scholarly journals The Effect of rTMS over the Different Targets on Language Recovery in Stroke Patients with Global Aphasia: A Randomized Sham-Controlled Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Caili Ren ◽  
Guofu Zhang ◽  
Xinlei Xu ◽  
Jianfeng Hao ◽  
Hui Fang ◽  
...  
Keyword(s):  
Repetitive Transcranial Magnetic Stimulation ◽  
Inferior Frontal Gyrus ◽  
Spontaneous Speech ◽  
Controlled Study ◽  
Auditory Comprehension ◽  
Stroke Patients ◽  
Entire Study ◽  
Subacute Stroke ◽  
Language Recovery ◽  
The Right

Objective.To evaluate and compare the effects of repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis of the posterior inferior frontal gyrus (pIFG) and the right posterior superior temporal gyrus (pSMG) in global aphasia following subacute stroke.Methods.Fifty-four patients with subacute poststroke global aphasia were randomized to 15-day protocols of 20-minute inhibitory 1 Hz rTMS over either the right triangular part of the pIFG (the rTMS-b group) or the right pSTG (the rTMS-w group) or to sham stimulation, followed by 30 minutes of speech and language therapy. Language outcomes were assessed by aphasia quotient (AQ) scores obtained from the Chinese version of the Western Aphasia Battery (WAB) at baseline and immediately after 3 weeks (15 days) of experimental treatment.Results.Forty-five patients completed the entire study. The primary outcome measures include the changes in WAB-AQ score, spontaneous speech, auditory comprehension, and repetition. These measures indicated significant main effect between the baseline of the rTMS-w, rTMS-b, and sham groups and immediately after stimulation (P<0.05). Compared with the sham group, the increases were significant for auditory comprehension, repetition, and AQ in the rTMS-w group (P<0.05), whereas the changes in repetition, spontaneous speech, and AQ tended to be higher in the rTMS-b group (P<0.05).Conclusions.Inhibitory rTMS targeting the right pIFG and pSTG can be an effective treatment for subacute stroke patients with global aphasia. The effect of rTMS may depend on the stimulation site. Low-frequency rTMS inhibited the right pSTG and significantly improved language recovery in terms of auditory comprehension and repetition, whereas LF-rTMS inhibited the right pIFG, leading to apparent changes in spontaneous speech and repetition.

scholarly journals Is Lateropulsion Really Related with a Specific Lesion of the Brain?

2021 ◽  
Vol 11 (3) ◽  
pp. 354
Author(s):  
Kyoung Lee ◽  
Sang Yoo ◽  
Eun Ji ◽  
Woo Hwang ◽  
Yeun Yoo ◽  
...  
Keyword(s):  
Right Hemisphere ◽  
Parietal Lobe ◽  
Inferior Frontal Gyrus ◽  
Brain Lesions ◽  
Vertical Posture ◽  
Lesion Volume ◽  
Precentral Gyrus ◽  
Stroke Patients ◽  
The Right ◽  
Right Hemisphere Stroke

Lateropulsion (pusher syndrome) is an important barrier to standing and gait after stroke. Although several studies have attempted to elucidate the relationship between brain lesions and lateropulsion, the effects of specific brain lesions on the development of lateropulsion remain unclear. Thus, the present study investigated the effects of stroke lesion location and size on lateropulsion in right hemisphere stroke patients. The present retrospective cross-sectional observational study assessed 50 right hemisphere stroke patients. Lateropulsion was diagnosed and evaluated using the Scale for Contraversive Pushing (SCP). Voxel-based lesion symptom mapping (VLSM) analysis with 3T-MRI was used to identify the culprit lesion for SCP. We also performed VLSM controlling for lesion volume as a nuisance covariate, in a multivariate model that also controlled for other factors contributing to pusher behavior. VLSM, combined with statistical non-parametric mapping (SnPM), identified the specific region with SCP. Lesion size was associated with lateropulsion. The precentral gyrus, postcentral gyrus, inferior frontal gyrus, insula and subgyral parietal lobe of the right hemisphere seemed to be associated with the lateropulsion; however, after adjusting for lesion volume as a nuisance covariate, no lesion areas were associated with the SCP scores. The size of the right hemisphere lesion was the only factor most strongly associated with lateropulsion in patients with stroke. These results may be useful for planning rehabilitation strategies of restoring vertical posture and understanding the pathophysiology of lateropulsion in stroke patients.

scholarly journals Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016566
Author(s):  
Eline C C van Lieshout ◽  
Johanna M A Visser-Meily ◽  
Sebastiaan F W Neggers ◽  
H Bart van der Worp ◽  
Rick M Dijkhuizen
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Primary Outcome ◽  
Primary Motor Cortex ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.Methods and analysisIn a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.Trial registration numberNTR6133

scholarly journals The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Ana Dionísio ◽  
Rita Gouveia ◽  
João Castelhano ◽  
Isabel Catarina Duarte ◽  
Gustavo C. Santo ◽  
...  
Keyword(s):  
Motor Function ◽  
Primary Motor Cortex ◽  
Phase Iii ◽  
Repeated Measure ◽  
Controlled Study ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke ◽  
Theta Burst

Objectives: Transcranial magnetic stimulation, in particular continuous theta burst (cTBS), has been proposed for stroke rehabilitation, based on the concept that inhibition of the healthy hemisphere helps promote the recovery of the lesioned one. We aimed to study its effects on cortical excitability, oscillatory patterns, and motor function, the main aim being to identify potentially beneficial neurophysiological effects.Materials and Methods: We applied randomized real or placebo stimulation over the unaffected primary motor cortex of 10 subacute (7 ± 3 days) post-stroke patients. Neurophysiological measurements were performed using electroencephalography and electromyography. Motor function was assessed with the Wolf Motor Function Test. We performed a repeated measure study with the recordings taken pre-, post-cTBS, and at 3 months' follow-up.Results: We investigated changes in motor rhythms during arm elevation and thumb opposition tasks and found significant changes in beta power of the affected thumb's opposition, specifically after real cTBS. Our results are consistent with an excitatory response (increase in event-related desynchronization) in the sensorimotor cortical areas of the affected hemisphere, after stimulation. Neither peak-to-peak amplitude of motor-evoked potentials nor motor performance were significantly altered.Conclusions: Consistently with the theoretical prediction, this contralateral inhibitory stimulation paradigm changes neurophysiology, leading to a significant excitatory impact on the cortical oscillatory patterns of the contralateral hemisphere. These proof-of-concept results provide evidence for the potential role of continuous TBS in the neurorehabilitation of post-stroke patients. We suggest that these changes in ERS/ERD patterns should be further explored in future phase IIb/phase III clinical trials, in larger samples of poststroke patients.

scholarly journals Effect of Repetitive Transcranial Magnetic Stimulation on the Right Superior Temporal Gyrus for Severe Aphasia Caused by Damage to the Left Inferior Frontal Gyrus

2019 ◽  
Vol 11 (2) ◽  
pp. 189-198 ◽  
Author(s):  
Mimpei Kawamura ◽  
Nobuhiro Takahashi ◽  
Yasutaka Kobayashi
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Inferior Frontal Gyrus ◽  
Low Frequency ◽  
Superior Temporal Gyrus ◽  
Verbal Expression ◽  
Left Inferior Frontal Gyrus ◽  
The Right ◽  
Low Frequency Rtms

Several reports on repetitive transcranial magnetic stimulation (rTMS) for the treatment of aphasia caused by damage to the left inferior frontal gyrus state that low-frequency rTMS therapy for the right inferior frontal gyrus, which is contralateral to the focus area, is effective for improving verbal expression. However, most of these reports have studied the effects of rTMS therapy for comparatively mild aphasia. This study attempted to perform low-frequency rTMS on the right posterior superior temporal gyrus (BA22), which is the center for language reception for aphasia patients with a drastic decline in verbal expression due to damage to the left inferior frontal gyrus and a considerable decline in language perception. The participants performed a language task that was displayed on a computer monitor during rTMS. In addition, intensive speech-language and hearing therapy was performed by the therapist after rTMS. This study reports that a resultant improvement in language perception was observed in the activated brain regions based on neuropsychological tests and functional magnetic resonance imaging. This study is considered to be significant as it highlights a new method of rTMS treatment for severe aphasia.

Excitatory Deep Transcranial Magnetic Stimulation With H-Coil Over the Right Homologous Broca’s Region Improves Naming in Chronic Post-stroke Aphasia

2013 ◽  
Vol 28 (3) ◽  
pp. 291-298 ◽  
Author(s):  
Raffaella Chieffo ◽  
Federico Ferrari ◽  
Petronilla Battista ◽  
Elise Houdayer ◽  
Arturo Nuara ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Right Hemisphere ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Random Sequence ◽  
Inferior Frontal Gyrus ◽  
Naming Task ◽  
Broca’S Region ◽  
The Right

Background. The role of the right hemisphere in poststroke aphasia recovery is still controversial and the effects of repetitive transcranial magnetic stimulation (rTMS) over the right homologous Broca’s region have been seldom investigated. Objective. This study aimed to compare the effect of excitatory, inhibitory, and sham rTMS delivered with H-coil over the right inferior frontal gyrus in chronic aphasic patients. Methods. Five right-handed poststroke aphasic patients underwent a picture naming task before and immediately after each of 3 sessions of rTMS: excitatory (10 Hz), inhibitory (1 Hz), and sham rTMS, in random sequence and separated by at least 1 week. Results. Only the excitatory 10-Hz stimulation was associated with a significant improvement in naming performance ( P = .043) and was significantly more effective than 1-Hz rTMS ( P = .043). Conclusions. A single session of excitatory deep brain rTMS over the right inferior frontal gyrus with H-coil significantly improves naming in right-handed chronic poststroke aphasic patients. This result is in line with the hypothesis of a positive, rather than detrimental, role of the right hemisphere in chronic aphasia due to a left-hemispheric stroke.

Dissociable Mechanisms of Cognitive Control in Prefrontal and Premotor Cortex

2007 ◽  
Vol 98 (6) ◽  
pp. 3638-3647 ◽  
Author(s):  
Christopher D. Chambers ◽  
Mark A. Bellgrove ◽  
Ian C. Gould ◽  
Therese English ◽  
Hugh Garavan ◽  
...  
Keyword(s):  
Response Inhibition ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Flanker Task ◽  
Inferior Frontal Gyrus ◽  
Premotor Cortex ◽  
Response Competition ◽  
Stop Signal ◽  
Stop Signal Task ◽  
The Right ◽  
Stimulation Of

Intelligent behavior depends on the ability to suppress inappropriate actions and resolve interference between competing responses. Recent clinical and neuroimaging evidence has demonstrated the involvement of prefrontal, parietal, and premotor areas during behaviors that emphasize conflict and inhibition. It remains unclear, however, whether discrete subregions within this network are crucial for overseeing more specific inhibitory demands. Here we probed the functional specialization of human prefrontal cortex by combining repetitive transcranial magnetic stimulation (rTMS) with integrated behavioral measures of response inhibition (stop-signal task) and response competition (flanker task). Participants undertook a combined stop-signal/flanker task after rTMS of the inferior frontal gyrus (IFG) or dorsal premotor cortex (dPM) in each hemisphere. Stimulation of the right IFG impaired stop-signal inhibition under conditions of heightened response competition but did not influence the ability to suppress a competing response. In contrast, stimulation of the right dPM facilitated execution but had no effect on inhibition. Neither of these results was observed during rTMS of corresponding left-hemisphere regions. Overall, our findings are consistent with existing evidence that the right IFG is crucial for inhibitory control. The observed double dissociation of neurodisruptive effects between the right IFG and right dPM further implies that response inhibition and execution rely on distinct neural processes despite activating a common cortical network.

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