Effects of noninvasive brain stimulation on language networks and recovery in early poststroke aphasia.

Efeitos da estimulação cerebral não invasiva nas redes de linguagem e na recuperação na afasia precoce pós-AVC.

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ID: 43405
2013
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Abstract
Modulation of activity in language networks using repetitive transcranial magnetic stimulation (rTMS) may possibly support recovery from poststroke aphasia. Case series and feasibility studies seem to indicate a therapeutic effect; however, randomized sham-controlled, proof-of-principle studies relating clinical effects to activation patterns are missing.Twenty-four patients with subacute poststroke aphasia were randomized to a 10-day protocol of 20-minute inhibitory 1 Hz rTMS over the right triangular part of the posterior inferior frontal gyrus or sham stimulation, followed by 45 minutes of speech and language therapy. Activity in language networks was measured with O-15-water positron emission tomography during verb generation before and after treatment. Language performance was assessed using the Aachen Aphasia Test battery.The primary outcome measure, global Aachen Aphasia Test score change, was significantly higher in the rTMS group (t test, P=0.003). Increases were largest for subtest naming (P=0.002) and tended to be higher for comprehension, token test, and writing (P<0.1). Patients in the rTMS group activated proportionally more voxels in the left hemisphere after treatment than before (difference in activation volume index) compared with sham-treated patients (t test, P=0.002).There was a moderate but significant linear relationship between activation volume index change and global Aachen Aphasia Test score change (r2=0.25; P=0.015).Ten sessions of inhibitory rTMS over the right posterior inferior frontal gyrus, in combination with speech and language therapy, significantly improve language recovery in subacute ischemic stroke and favor recruitment of left-hemispheric language networks.
Modulasi aktivitas pada jaringan bahasa menggunakan *repetitive transcranial magnetic stimulation* (rTMS) kemungkinan dapat mendukung pemulihan dari afasia pascastrok. Serial kasus dan studi kelayakan tampaknya mengindikasikan adanya efek terapeutik; namun, studi pembuktian prinsip (*proof-of-principle*) tersamar acak terkontrol-sham yang menghubungkan efek klinis dengan pola aktivasi masih belum ada. Dua puluh empat pasien dengan afasia pascastrok subakut diacak ke dalam protokol 10 hari berupa rTMS inhibitorik 1 Hz selama 20 menit pada pars triangularis girus frontal inferior posterior kanan atau stimulasi sham, yang diikuti oleh 45 menit terapi wicara dan bahasa. Aktivitas pada jaringan bahasa diukur dengan tomografi emisi positron air-O-15 selama pembentukan kata kerja (*verb generation*) sebelum dan sesudah terapi. Performa bahasa dievaluasi menggunakan instrumen Aachen Aphasia Test. Tolok ukur luaran primer, yaitu perubahan skor global Aachen Aphasia Test, secara signifikan lebih tinggi pada kelompok rTMS (uji t, P=0,003). Peningkatan terbesar terjadi pada subtes penamaan (P=0,002) dan cenderung lebih tinggi untuk pemahaman, uji token, serta menulis (P<0,1). Pasien pada kelompok rTMS secara proporsional mengaktivasi lebih banyak voksel di hemisfer kiri setelah terapi dibandingkan sebelum terapi (perbedaan dalam indeks volume aktivasi) dibandingkan dengan pasien yang menerima stimulasi sham (uji t, P=0,002). Terdapat hubungan linear sedang yang signifikan antara perubahan indeks volume aktivasi dan perubahan skor global Aachen Aphasia Test (r2=0,25; P=0,015). Sepuluh sesi rTMS inhibitorik pada girus frontal inferior posterior kanan, yang dikombinasikan dengan terapi wicara dan bahasa, secara signifikan meningkatkan pemulihan bahasa pada strok iskemik subakut dan mendukung perekrutan jaringan bahasa hemisfer kiri.
Reference Key
thiel2013effectsstroke Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Thiel, Alexander;Hartmann, Alexander;Rubi-Fessen, Ilona;Anglade, Carole;Kracht, Lutz;Weiduschat, Nora;Kessler, Josef;Rommel, Thomas;Heiss, Wolf-Dieter;
Journal Stroke
Year 2013
DOI
10.1161/STROKEAHA.111.000574
URL
Keywords
stroke treatment recovery plasticity transcranial magnetic stimulation

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