Introduction: Aphasia is a common symptom in stroke patients and is a factor that decreases the quality of life and the effectiveness of rehabilitation. There are some evidences for treating non-fluent aphasia with repetitive transcranial magnetic stimulation (rTMS). The purpose of this study is to compare the effect of rTMS for aphasia between patients with Broca’s area involved and non-involved patients.
Method: This is a retrospective study. We enrolled stroke patients with non-fluent aphasia who underwent rTMS within one year of onset. Aphasia type was evaluated using Korean Western Aphasia Battery (K-WAB). Patients with Broca’s area involvement were selected based on the magnetic resonance T1 weighted image (MR T1WI) of the brain. The MR T1WI was standardized by SPM 12 software and Brodmann area 44 and 45 were selected using Talairach coordinates. All subjects were divided to two groups of patients who had involvement Broca’s area (BA) and who had non-involvement of Broca’s area (NBA). The rTMS protocol was performed with inhibition of Broca’s area on the contralesional hemisphere (90% RMT, 1 Hz, total 1200 pulses) under the guide of neuronavigation. Ten session course of rTMS with language therapy was done. We compared K-WAB scores of pre- and post- rTMS in total and subgroups of BA and NBA. In addition, mean K-WAB scores were compared between BA and NBA groups. For receptive language, comprehension score was calculated as a percentage and for expressive language, sum of spontaneous speech, repetition and naming score was calculated as a percentage. All statistical analyses were performed using SPSS software. A p-value lower than 0.05 was considered as statistically significant.
Results: A total of 20 patients were enrolled in our study, including 18 men and 2 women. Their mean age was 55 ± 23.34 years. Of the twenty patients, 13 patients suffered from ischemic stroke, and 7 patients suffered from hemorrhagic stroke. There was no significant difference in characteristics between BA and NBA groups (Table 1). Within each groups, K-WAB scores of post- rTMS were compared statistically to pre- rTMS. The aphasia quotient (AQ), receptive language, expressive language, fluency, comprehension, repetition, and naming scores of post- rTMS were significantly increased in the total subjects (p<0.05) (Fig. 1). In the BA group, AQ, receptive language, expressive language, comprehension, repetition, and naming scores of post- rTMS were significantly improved (p<0.05). In the NBA group, AQ, receptive language, expressive language, fluency, comprehension, repetition, and naming scores of post- rTMS were significantly improved (p<0.05). Between two groups, there were no differences in AQ, receptive language, expressive language, fluency, comprehension, repetition and naming of pre- rTMS , post- rTMS and ΔK-WAB (Table 2).
Conclusion: rTMS was effective in non-fluent aphasia patients, but there was no significant difference between BA and NBA group. |
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Demographics of subjects
K-WAB scores of Pre- and post- rTMS in total subjects, Broca’s area involved group and Broca’s area non-involved group. (a) Scores of aphasia quotient, receptive language and expressive language. (b) Scores of fluency, comprehension, repetition and naming. BA; Broca’s area involved group, NBA; Broca’s area non-involved group, Asterisk means statistically significant (p<0.05)
K-WAB score comparison of Broca’s area involvement (BA) and Broca’s area non-involvement group (NBA).
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