Treatment of dysphasia with rTMS and language therapy after childhood stroke: Multimodal imaging of plastic change

Helen L. Carlson, Zeanna Jadavji, Aleksandra Mineyko, Omar Damji, Jacquie Hodge, Jenny Saunders, Mia Hererro, Michele Nowak, Rebecca Patzelt, Anya Mazur-Mosiewicz, Frank P. MacMaster, Adam Kirton

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Expressive dysphasia accompanies left inferior frontal gyrus (IFG/Broca) injury. Recovery may relate to interhemispheric balance with homologous, contralesional IFG but is unexplored in children. We evaluated effects of inhibitory rTMS to contralesional IFG combined with intensive speech therapy (SLT). A 15 year-old, right-handed male incurred a left middle cerebral artery stroke. After 30 months, severe non-fluent dysphasia impacted quality of life. Language networks, neuronal metabolism and white matter pathways were explored using MRI. Language function was measured longitudinally. An intensive SLT program was combined with contralesional inhibitory rTMS of right pars triangularis. Procedures were well tolerated. Language function improved persisting to four months. Post-treatment fMRI demonstrated increased left perilesional IFG activations and connectivity at rest. Bilateral changes in inositol and glutamate metabolism were observed. Contralesional, inhibitory rTMS appears safe in childhood stroke-induced dysphasia. We observed clinically significant improvements after SLT coupled with rTMS. Advanced neuroimaging can evaluate intervention-induced plasticity.

Original languageEnglish
Pages (from-to)23-34
Number of pages12
JournalBrain and Language
Volume159
DOIs
StatePublished - 1 Aug 2016

Keywords

  • Diffusion
  • Dysphasia
  • MRI
  • MRS
  • Neuroimaging
  • Pediatric
  • Resting state
  • Speech
  • Stroke

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