Transcranial Magnetic Stimulation Improves Fluency in Non-Fluent Aphasia after Stroke (IN4-1.002)

Abstract

Objective: To determine whether repetitive transcranial magnetic stimulation (rTMS) improves speech fluency in individuals with chronic nonfluent aphasia, and to identify linguistic properties that mediate improved fluency in persons who respond to rTMS. Background Failure of spontaneously generated fluent speech is a significant source of functional impairment in many individuals with aphasia. Repetitive transcranial magnetic stimulation (rTMS) administered to the right inferior frontal gyrus (IFG) has been shown to induce improvements in naming ability in persons with chronic left hemisphere stroke and non-fluent aphasia. However, changes in fluency in aphasic subjects receiving rTMS have not been adequately explored. Design/Methods: Ten individuals with left hemisphere MCA strokes and mild to moderate non-fluent aphasia participated in the study. Before treatment, subjects were asked to describe the Cookie Theft picture scene in three separate sessions. In the treatment arm, subjects received 1200 pulses of 1 Hz rTMS daily for 10 days at a site that had previously been shown to elicit a patient-dependent optimal response to rTMS on a naming task. They repeated the task two months after treatment. Five of these subjects initially received sham stimulation instead of real TMS. Two months after sham treatment, these individuals entered into the treatment arm. Performance both at baseline and after stimulation was coded using Quantitative Production Analysis (Saffran, Berndt & Schwartz, 1989) and Correct Information Unit (Nicholas & Brookshire, 1993)analysis. Results: Real rTMS treatment resulted in a significant increase in multiple measures of discourse productivity compared to baseline performance. There was no significant increase in measures of sentence productivity or grammatical accuracy. There was no significant increase from baseline in the sham condition on any study measures. Conclusions: Stimulation of the right IFG in patients with chronic non-fluent aphasia can improve fluency, and does so specifically by facilitating discourse production, potentially reflecting improved lexical-semantic access. Disclosure: Dr. Hamilton has nothing to disclose. Dr. Medina has nothing to disclose. Dr. Norise has nothing to disclose. Dr. Turkeltaub has nothing to disclose. Dr. Coslett has nothing to disclose.