Table 1.
rTMS Studies in Aphasia
| Study | N | Lesion Location | Time Since Stroke | Aphasia Type(s) | Location(s) Stimulated | Stimulation Parameters | Outcome Measures | Results |
|---|---|---|---|---|---|---|---|---|
| Naeser et al., 2005a | 4 | Large left frontotemporal cortical/subcortical lesions (n=3); frontotemporal subcortical lesion with cortical sparing (n=1) | 5–11 years | Broca’s (n=2); anomic/conduction (n=1); global (n=1) | Right pars triangularis | 1 Hz rTMS; 90/MT; 10 daily sessions over two weeks | Boston Naming lest (BNI), Boston DiagnosticAphasia Examination (BDAE); Snodgrass and Vanderwart (S&V) picture naming | Improved accuracy and speeded reaction time for S&V items after 10 TMS sessions; improvement on BNT and Animal and Tool/Implement subtests of BDAE 2 and 8 months after stimulation |
| Naeser et al., 2005b* | 1 | Left frontotemporal subcortical lesion with cortical sparing | 6.5 years | Global | Best cortical region of interest (ROI) determined by stimulation of multiple left hemisphere targets; Right pars triangularis selected | 1 Hz rTMS; 90/MT; 10 daily sessions over two weeks | BNT, BDAE, Cognitive Linguistic Quick Test (CLQT) | Improvements in BNT and Animal and Tool/Implement subtests of BDAE as above; further improvement on BDAE and CLQT in speech therapy 1 year following stimulation |
| Martin et al., 2009 | 2 | Subjects 1&2: Large left frontotemporal cortical/subcortical lesions; Subject 2: Additional involvement of fibers under SMA, Wernicke’s area, and posterior middle frontal gyrus | 1.5 and 10 years | Nonfluent | ROI determined by stimulation of multiple targets; Right pars triangularis selected | 1 Hz rTMS; 90/MT; 10 daily sessions over two weeks | BNT, BDAE, Cookie Theft Picture Description, fMRI during overt naming task | Subject 1: Improvement on BNT, BDAE, and Cookie Theft; new perilesional left frontal activation on fMRI 16 months post-TMS; Subject 2: No significant language improvement or fMRI changes |
| Naeser et al., 2010 | 1 | Left temporal cortical/subcortical lesion; minor involvement of left inferior frontal gyrus | 2 years | Nonfluent | ROI determined by stimulation of multiple targets; Right pars triangularis selected | 1 Hz rTMS; 90/MT; 10 daily sessions over two weeks; patient started on CPAP | BDAE, BNT | Increased phrase length, auditory comprehension, and naming persisting 3 months, 6 months, and 2.4 years after stimulation |
| Hamilton et al., 2010 | 1 | Large left frontotemporal cortical/subcortical lesion | 7 years | Broca’s | ROI determined by stimulation of multiple targets; Right pars triangularis selected | 1 Hz rTMS; 90/MT; 10 daily sessions over two weeks | Western Aphasia Battery (WAB), BDAE, Cookie Theft Picture Description | Improved object and action naming and Cookie Theft. Persistent benefits at 2,6, and 10 months |
| Kakuda et al., 2010a | 4 | Left frontotemporal cortical lesion (n=2); frontal cortical lesion (n=1); left putamen (n=1) | 5–28 years | Motor-dominant (impaired speech). | Site determined by fMRI activation during naming task: left frontal (n=2) and right frontal (n=2). | 1 Hz rTMS; 90/MT; 10 sessions over six days | Japanese versions of WAB, Standard Language Test of Aphasia (SLTA), and Supplementary tests of SLTA (SLTA-ST) | Presumed improvement in WAB, SLTA, and SLTA-ST (no statistical analyses) |
| Kakuda et al., 2010b | 2 | Left MCA territory lesions | 7 months and 8 months | Sensory-dominant (impaired comprehension) | Wernicke’s area | 1 Hz rTMS; 90/MT; 10 sessions over six days; daily language therapy | Token test, Japanese SLTA | Presumed improvement in scores on Token test and some subtests of SLTA that persisted at 3 months (no statistical analyses). |
| Barwood et al., 2010 | 12 | Left MCA territory cortical/subcortical lesions | 2–6 years | Nonfluent | Right pars triangularis; subjects received real (n=6) or sham (n=6) stimulation | 1 Hz rTMS; 90/MT; 10 daily sessions over 10 days | BDAE, Cookie Theft, BNT, S&V. | Improved naming and picture description among subjects receiving real TMS but not sham; persistent effects 2 months after real stimulation. |
| Weiduschat et al., 2010 | 10 | Left posterior temporoparietal lesions (n=4);frontal cortical/subcortical lesions (n=3); subcortical lesions (n=2); entire left MCA territory (n=1) | 16 weeks | Wernicke’s (n=5); Broca’s (n=2); global (n=1); amnestic (n=1) | Right pars triangularis (study group, n=5), vertex (control control group, n=5) | 1 Hz rTMS; 90/MT; 10 daily sessions over two weeks; Speech and language therapy after each TMS session | Aachen Aphasia Test (AAT), PET activation during verb generation task | Improved AAT scores 2 weeks after stimulation in study patients but not control group; PET activation toward right hemisphere in control but not in treatment group 2 weeks after stimulation compared to baseline; no relationship between laterality shift and clinical improvement. |
*
Naeser et al., 2005b describes in further detail a patient previously reported in Naeser et al., 2005a