Table 1.
Summary of Reviewed rTMS Studies from 2015–2019.
| Author | Participants | Study Design | Stimulation Type | Stimulation Location | Number of Treatment Sessions | Outcome Variables | Results |
|---|---|---|---|---|---|---|---|
| Hara et al., 2015 | 50 chronic | Exploratory | inhibitory low frequency rTMS (1Hz) | IFG for non-fluent aphasia, STG for fluent aphasia; stimulate hemisphere contralateral to that identified by fMRI as the compensatory language hemisphere (left or right) | 10 | SLTA; SPECT | Behavioral language measures correlate with changes in laterality index (LI) of regional cerebral blood flow measured via SPECT. When stimulate right hemisphere: total SLTA score correlated with LI change in BA 44; speaking subscale correlated with LI change in BA 11, 20, 21; writing subscale correlated with LI change in BA 6 and 39. When stimulate left hemisphere: LH stimulation: Speaking subscale correlated with LI change in BA10; reading subscale correlated with LI change in BA 13, 20, 22, 44 |
| Rubi-Fessen et al., 2015 | 30 subacute | Randomized, sham controlled | inhibitory low frequency rTMS (1Hz) | right IFG | 10 | Aachen Aphasia Test; Amsterdam-Nijmegen Everyday Language Test; picture naming; functional communication | rTMS led to significant improvement on all measures of linguistic skills and functional communication; 5/10 measures had greater improvement for real vs. sham; generalization to everyday communication observed |
| Yoon et al., 2015 | 20 subacute | Randomized, controlled | inhibitory low frequency rTMS (1Hz) | right IFG | 20 | WAB | Significant improvement in repetition and naming for the rTMS + speech therapy, but not for speech therapy alone |
| Harvey et al., 2017 | 9 chronic | Exploratory | inhibitory low frequency rTMS (1Hz) | right IFG | 10 | Picture naming; semantic fluency; fMRI | Naming improved within rTMS sessions; generalization to naming of novel pictures; naming improvement at 6 month follow-up. On fMRI, posterior shift in activation of right IFG from BA 45 to BA 6, 44, and 46 associated with long-lasting effects; increased left hemisphere recruitment for naming |
| Santos et al., 2017 | 13 chronic | Randomized, double blind, sham-controlled, cross over study | inhibitory low frequency rTMS (1Hz); anodal tDCS | tDCS: Left IFG rTMS: Right IFG |
1 rTMS, 1 tDCS, 1 sham | Picture naming | No statistically significant difference between A-tDCS, rTMS and sham stimulation in picture naming |
| Haghighi et al. 2018 | 12 subacute | Randomized, sham controlled | inhibitory low frequency rTMS (1Hz) | right IFG | 10 | WAB | Greater improvement for rTMS than sham for AQ, content, fluency, command comprehension, and repetition but not for auditory comprehension and naming |
| Ren et al. 2019 | 45 subacute | Randomized, sham controlled | inhibitory low frequency rTMS (1Hz) | right IFG or right posterior STG | 15 | WAB | rTMS of right IFG group had significantly greater increases in auditory comprehension, repetition, and AQ vs. sham group; rTMS of right STG group had significantly greater increases in repetition, spontaneous speech, and AQ vs. sham group |
| Rossetti et al. 2019 | 1 chronic | Case study | inhibitory low frequency rTMS (1Hz) | right IFG | 10 | Picture naming; Semantic and phonemic fluenc; Stroop test | Phonemic fluency increased immediately after rTMS, and gains continued to 2 month follow-up. Semantic fluency, naming, and Stroop test performance did not improve |
| Heikkinen et al. 2019 | 17 chronic | Randomized, sham controlled | inhibitory low frequency rTMS (1Hz) | right IFG | 20 | WAB; picture naming | Improvement associated with Intensive Language-Action Therapy (ILAT), but no effect of rTMS or effect of combining ILAT and rTMS |
| Zhang et al. 2017 | 1 subacute | Case study | excitatory, high frequency rTMS (5Hz) | left IFG | 10 | WAB; fMRI | WAB scores improved at 2 weeks and 2.5 months post-rTMS. fMRI showed a shift from right hemisphere activation to more focused activation in perilesional left hemisphere areas. Fractional anisotropy increased in left STG |
| Hara et al. 2017 | 8 chronic | Exploratory | inhibitory low frequency rTMS (1Hz) or excitatory high frequency rTMS (5Hz) | right IFG; use fNIRS lateralization information to determine whether low or high frequency stimulation group | 10 | SLTA; fNIRS | Both groups showed significant, comparable improvement on SLTA; fNIRS showed resolution of imbalance of interhemispheric inhibition in low frequency rTMS/left hemisphere activation group and activation of the target hemisphere in the high frequency rTMS /right hemisphere activation group |
| Hu et al. 2018 | 40 chronic | Randomized, sham controlled | inhibitory low frequency rTMS (1Hz) or excitatory high frequency rTMS (10Hz) | right IFG | 10 | WAB | Low frequency rTMS had immediate benefits that persisted long-term. High frequency rTMS had long-term but not immediate benefits. Low frequency rTMS group performed better than high frequency rTMS group immediately after treatment and at 2 months. High frequency group performed better than control group (but not sham group) at 2 months. Placebo effect with better immediate performance by sham than control group immediately after treatment |
| Griffis et al. (2016) | 8 chronic | Exploratory | excitatory iTBS | left IFG | 10 | Picture naming; Semantic fluency; COWAT; BDAE; functional communication; fMRI | Significant improvement in semantic fluency. fMRI showed increase in left IFG (IFG) activation and decrease in right IFG activation. Reduced connectivity from right to left IFG during covert verb generation. Reduction in right IFG activation was correlated with behavioral improvements in semantic fluency. No gray matter volume changes. |
| Szaflarski et al. (2018) | 12 chronic | Exploratory | excitatory iTBS | left fronto-temporal region | 10 | WAB; BNT; COWAT; Semantic Fluency; fMRI | Significant improvement on WAB-AQ correlated with decreased BOLD signal in left inferior parietal lobe. Significant improvement in naming correlated with decreased BOLD signal in right IFG. COWAT and SFT did not change significantly but trended toward improvement. |
| Harvey et al. (2019) | 11 chronic | Sham-controlled cross-over design | inhibitatory cTBS | right IFG | 1 cTBS, 1 sham | Picture naming | Relative to sham, cTBS improved naming of items that were inconsistently named at baseline but not those that were consistently named incorrectly for those with more severe baseline impairments. Baseline phonological but not semantic naming impairment severity was correlated with improved overall accuracy and with decreased phonological errors. |
| Georgiou et al. 2019 | 2 chronic | Case series | inhibitatory cTBS | right IFG | 10 | BDAE; narrative production; quality of life | Participant 1: improved comprehension and expressive language both post-treatment and at 3 month follow-up and improved overall quality of life. Participant 2: improved comprehension post-treatment that was maintained at 3 month follow-up, but declined on expressive language and overall quality of life |
| Vuksanović et al. 2015 | 1 chronic | Case study | excitatory iTBS and inhibitory cTBS | iTBS of left IFG; cTBS of right IFG | 15 | Picture naming; BDAE; Rey Auditory Verbal Learning Test | Improvements in propositional speech, semantic verbal fluency, auditory comprehension, naming, short-term verbal memory, and verbal learning |
Abbreviations: rTMS= repetitive transcranial magnetic stimulation; iTBS= intermittent theta bust stimulation; cTBS= continuous theta burst stimulation; IFG=inferior frontal gyrus; STG=superior temporal gyrus; fMRI=functional magnetic resonance imaging; fNIRS=functional near-infrared spectroscopy; SPECT= Single Photon Emission Computed Tomography; tDCS= transcranial direct current stimulation; WAB= Western Aphasia Battery; AQ=aphasia quotient; BNT= Boston Naming Test; BDAE= Boston Diagnostic Aphasia Examination; BA=Brodmann Area; SLTA=Standard Language Test of Aphasia; COWAT=Controlled Oral Word Association Test