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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

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Abstract

We provided an intervention to chronic post-stroke aphasic patients using low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) guided by a functional magnetic resonance imaging (fMRI) evaluation of language laterality, combined with intensive speech therapy (ST). We performed a single photon emission-computed tomography (SPECT) scan pre- and post-intervention and investigated the relationship between cerebral blood flow (CBF) and language function. Fifty right-handed chronic post-stroke aphasic patients were enrolled in the study. During their 11-day hospital admission, the patients received a 40-min session of 1-Hz LF-rTMS on the left or right hemisphere, according to language localization identified by the fMRI evaluation, and intensive ST daily for 10 days, except for Sunday. A SPECT scan and language evaluation by the Standard Language Test of Aphasia (SLTA) were performed at the time of admission and at 3 months following discharge. We calculated laterality indices (LIs) of regional CBF (rCBF) in 13 language-related Brodmann area (BA) regions of interest. In patients who received LF-rTMS to the intact right hemisphere (RH-LF-rTMS), the improvement in the total SLTA score was significantly correlated with the pre- and post-intervention change of LI (ΔLI) in BA44. In patients who received LF-rTMS to the lesional left hemisphere (LH-LF-rTMS), this association was not observed. Analyses of the SLTA subscales and rCBF ΔLI demonstrated that in the RH-LF-rTMS group, the SLTA Speaking subscale scores were significantly correlated with ΔLIs in BA11, 20, and 21, and the SLTA Writing subscale scores were significantly correlated with ΔLIs in BA6 and 39. Conversely, in the LH-LF-rTMS group, the SLTA Speaking subscale scores were correlated with ΔLI in BA10, and the SLTA Reading subscale scores were significantly correlated with ΔLIs in BA13, 20, 22, and 44. Our results suggest the possibility that fMRI-guided LF-rTMS combined with intensive ST may affect CBF and contribute to the improvement of language function of post-stroke aphasic patients. LF-rTMS to the non-lesional and lesional hemispheres showed a difference in the associations between language performance and CBF. The results indicate that more effective rTMS intervention needs to be explored for patients who show right hemisphere language activation in an fMRI language evaluation.

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Abbreviations

BA:

Brodmann area

fMRI:

Functional magnetic resonance imaging

IFG:

Inferior frontal gyrus

LF:

Low frequency

LH-LF-rTMS:

LF-rTMS to the lesional left hemisphere

LIs:

Laterality indices

PET:

O-15-water positron emission tomography

rCBF:

Regional cerebral blood flow

ROIs:

Region of interest

RH-LF-rTMS:

LF-rTMS to the lesional right hemisphere

rTMS:

Repetitive transcranial magnetic stimulation

SLTA:

The Standard Language Test of Aphasia

SMA:

Supplementary motor area

SPECT:

A single photon emission-computed tomography

ST:

Speech therapy

STG:

Superior temporal gyrus

∆LI:

The change ratio of the LIs

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Acknowledgments

The authors gratefully acknowledge the participation of the patients in the study. This work was supported by the Grant-in-Aid for Scientific Research from the Japan Society for the Promotion of Science.

Conflict of Interest

Takatoshi Hara, Masahiro Abo, MD, Kentaro Kobayashi, Motoi Watanabe, Wataru Kakuda and Atushi Senoo declare that they have no conflict of interest.

Compliance with Ethics Requirements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-Ku, Tokyo, 105-8461, Japan

    Takatoshi Hara, Masahiro Abo, Kentaro Kobayashi, Motoi Watanabe, Wataru Kakuda & Atushi Senoo

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  1. Takatoshi Hara
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  2. Masahiro Abo
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  3. Kentaro Kobayashi
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Correspondence to Masahiro Abo.

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Hara, T., Abo, M., Kobayashi, K. et al. Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation Combined with Intensive Speech Therapy on Cerebral Blood Flow in Post-Stroke Aphasia. Transl. Stroke Res. 6, 365–374 (2015). https://doi.org/10.1007/s12975-015-0417-7

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  • DOI: https://doi.org/10.1007/s12975-015-0417-7

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