Table 4.
Summary of potential improvements in speech and swallowing after using rTMS therapy in stroke patients in RCTs, meta-analyses (MA), and clinical trials (CT) with a valid measure of the methodological quality of clinical trials using PEDro.
| Study, Year | Stage of Stroke | Application Area, Frequency |
Outcome, Measures | Main Findings |
|---|---|---|---|---|
| Mottaghy et al. [107], 2006 PEDro: none |
MA | Wernicke’s Area Dominant Motor Cortex, TMS vs. rTMS |
simple picture naming task | Single-pulse TMS facilitates lexical processes due to a general pre-activation of language-related neuronal networks when delivered over Wernicke’s area. rTMS over Wernicke’s area also leads to brief facilitation of picture naming, possibly by shortening linguistic processing time. |
| Li et al. [108], 2020 PEDro:none |
MA | LF-rTMS, HF-rTMS |
SMD 95%CI | After rTMS with both low- and high-frequency, there was significant improvement in naming, while understanding and repetition did not change. Low-frequency rTMS has significant short-term importance in the subacute phase of a stroke. |
| Kakuda et al. [109], 2011 PEDro: none |
CT, n = 4, Chronic aphasia |
Inferior Frontal Gyrus (IFG), LF-rTMS |
ST, SLTA, SLTA-ST, WAB |
Combined LF-rTMS and intensive speech therapy (ST) is a safe and feasible therapeutic approach. Improved language function in post-stroke patients with motor-dominant aphasia. |
| Barwood et al. [110], 2013 PEDro: none |
RCT, n = 12, Chronic non-fluent aphasia |
Pre-central Gyrus Contralateral Hemisphere, Brodmann area 45 in Broca’s area, LF-rTMS |
Behavioral language measures | Changes observed up to 12 months post-intervention when compared to the placebo control group in naming performance, expressive language, and auditory comprehension. LF-rTMS has potential clinical application for language rehabilitation in chronic aphasia. |
| Abo et al. [111], 2012 PEDro: none |
CT, n = 24, Chronic non-fluent/fluent aphasia |
Inferior Frontal Gyrus (IGF), Superior Temporal Gyrus (STG), LF-rTMS |
ST | Significant improvement in listening comprehension, reading comprehension, and repetition in non-fluent aphasia patients. Significant improvement only in spontaneous speech in fluent aphasia patients. |
| Lopez-Romero et al. [105], 2019 PEDro: none |
RCT, n = 82, Chronic non-fluent aphasia |
Inferior Frontal Gyrus (IGF), LF-rTMS |
MRS, BI, BT |
rTMS applied to the inferior frontal gyrus is a safe therapeutic alternative in patients with non-fluent aphasia. Statistically significant differences in the Boston test of auditory compression, denomination, and praxis; also occurred on the 30th day in the naming domains and reading. |
| Hu et al. [112], 2018 PEDro: none |
RCT, n = No data, Chronic non-fluent aphasia |
Right Hemispheric Broca’s area, LF-rTMS, HF-rTMS |
WAB | LF-rTMS group exhibited marked improvement over the HF-rTMS group in spontaneous speech, auditory comprehension, and aphasia quotients. LF-rTMS produced immediate benefits that persisted long-term, while HF-rTMS only produced long-term benefits. |
| Waldowski et al. [106], 2012 PEDro: none |
RCT, n = 26, Early stroke aphasia |
Right Inferior Frontal Gyrus (RIGF), LF-rTMS |
CPNT, BDAE, ASRS |
rTMS subgroup with a lesion including the anterior part of the language area showed greater improvement primarily in naming reaction time 15 weeks after completion of the treatment. Improvement in functional communication abilities. LF-rTMS over the inferior frontal gyrus area in combination with speech and language therapy seems to be beneficial for patients with frontal language area damage, mostly long after after finishing stimulation. |
| Thiel et al. [113], 2013 PEDro: none |
RCT, n = 24, Early stroke aphasia |
Right Inferior Frontal Gyrus (RIGF), LF-rTMS |
AAT | Global Aachen Aphasia Test score was significantly higher in the rTMS group. Patients in the rTMS group activated proportionally more voxels in the left hemisphere after treatment than before (difference in activation volume index) compared with sham-treated patients. |
| Lim et al. [114], 2014 PEDro: 6/10 |
RCT, n = 47, Subacute stroke with dysphagia |
Pharyngeal Motor Cortex (PMC), LF-rTMS |
FDS, PTT, PAS, ASHA NOMS |
FDS and PAS for liquid during the first 2 weeks in the rTMS and neuromuscular electrical stimulation (NMES) groups were significantly higher than those in the conventional dysphagia therapy (CDT) group, but no significant differences were found between the rTMS and NMES group. No significant difference in mean changes of FDS and PAS for semi-solid, PTT, and ASHA NOMS. Results indicated that both low-frequency rTMS and NMES could induce early recovery from dysphagia; therefore, both could be useful therapeutic options for dysphagia stroke patients. |
Abbreviations: RCT: Randomized Controlled Trial; MA: Meta-Analysis; CT: Clinical Trial; SMD: Standardized Mean Difference; ST: Speech Test; SLTA: Standard Language Test of Aphasia; SLTA-ST: Supplementary Test of SLTA; WAB: The Japanese version of Western Aphasia Battery; MRS: Modified Rankin Scale; BI: Barthel Index; BT: Boston Test; CPNT: Computerized Picture Naming Test; BDAE: Boston Diagnostic Aphasia Test; ASRS: Aphasia Severity Rating Scale; AAT: Aachen Aphasia Test; FDS: Functional Dysphagia Scale; PTT: Pharyngeal Transit Time; PAS: Penetration–Aspiration Scale; ASHA NOMS: American Speech-Language Hearing Association National Outcomes Measurement System.