Effect of High Frequency Transcranial Magnetic Stimulation on Recovery of Chronic Post-Stroke Aphasia
Condition: Post Stroke Aphasia
MeSH terms: Stroke; Aphasia
Study type: Interventional

Summary: 
      high frequency excitatory rTMS applied over the dominant hemisphere in chronic post stroke
      aphasic patients to help the restoration of function by the left hemisphere
    

Detailed description: 
      Repetitive transcranial magnetic stimulation (rTMS) has been used in many studies as a novel
      intervention to treat disorders associated with stroke, including paralysis or dysphagia,
      hemispatial neglect, pain, and aphasia. Number of studies have demonstrated that
      low-frequency rTMS over the unaffected hemisphere can be useful for enhancing recovery in
      aphasic patients.. It is expected that application of high-frequency (facilitatory) rTMS over
      the dominant speech area would have a beneficial effect on improving speech performance.

      The aim of this study is to evaluate the effect of excitatory high frequency rTMS on recovery
      of aphasia in chronic aphasic patients due to cerebrovascular stroke. Twenty patients with
      post-stroke aphasia were enrolled in this study. Patients were selected from those attending
      the stroke clinic of Neurology department, Cairo University during the period from June 2020
      to November 2020. The protocol of the study was approved by the ethical committee of the
      Department of Neurology, Faculty of Medicine, Cairo University. The aim and procedures of the
      study were explained and written consent forms were taken from all patients prior to
      participation.

      The eligibility criteria were: chronic post stroke nonfluent aphasia due to first-ever
      ischemic stroke in the distribution of middle cerebral artery diagnosed clinically and
      documented by computed tomography or magnetic resonance imaging on the brain, right
      handedness, both sexes, age ranged from 33 to 66 years old, duration at least 4 months from
      stroke onset, patients not receiving speech therapy and educated at least 10 years of
      education.

      Exclusion criteria were: aphasia due to head injury or neurological disease other than
      stroke, other clinical forms of aphasia, unstable cardiac dysrhythmia or cardiac pacemaker,
      unstable or critically ill patients, current or history of epilepsy, skull wounds and
      pregnant females. Also patients with severe grade of weakness which interfere with writing
      ability.

      The severity of aphasia was assessed for every patient using the Aphasia Severity Rating
      Scale (ASRS). According to this scale, language deficits were recognized ranging from 0 to 5
      points.Every patient was then assessed for linguistic deficits using Kasr El-Eini Arabic
      Aphasia test (KAAT), which is a simple, rapid, standardized, valid, and reliable bedside test
      for Egyptian patients, literate and illiterate.

      Neuroimaging studies (computerized tomography (CT) and/or magnetic resonance imaging (MRI) of
      the brain) were done for all participants.

      Treatment procedures:

      Real rTMS was applied three times per week for 10 sessions. Fifty trains of 10-Hz
      stimulation, each lasting for 5 seconds with an intertrain interval of 15 seconds were given
      through a figure-of-8 coil (9-cm diameter loop) positioned over the left Broca's area of the
      affected hemisphere (25 trains over pars triangularis followed by 25 trains over pars
      opercularis.The intensity of stimulation was set at 80% of the resting motor threshold (rMT)
      for the first dorsal interosseous of unaffected hemisphere.Two parts of Broca's area were
      sequentially stimulated: the anterior part (pars triangularis-PTr) and the posterior part
      (pars opercularis-POp). To target the regions of interest precisely, the coil was positioned
      on the scalp according to the coordinates used by Gough et al.The anterior stimulation site
      was 2.5 cm posterior to the canthus along the canthus-tragus line and 3 cm superior to this
      line; the posterior stimulation site was 4.5 cm posterior and 6 cm superior to the
      canthus-tragus line. The stimulation was applied in the same session with 1000 pulses over
      pars triangularis followed by 1000 pulses over pars opercularis in left hemisphere.All
      patients were evaluated before, after the end of last session of rTMS and after one month
      with ASRS and KAAT. The outcome measures were collected and statistically analyzed
    

Intervention name(s): rTMS (repetitive transcranial magnetic stimulation )
Intervention type(s): Device
Intervention description(s): applying high frequency TMS over the damaged hemisphere in chronic post stroke aphasic patients
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment