and naming were not significantly different in the piracetam and placebo groups, the difference reached significance only for auditory comprehension in favor of piracetam at the end of the treatment. Piracetam is well-tolerated in patients with post-stroke aphasia. Piracetam taken orally in a daily dose of 4.8 g for 6 months has no clear beneficial effect on post-stroke language disorders.
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Affiliation(s)
- Levent Güngör
- Department of Neurology, Ondokuz Mayis University, School of Medicine, Samsun, Turkey.
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Barwood CHS, Murdoch BE, Whelan BM, Lloyd D, Riek S, O' Sullivan JD, Coulthard A, Wong A. Improved language performance subsequent to low-frequency rTMS in patients with chronic non-fluent aphasia post-stroke. Eur J Neurol 2010; 18:935-43. [PMID: 21138505 DOI: 10.1111/j.1468-1331.2010.03284.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C H S Barwood
- Centre for Neurogenic Communication Disorders Research, School of Health and Rehabilitation Sciences, University of Queensland, Australia
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Postman-Caucheteux WA, Birn RM, Pursley RH, Butman JA, Solomon JM, Picchioni D, McArdle J, Braun AR. Single-trial fMRI shows contralesional activity linked to overt naming errors in chronic aphasic patients. J Cogn Neurosci 2010; 22:1299-318. [PMID: 19413476 DOI: 10.1162/jocn.2009.21261] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We used fMRI to investigate the roles played by perilesional and contralesional cortical regions during language production in stroke patients with chronic aphasia. We applied comprehensive psycholinguistic analyses based on well-established models of lexical access to overt picture-naming responses, which were evaluated using a single trial design that permitted distinction between correct and incorrect responses on a trial-by-trial basis. Although both correct and incorrect naming responses were associated with left-sided perilesional activation, incorrect responses were selectively associated with robust right-sided contralesional activity. Most notably, incorrect responses elicited overactivation in the right inferior frontal gyrus that was not observed in the contrasts for patients' correct responses or for responses of age-matched control subjects. Errors were produced at slightly later onsets than accurate responses and comprised predominantly semantic paraphasias and omissions. Both types of errors were induced by pictures with greater numbers of alternative names, and omissions were also induced by pictures with late acquired names. These two factors, number of alternative names per picture and age of acquisition, were positively correlated with activation in left and right inferior frontal gyri in patients as well as control subjects. These results support the hypothesis that some right frontal activation may normally be associated with increasing naming difficulty, but in patients with aphasia, right frontal overactivation may reflect ineffective effort when left hemisphere perilesional resources are insufficient. They also suggest that contralesional areas continue to play a role--dysfunctional rather than compensatory--in chronic aphasic patients who have experienced a significant degree of recovery.
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Affiliation(s)
- Whitney Anne Postman-Caucheteux
- Department of Communication Sciences and Disorders, Temple University, 110Weiss Hall, 1701 North 13th Street, Philadelphia, PA 19122, USA.
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Kakuda W, Abo M, Kaito N, Watanabe M, Senoo A. Functional MRI-Based Therapeutic rTMS Strategy for Aphasic Stroke Patients: A Case Series Pilot Study. Int J Neurosci 2010; 120:60-6. [DOI: 10.3109/00207450903445628] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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43
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Mountz JM. Imaging Pathophysiology and Neuroplasticity After Stroke. PET Clin 2010; 5:107-25. [DOI: 10.1016/j.cpet.2009.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cao Y, George KP, Ewing JR, Vikingstad EM, Johnson AF. Neuroimaging of language and aphasia after stroke. J Stroke Cerebrovasc Dis 2009; 7:230-3. [PMID: 17895089 DOI: 10.1016/s1052-3057(98)80031-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/1997] [Accepted: 01/08/1998] [Indexed: 01/27/2023] Open
Abstract
Over the past 25 years, neuroimaging techniques have advanced rapidly. These techniques, including computed tomography, magnetic resonance imaging, positron emission tomography and single photon emission computed tomography, have improved our understanding of the relationships of language, language disorder, and brain language organization. In this article, we review the contribution of these neuroimaging techniques to the fields of brain language function and speech-language disorders after ischemic stroke. We also discuss the future of these techniques in the research and clinical arenas of ischemic stroke and aphasia rehabilitation.
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Affiliation(s)
- Y Cao
- Department of Neurology, Henry Ford Health Sciences Center, Detroit, MI, USA
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45
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Uruma G, Kakuda W, Abo M. Changes in regional cerebral blood flow in the right cortex homologous to left language areas are directly affected by left hemispheric damage in aphasic stroke patients: evaluation by Tc-ECD SPECT and novel analytic software. Eur J Neurol 2009; 17:461-9. [DOI: 10.1111/j.1468-1331.2009.02849.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Treger I, Luzki L, Gil M, Ring H. Transcranial doppler monitoring during language tasks in stroke patients with aphasia. Disabil Rehabil 2009; 29:1177-83. [PMID: 17653991 DOI: 10.1080/09638280600999493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the pattern of hemispheric activation, according to cerebral blood flow changes, as measured by Transcranial Doppler Ultrasonography (TCD) during language tasks in stroke patients with aphasia. METHOD Prospective study investigating results of TCD monitoring during language naming and recognition tasks in ischemic stroke patients (n = 32) with and without aphasia and 5 control subjects. RESULTS Delta mean flow velocity (MFV) in the left Middle Cerebral Artery (MCA) was found to be much lower in aphasia patients as compared to healthy subjects. Negative statistical correlation was found between the improvement of language ability and the blood flow velocity parameters in the left hemisphere. Aphasia patients with good language ability showed much higher MFV in the right MCA during the first test. Left hemispheric blood flow velocity shift was found to be higher during speech tasks in the patients with poor language ability. CONCLUSIONS Our study suggests that the performance of language tasks in aphasia patients during early recovery after stroke is associated with relatively high right hemisphere activation. High blood flow velocity in the right MCA of aphasia patients was found to be a good prognostic sign for better language ability. Arterial blood flow that shifted towards the left hemisphere during speech tasks was associated with poor language ability.
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Affiliation(s)
- I Treger
- Loewenstein Rehabilitation Hospital, Ra'anana, Israel
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47
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Heiss WD. WSO Leadership in Stroke Medicine Award Lecture Vienna, September 26, 2008: Functional Imaging Correlates to Disturbance and Recovery of Language Function. Int J Stroke 2009; 4:129-36. [DOI: 10.1111/j.1747-4949.2009.00268.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Disturbance of neurologic function in disorders of the central nervous system is expressed as an altered activation pattern in functional networks used by specific tasks and can be studied by functional imaging modalities, e.g., positron emission tomography and functional magnetic resonance imaging. Language, a complex brain function, is based on the interplay of a distributed network in which partial functions are executed in various centers, the primary language areas. These areas are hierarchically organized and activated according to the complexity of the specific language task. The specialization of different centers and the lateralization of integrative functions into the dominant (usually left) hemisphere are achieved by collateral and transcallosal inhibition of secondary language areas that are not used normally for performance of a specific language task. Changes in the interaction within the functional network of language are important for the recovery from aphasia after stroke. In particular, studies of changes in the activation patterns during speech tasks have demonstrated that patients with favorable recovery predominantly activate structures in the ipsilateral hemisphere, but some activation was also seen in the right hemisphere. Increased activation within the right hemisphere may be a marker of failed or faulty recovery attempts in the sense of maladaptive plasticity or the breakdown of normal interhemispheric control within the distributed neural network. The role of activation in the right hemisphere for residual language performance can be investigated by combining repetitive transcranial magnetic stimulation (rTMS) with functional imaging [e.g., positron emission tomography (PET)]. These studies suggested a less effective compensatory potential of right-sided network areas. Overactivation of right language homologues may represent a maladaptive strategy by paradoxical functional facilitation as a result of decreased transcallosal inhibition attributable to damage of specialized and lateralized speech areas. Suppression of this paradoxical activation might therefore improve aphasic deficits.
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Marsh EB, Newhart M, Kleinman JT, Heidler-Gary J, Vining EP, Freeman JM, Kossoff EH, Hillis AE. Hemispherectomy sustained before adulthood does not cause persistent hemispatial neglect. Cortex 2008; 45:677-85. [PMID: 19059587 DOI: 10.1016/j.cortex.2008.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 04/14/2008] [Accepted: 06/11/2008] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hemispatial neglect has been well established in adults following acute ischemic stroke, but has rarely been investigated in children and young adults following brain injury. It is known that young brains have a tremendous potential for reorganization; however, there is controversy as to whether functions are assumed by the opposite hemisphere, or perilesional areas in the same hemisphere. Patients with intractable epilepsy who undergo hemispherectomy for treatment are missing the entire cortex on one side following surgery. In these patients, only the opposite hemisphere is available to assume function. Therefore, they provide the unique opportunity to determine in what cases the left or right hemisphere can take over the spatial attention functions of the opposite hemisphere following damage. The objective of this study was to determine the incidence and types of hemispatial neglect in children and young adults following both right- and left-sided hemispherectomy; which types of spatial attention functions can be assumed by the opposite hemisphere; and whether factors like their age at time of surgery, handedness, or gender influence recovery. METHODS Thirty-two children and young adults who had previously undergone hemispherectomy were administered two tests to evaluate for two types of hemispatial neglect: a gap detection test and a line cancellation test. Egocentric neglect was defined as significantly more omissions of targets on the contralesional versus ipsilesional side of the page (by chi square analysis; p<.05). Allocentric neglect was defined as significantly more errors in detecting contralesional versus ipsilesional gaps in circles. RESULTS Only one of the patients displayed statistically significant hemispatial egocentric neglect on the line cancellation test, and none of the patients displayed statistically significant egocentric or allocentric neglect on the gap detection test. CONCLUSIONS These results imply that reorganization to the contralateral hemisphere occurs peri-hemispherectomy, as there are no perilesional areas to assume function.
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Richter M, Miltner WHR, Straube T. Association between therapy outcome and right-hemispheric activation in chronic aphasia. Brain 2008; 131:1391-401. [PMID: 18349055 DOI: 10.1093/brain/awn043] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maria Richter
- Department of Biological and Clinical Psychology, Friedrich Schiller University, Am Steiger 3/1; D-07743 Jena, Germany
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Affiliation(s)
- Masahiro Mishina
- Department of Neurological, Nephrological and Rheumatological Science, Graduate School of Medicine, Nippon Medical School
- Neurological Institute, Nippon Medical School Chiba Hokusoh Hospital
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