Effectiveness of Low-Frequency rTMS and Intensive Speech Therapy in Poststroke Patients with Aphasia: A Pilot Study Based on Evaluation by fMRI in Relation to Type of Aphasia

Abstract

AIM: To assess the safety and clinical efficacy of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with intensive speech therapy (ST) in poststroke patients with aphasia. SUBJECTS AND METHODS: Twenty-four patients with left-hemispheric stroke and aphasia were subjected. During 11-day hospitalization, each patient received 10 treatment sessions consisting of 40-min 1-Hz LF-rTMS and 60-min intensive ST, excluding Sundays. The scalp area for stimulation was selected based on the findings of fMRI with language tasks and the type of aphasia. LF-rTMS was applied to the inferior frontal gyrus (IGF) for patients with nonfluent aphasia and to the superior temporal gyrus (STG) for patients with fluent aphasia. RESULTS: On pretreatment fMRI, the most activated areas were in the left hemisphere (n=16) and right hemisphere (n=8). The types of aphasia were nonfluent (n=14) and fluent (n=10). The LF-rTMS was applied to the right STG (n=5), left STG (n=5), right IFG (n=11) and left IFG (n=3). Nonfluent aphasic patients showed significant improvement of auditory comprehension, reading comprehension and repetition. Fluent aphasic patients showed significant improvement in spontaneous speech only. CONCLUSION: The fMRI with aphasic type-based therapeutic LF-rTMS/intensive ST for chronic aphasia seems feasible and a potentially useful neurorehabilitative protocol.