Artikel
Contralateral inhibition of the motoric language area in left sided ischemia and its effect on language performance – a model for neurosurgical patients with aphasia
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Autoren
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Alexander Erich Hartmann
- Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Universität Witten/Herdecke, Köln, Deutschland
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Ilona Rubi-Fessen
- RehaNova Neurologische Rehabilitationsklinik, Köln, Deutschland
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Thomas Rommel
- RehaNova Neurologische Rehabilitationsklinik, Köln, Deutschland
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Alexander Thiel
- McGill University, Jewish General Hospital, Dept. of Neurosurgery, Montreal, Kanada
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Makoto Nakamura
- Krankenhaus Köln-Merheim, Klinikum der Universität Witten/Herdecke, Universität Witten/Herdecke, Köln, Deutschland
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Wolf Dieter Heiß
- Max Planck Institute für Stoffwechsel Forschung - MPI for Metabolism Research, and Universität zu Köln, Köln, Deutschland
| Veröffentlicht: | 4. Juni 2021 |
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Gliederung
Text
Objective: Repetitive transcranial 5Hz-magnetic stimulation (rTMS) supports and 1Hz rTMS impairs neuronal depolarization of cortical neurons. Both techniques are used to reinforce speech therapy (ST) and were tested by us in 2 randomized double blind sham controlled protocols.
Methods:
Protocol 1:
Right handed patients with left sided brain infarcts were treated over 2 weeks with daily ST, preceded by 20 min of inhibitory rTMS to the contralateral (right hemisphere) homologous Broca area. 15 pts. received sham stimulation and 15 verum rTMS at 1 Hz. Clinical speech capacity was tested before and after the protocol with the Aachener Aphasia Test (AAT).
Protocol 2:
63 pts. suffering from sub-acute ischemic stroke aphasia of the Cologne-Canadian randomized, double blind placebo controlled protocol (1, details see [1]) were divided into 3 groups and treated within 45 days after stroke over 2 weeks with either inhibitory rTMS (N = 20) (same protocol as in study 1), cathodal transcranial direct current stimulation (ctDCS) (N = 24) or sham (N = 19) over the right-hemispheric homologous Broca area as preceding adjuvant therapy to daily ST.
Test on progression at three language primary outcomes were performed on days 0 and 30 using the Boston Naming Test (BNT), Token Test (sentence comprehension) and Semantic Fluency test.
Results: In both protocols pts. treated with daily ST plus rTMS had at end of protocol a better speech performance (Naming, sentence comprehension) as pts. with sham treatment.
At day 30 there was a difference for naming (p = .010) and sentence comprehension tasks (p = .033). Naming scores of rTMS patients improved significantly more than Naming-scores of tDCS patients. The tDCS group improved more on the Token test. Per-protocol analyses (N=48) confirmed the beneficial effect of rTMS on naming recovery at Day 30 post-treatment.
Conclusion: In left sided ischemic aphasia of the postacute state speech therapy plus preceding repetitive transcranial magnet inhibition of the right sided homologous Broca area is an effective treatment. Cathodal direct current stimulation seems to be an alternative to rTMS. It seems possible that patients with neurosurgical interventions suffering from pre- or postoperative aphasia will also benefit. This should be evaluated in studies with aphasic patients suffering from craniectomy, posttraumatic state, subarachnoid hemorrhage, and other intracerebral lesions.
References
- 1.
- Zumbansen A, Black SE, Chen JL, J Edwards D, Hartmann A, Heiss WD, Lanthier S, Lesperance P, Mochizuki G, Paquette C, Rochon EA, Rubi-Fessen I, Valles J, Kneifel H, Wortman-Jutt S, Thiel A; NORTHSTAR-study group. Non-invasive brain stimulation as add-on therapy for subacute post-stroke aphasia: a randomized trial (NORTHSTAR). Eur Stroke J. 2020 Dec;5(4):402-13. DOI: 10.1177/2396987320934935
