Researchers randomized 24 patients with subacute poststroke aphasia 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.
The change in global Aachen Aphasia Test score, the primary outcome measure, was significantly higher in the rTMS group than in the sham arm (t test, P=0.003), Alexander Thiel, MD, of McGill University in Montreal, and colleagues reported online in Stroke.
The TMS group's improvements were on average three times greater than the non-TMS group, the researchers said.
Increases were largest for subtest naming (P=0.002) and tended to be higher for comprehension, token test, and writing (P<0.1).
"A combination of repetitive TMS and standard treatment led to improved outcomes, particularly in word finding and naming," said Bruce Dobkin, MD, a professor of neurology at UCLA Geffen School of Medicine who was not involved with the study.
Importantly, while rTMS was applied over the right frontal cortex, PET scans showed patients in the rTMS group activated proportionally more voxels in the left hemisphere after treatment than before compared with sham-treated patients (t test, P=0.002).
"The increased activation in the left side of the brain that had the lesion suggests that inhibiting the homologous cortex on the right of the brain led to reorganization of left speech areas," Dobkin explained.
There were no adverse effects related to the treatment.
Aphasia affects more than a third of all stroke victims, and early and intensive speech and language therapy is the only effective treatment to date, but usually is limited in duration and intensity.
With this sham-controlled, blinded, and randomized study, we present the first evidence that inhibitory rTMS over the right posterior inferior frontal gyrus can easily be applied in a clinical rehabilitation setting, is safe, and improves the effectiveness of conventional speech and language therapy by fostering the left-hemispheric language networks," the researchers wrote.
"The results are modest," Dobkin said. But they open the door to larger, multicenter trials, he said, which is just what the researchers plan. The NORTHSTAR study has been funded by the Canadian Institutes of Health Research and will be launched at four Canadian sites and one German site later in 2013.
(Source: medpagetoday.com)
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