Original Contribution

Effects of Noninvasive Brain Stimulation on

Language Networks and Recovery in Early
Poststroke Aphasia
1. Alexander Thiel, MD,
2. Alexander Hartmann, MD,
3. Ilona Rubi-Fessen, MSc,
4. Carole Anglade, MSc,
5. Lutz Kracht, MD,
6. Nora Weiduschat, MD, MSc,
7. Josef Kessler, PhD,
8. Thomas Rommel, MD and
9. Wolf-Dieter Heiss, MD
+ Author Affiliations
1. From the Department of Neurology and Neurosurgery, McGill University, Montreal,
Canada (A.T., C.A.); Max Planck Institute for Neurological Research, Cologne,
Germany (L.K., N.W., J.K., W.-D.H.); RehaNova GmbH, Cologne, Germany (A.H.,
I.R.-F., T.R.); and Cornell University, New York, NY (N.W.).
1. Correspondence to Alexander Thiel, MD, Department of Neurology and
Neurosurgery, McGill University at Jewish General Hospital, 3755 Chemin Cote St,
Catherine, Montreal, QC H2E 1I2, Canada (E-mail alexander.thiel@mcgill.ca); or
Wolf-Dieter Heiss, MD, Max-Planck-Institute for Neurological Research, Gleueler
Str. 50, 50931 Cologne, Germany (E-mail wdh@nf.mpg.de).

Abstract
Background and PurposeModulation of activity in language networks using repetitive
transcranial magnetic stimulation (rTMS) may possibly support recovery from poststroke
aphasia. Case series and feasibility studies seem to indicate a therapeutic effect; however,
randomized sham-controlled, proof-of-principle studies relating clinical effects to activation
patterns are missing.

MethodsTwenty-four patients with subacute poststroke aphasia were randomized to a 10day protocol of 20-minute inhibitory 1 Hz rTMS over the right triangular part of the posterior
inferior frontal gyrus or sham stimulation, followed by 45 minutes of speech and language
therapy. Activity in language networks was measured with O-15-water positron emission
tomography during verb generation before and after treatment. Language performance was
assessed using the Aachen Aphasia Test battery.
ResultsThe primary outcome measure, global Aachen Aphasia Test score change, was
significantly higher in the rTMS group (t test, P=0.003). Increases were largest for subtest
naming (P=0.002) and tended to be higher for comprehension, token test, and writing
(P<0.1). 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 (t test, P=0.002).There was a moderate but significant linear
relationship between activation volume index change and global Aachen Aphasia Test score
change (r2=0.25; P=0.015).
ConclusionsTen sessions of inhibitory rTMS over the right posterior inferior frontal gyrus,
in combination with speech and language therapy, significantly improve language recovery in
subacute ischemic stroke and favor recruitment of left-hemispheric language networks.
Key Words:

plasticity

recovery

stroke

transcranial magnetic stimulation

treatment

Received December 20, 2012.

Accepted April 22, 2013.

2013 American Heart Association, Inc.