Abstract
BackgroundSmall clinical trials have reported that low-frequency repetitive transcranial magnetic stimulation (rTMS) might improve language recovery in patients with aphasia after stroke. However, no systematic reviews or meta-analyses studies have investigated the effect of rTMS on aphasia. The objective of this study was to perform a meta-analysis of studies that explored the effects of low-frequency rTMS on aphasia in stroke patients.MethodsWe searched PubMed, CENTRAL, Embase, CINAHL, ScienceDirect, and Journals@Ovid for randomized controlled trials published between January 1965 and October 2013 using the keywords “aphasia OR language disorders OR anomia OR linguistic disorders AND repetitive transcranial magnetic stimulation OR rTMS”. We used fixed- and random-effects models to estimate the standardized mean difference (SMD) and a 95% CI for the language outcomes.ResultsSeven eligible studies involving 160 stroke patients were identified in this meta-analysis. A significant effect size of 1.26 was found for the language outcome severity of impairment (95% CI = 0.80 to 1.71) without heterogeneity (I2 = 0%, P = 0.44). Further analyses demonstrated prominent effects for the naming subtest (SMD = 0.52, 95% CI = 0.18 to 0.87), repetition (SMD = 0.54, 95% CI = 0.16 to 0.92), writing (SMD = 0.70, 95% CI = 0.19 to 1.22), and comprehension (the Token test: SMD = 0.58, 95% CI = 0.07 to 1.09) without heterogeneity (I2 = 0%). The SMD of AAT and BDAE comprehension subtests was 0.32 (95% CI = −0.08 to 0.72) with moderate heterogeneity (I2 = 32%,P = 0.22). The effect size did not change significantly even when any one trial was eliminated. None of the patients from the 7 included articles reported adverse effects from rTMS.ConclusionsLow-frequency rTMS with a 90% resting motor threshold that targets the triangular part of the right inferior frontal gyrus (IFG) has a positive effect on language recovery in patients with aphasia following stroke. Further well-designed studies with larger populations are required to ascertain the long-term effects of rTMS in aphasia treatment.
Highlights
Stroke is a primary cause of disability worldwide and contributes considerably to the global disease burden (WHO 2011)
The search terms were ‘‘aphasia OR language disorders OR anomia OR linguistic disorders AND repetitive transcranial magnetic stimulation OR rTMS.’’ The searches were limited to human studies that were written in English and published between January 1965 and October 2013
Study selection The following inclusion criteria were applied: (1) the patients were diagnosed with stroke, (2) the patients were adults, (3) $5 participants were recruited, (4) the focus was on the effects of rTMS on aphasic patients after stroke, (5) the outcome measures were reported with continuous scales that evaluated the degree of language impairment, and (6) the study was a randomized controlled trial
Summary
Stroke is a primary cause of disability worldwide and contributes considerably to the global disease burden (WHO 2011). One-third of all stroke patients develop aphasia [1,2]. Intensive speech and language therapy (SLT), one of the effective treatments for aphasia, has been demonstrated to improve outcomes for affected stroke patients [6]. A recent meta-analysis found no evidence that transcranial direct current stimulation (tDCS) enhanced SLT outcomes [8]. Small clinical trials have reported that low-frequency repetitive transcranial magnetic stimulation (rTMS) might improve language recovery in patients with aphasia after stroke. The objective of this study was to perform a meta-analysis of studies that explored the effects of low-frequency rTMS on aphasia in stroke patients
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