Abstract
BackgroundAlthough low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) has shown promise in the treatment of poststroke aphasia, the efficacy of high-frequency rTMS (HF-rTMS) has yet to be determined.PurposeWe investigated the efficacy of intermittent theta burst stimulation (iTBS) in ameliorating chronic non-fluent aphasia and compared it with that of LF-rTMS.MethodsWe randomly assigned patients with poststroke non-fluent aphasia to an ipsilesional iTBS (n = 29), contralesional 1-Hz rTMS (n = 27), or sham (n = 29) group. Each group received the rTMS protocol executed in 10 daily sessions over 2 weeks. We evaluated language function before and after the intervention by using the Concise Chinese Aphasia Test (CCAT).ResultsCompared with the sham group, the iTBS group exhibited significant improvements in conversation, description, and expression scores (P = 0.0004–0.031), which characterize verbal production, as well as in auditory comprehension, reading comprehension, and matching scores (P < 0.01), which characterize language perception. The 1-Hz group exhibited superior improvements in expression, reading comprehension, and imitation writing scores compared with the sham group (P < 0.05). The iTBS group had significantly superior results in CCAT total score, matching and auditory comprehension (P < 0.05) relative to the 1-Hz group.ConclusionOur study findings contribute to a growing body of evidence that ipsilesional iTBS enhances the language recovery of patients with non-fluent aphasia after a chronic stroke. Auditory comprehension was more preferentially enhanced by iTBS compared with the 1-Hz protocol. Our findings highlight the importance of ipsilesional modulation through excitatory rTMS for the recovery of non-fluent aphasia in patients with chronic stroke.Clinical Trial Registration:[www.ClinicalTrials.gov], identifier [NCT03059225].
Highlights
Stroke is a leading cause of disability and the third most frequent cause of death globally (Wade et al, 1986; Dionisio et al, 2018)
We investigated the efficacy of intermittent theta burst stimulation in ameliorating chronic non-fluent aphasia and compared it with that of LF-repetitive transcranial magnetic stimulation (rTMS)
Our study findings contribute to a growing body of evidence that ipsilesional intermittent theta burst stimulation (iTBS) enhances the language recovery of patients with non-fluent aphasia after a chronic stroke
Summary
Stroke is a leading cause of disability and the third most frequent cause of death globally (Wade et al, 1986; Dionisio et al, 2018). The goldstandard treatment for aphasia, requires active participation and repetition; it is usually associated with unsatisfactory recovery (Brady et al, 2016). Novel rehabilitation approaches such as neuromodulation with non-invasive brain stimulation, repetitive transcranial magnetic stimulation (rTMS), have opened a new era in neurorehabilitation (Hilari et al, 2012). According to the theory of long-term potentiation, long-term depression, and paradoxical functional facilitation (Kapur, 1996), rTMS harnesses neuroplasticity and ameliorates interhemispheric imbalance, leading to effective language recovery (Wu et al, 2000; Heiss and Thiel, 2006; Calautti et al, 2007; Cramer, 2008; Griffis et al, 2016; Dionisio et al, 2018). Low-frequency repetitive transcranial magnetic stimulation (LFrTMS) has shown promise in the treatment of poststroke aphasia, the efficacy of highfrequency rTMS (HF-rTMS) has yet to be determined.
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