The purpose of this research is to investigate whether repetitive transcranial magnetic stimulation (rTMS) can be used to improve speech in chronic stroke patients with nonfluent aphasia. rTMS allows non-invasive stimulation of human cortex. Slow (1 Hz) rTMS appears to decrease excitability in the targeted cortical region of interest (ROI) leading to measurable behavioral effects. A small 8-shaped coil (as will be used in the present study) affects primarily a cortical area of less than 2 x 2 cm. We have observed in fMRI studies that patients with nonfluent speech (slow, hesitant, poorly articulated, agranunatic speech) have excess blood flow (presumed abnormal increase in cortical excitability) in many right (R) perisylvian areas including R sensorimotor mouth, R Broca's homologue (BA 45) and R Wernicke's homologue(BA 22). Slow (1 Hz) rTMS will be used to suppress activation of specific ROls observed to have high blood flow (presumed overactivation) on fMRI. It is expected that suppression of activity in the directly targeted ROl will have an overall modulating effect on functionally connected elements of the distributed neural network for naming (and propositional speech) in chronic stroke patients with nonfluent aphasia, and will result in a behavioral improvement. Pilot data on four nonfluent aphasia patients support this claim and document the feasibility and safety of the study. Naming Ability (20 pictures of common objects) and reaction times are measured immediately pre- and immediately post- an rTMS treatment. There are two phases. Phase 1 includes aphasia patients (n=40) and age-matched normal controls (n=12). For normal controls, Phase 1 will provide information on the effect of slow rTMS on 7 language-related ROIs. For aphasia patients, Phase 1 will provide information regarding which of 5 ROIs is the most promising for more extensive rTMS treatment in Phase 2. Phase 2 (aphasia patients only) is a randomized, sham-controlled, incomplete crossover design. One group (n=20) receives 10 Real rTMS treatments over a two-week period; and one group (n=20), 10 Sham rTMS treatments over a two-week period. Only those who receive Sham treatments FIRST will be crossed over. It is hypothesized that 10 sessions of Real rTMS at 1 Hz given over a two week period to a specific ROl (e.g., R BA 45, supported from our pilot data) will significantly improve picture naming and propositional speech, when tested at 1-2 weeks and 2 months post- the last rTMS treatment, as compared to pre- Phase 2 testing. Sham rTMS to the same ROl is hypothesized to have no effect. This will be the first systematic rTMS study designed to improve speech in stroke patients with nonfluent aphasia. The implications could be far reaching regarding optimal treatment in aphasia with potential for combining current language therapies with rTMS to promote maximum recovery of language.

Agency
National Institute of Health (NIH)
Institute
National Institute on Deafness and Other Communication Disorders (NIDCD)
Type
Research Project (R01)
Project #
5R01DC005672-02
Application #
6607690
Study Section
Biobehavioral and Behavioral Processes 3 (BBBP)
Program Officer
Cooper, Judith
Project Start
2002-07-05
Project End
2005-06-30
Budget Start
2003-07-01
Budget End
2004-06-30
Support Year
2
Fiscal Year
2003
Total Cost
$307,972
Indirect Cost
Name
Boston University
Department
Neurology
Type
Schools of Medicine
DUNS #
604483045
City
Boston
State
MA
Country
United States
Zip Code
02118
Martin, Paula I; Treglia, Ethan; Naeser, Margaret A et al. (2014) Language improvements after TMS plus modified CILT: Pilot, open-protocol study with two, chronic nonfluent aphasia cases. Restor Neurol Neurosci 32:483-505
Papeo, Liuba; Pascual-Leone, Alvaro; Caramazza, Alfonso (2013) Disrupting the brain to validate hypotheses on the neurobiology of language. Front Hum Neurosci 7:148
Garcia, Gabriella; Norise, Catherine; Faseyitan, Olufunsho et al. (2013) Utilizing repetitive transcranial magnetic stimulation to improve language function in stroke patients with chronic non-fluent aphasia. J Vis Exp :e50228
Turkeltaub, Peter E; Benson, Jennifer; Hamilton, Roy H et al. (2012) Left lateralizing transcranial direct current stimulation improves reading efficiency. Brain Stimul 5:201-207
Naeser, Margaret A; Martin, Paula I; Ho, Michael et al. (2012) Transcranial magnetic stimulation and aphasia rehabilitation. Arch Phys Med Rehabil 93:S26-34
Turkeltaub, Peter E; Coslett, H Branch; Thomas, Amy L et al. (2012) The right hemisphere is not unitary in its role in aphasia recovery. Cortex 48:1179-86
Medina, Jared; Norise, Catherine; Faseyitan, Olufunsho et al. (2012) Finding the Right Words: Transcranial Magnetic Stimulation Improves Discourse Productivity in Non-fluent Aphasia After Stroke. Aphasiology 26:1153-1168
Naeser, Margaret A; Martin, Paula I; Theoret, Hugo et al. (2011) TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia. Brain Lang 119:206-13
Hamilton, Roy H; Sanders, Linda; Benson, Jennifer et al. (2010) Stimulating conversation: enhancement of elicited propositional speech in a patient with chronic non-fluent aphasia following transcranial magnetic stimulation. Brain Lang 113:45-50
Naeser, Margaret A; Martin, Paula I; Lundgren, Kristine et al. (2010) Improved language in a chronic nonfluent aphasia patient after treatment with CPAP and TMS. Cogn Behav Neurol 23:29-38

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