Effects of Repetitive Transcranial Magnetic Stimulation on Stroke Patients with Aphasia: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

 WANGPu ^1,2 , ZHANGJia-qi ³ , YUJia-dan ³ , ZHANGBing-bing ³ , GUShang ³ , YANGLiu-yi ³ , YANGYong-hong ^1,2 , WANGLing ^1,2 ,  HECheng-qi ^1,2

1. Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Key Laboratory of Rehabilitation Medicine of Sichuan Province, 610041, China;
3. West China Medical School, Sichuan University, Chengdu 610041, China;

Corresponding author：

HECheng-qi, Email: hxkfhcq@126.com

Keywords：

Repetitive transcranial magnetic stimulation; Aphasia; Stroke; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20140239

Video：

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Objective To systematically review the effects of repetitive transcranial magnetic stimulation (rTMS) on stroke patients with aphasia. Methods Databases such as PubMed, EMbase, The Cochrane Library (Issue 6, 2014), CBM, CNKI, WanFang Data were searched up to June 2014, for randomized controlled trials (RCTs) about rTMS for stroke patients with aphasia. Two reviewers independently screened literature according to the exclusion and inclusion criteria, extracted data and assessed methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 9 RCTs involving 130 patients were included. The results of meta-analysis showed that compared with the control group, rTMS improved stoke patients' speech function after treatment (WMD=14.36, 95%CI 6.93 to 21.79, P=0.000 2). The results of descriptive analysis showed that, rTMS at Broadmann area 45 (1 Hz, 90% RMT, once 20 or 30 minutes, 2 or 3 weeks as a course with 2-day intervals) possibly had a positive long-term effect on post-stroke patients' speech function. Conclusion rTMS may positively improve stroke patients' speech function. Due to limited quantity and quality of the included studies, more large-scale, multicenter, high quality RCTs are needed to verify the above conclusion.

Citation： WANGPu, ZHANGJia-qi, YUJia-dan, ZHANGBing-bing, GUShang, YANGLiu-yi, YANGYong-hong, WANGLing, HECheng-qi. Effects of Repetitive Transcranial Magnetic Stimulation on Stroke Patients with Aphasia: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2014, 14(12): 1497-1503. doi: 10.7507/1672-2531.20140239 Copy

1.	Allen L, Mehta S, McClure JA, et al. Therapeutic interventions for aphasia initiated more than six months post stroke:a review of the evidence. Top Stroke Rehabil, 2012, 19(6):523-535.
2.	Bersano A, Burgio F, Gattinoni M, et al. Aphasia burden to hospitalized acute stroke patients:need for an early rehabilitation programme. Int J Stroke, 2009, 4(6):443-447.
3.	Shah, PP, Szaflarski JP, et al. Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation. Front Hum Neurosci, 2013, 7:888.
4.	高素荣, 主编.失语症.第2版.北京:北京大学医学出版社, 2006:191-206.
5.	Salter K, Teasell R, Bhogal S, et al. Module14:The Evidence-Based Review of Stroke Rehabilitation (EBRSR) reviews current practices in stroke rehabilitation. 2rd edition Available at:http://www.ebrsr.com July 2012.
6.	Naeser MA, Martin PI, Ho M, et al. Transcranial Magnetic Stimulation and Aphasia rehabilitaion. Arch Phys Med Rehabil, 2012, 93(1):26-34.
7.	Wong IS, Tsang HW. A review on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on post-stroke aphasia. Rev Neurosci, 2013, 24(1):105-114.
8.	World Health Organization. Cerebrovascular Disorder:A Clinical Research and Classification. Geneva:World Health Organization. 1978.
9.	Rossi S, Hallett M, Rossini PM, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophusiol, 2009, 120(12):2008-2039.
10.	Barwood CH, Murdoch BE, Whelan BM, et al. The effects of low frequency repetitive transcranial magnetic stimulation (rTMS) and sham condition rTMS on behavioural language in chronic non-fluent aphasia:Short term outcomes. Neuro Rehabilitation, 2011, 28(2):113-128.
11.	Barwood CH, Murdoch BE, Whelan BM, et al. Improved language performance subsequent to low-frequency rTMS in patients with chronic non-fluent aphasia post-stroke. Eur J Neurol, 2011, 18(7):935-943.
12.	Barwood CH, Murdoch BE, Whelan BM, et al. Modulation of N400 in chronic non-fluent aphasia using low frequency Repetitive Transcranial Magnetic Stimulation (rTMS). Brain Lang, 2011, 116(3):125-135.
13.	Weiduschat N, Thiel A, Rubi-Fessen A, et al. Effects of repetitive transcranial magnetic stimulation in aphasic:a randomized controlled pilot study. Stroke, 2011, 42(2):409-415.
14.	Waldowski K, Seniów J, Leśniak M, et al. Effect of low-frequency repetitive transcranial magnetic stimulation on naming abilities in early-stroke aphasic patients:a prospective, randomized, double-blind sham-controlled study. Scientific World Journal, 2012, 2012:1-8.
15.	Thiel A, Hartmann A, Rubi-Fessen I, et al. Effects of noninvasive brain stimulation on language networks and recovery in early post-stroke aphasia. Stroke, 2013, 44(8):2240-2246.
16.	Seniów J, Waldowski K, Leśniak M, et al. Transcranial magnetic stimulation combined with speech and language training in early aphasia rehabilitation:a randomized double-blind controlled pilot study. Top Stroke Rehabil, 2013, 20(3):250-261.
17.	Barwood CH, Murdoch BE, Riek S, et al. Long term language recovery subsequent to low frequency rTMS in chronic non-fluent Aphasia. Neuro Rehabilitation, 2013, 32(4):915-928.
18.	Mirowska-Guzel D, Gromadzka G, Seniow J, et al. Association between BDNF-196 G>A and BDNF-270 C>T poymorphisms, BDNF concentration, and rTMS-supported long-term rehabilitation outcome after ischemic stroke. Neuro Rehabilitation, 2013, 32(3):573-582.
19.	Physiotherapy Evidence Database (PEDro) (1999). PEDro scale. Retrieved November 3, 2010. Available at:http://www.pedro.org.au/english/downloads/pedro-scale/ .
20.	Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther, 2003; 83(8):713-721.
21.	曾宪涛, 包翠萍, 曹世义, 等. Meta分析系列之三:随机对照试验的质量评价工具.中国循证心血管杂志, 2013, 4(3):182-185.
22.	Cohen LG, Roth BJ, Nilsson J, et al. Effects of coil design on delivery of focal magnetic stimulation. Technical considerations. Electroencephalogr Clin Neurophysiol, 1990, 75(4):350-357.
23.	Mark SG, Robert HB, Transcranial Magnetic Stimulation in Clinical Psychiatry Beijing:Peking University Medical Press. 2010:1-41.
24.	Margaret AN, Paula IM, Hugo T, et al. TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia. Brain Lang, 2011, 119(3):206-213.
25.	Vuksanović J, Jelić MB, Milanović SD, et al. Improvement of language functions in a chronic non-fluent post-stroke aphasic patient following bilateral sequential theta burst magnetic stimulation. Neurocase, 2014. Available at:http://dx.doi.org/doi:10.1080/13554794.2014.890731.
26.	Talelli P, Greenwood RJ, Rothwell JC, et al. Exploring Theta Burst Stimulation as an intervention to improve motor recovery in chronic stroke. Clin Neurophysiol, 2007, 118(2):333-342.
27.	孔莉.脑卒中后不同类型失语症的自然恢复状况研究.中国康复医学杂志, 2006, 6(21):532-534.
28.	Naeser MA, Martin PI, Baker EH, et al. Overt propositional speech in chronic nonfluent aphasia studied with the dynamic susceptibility contrast fMRI method. Neuroimage, 2004, 22(1):29-41.
29.	程亦男, 汪洁, 宋为群, 等.低频重复经颅磁刺激治疗卒中后失语症的临床应用进展.中国脑血管病杂志, 2012, 9(11):604-607.
30.	Málly J. Non-invasive brain stimulation (rTMS and tDCS) in patients with aphasia:Mode of action at the cellular level. Brain Res Bull, 2013, 98:30-35.
31.	Kakuda W, Abo M, Kaito N, et al. Functional MRI-based therapeutic rTMS strategy for aphasic stroke patients:a case series pilot study. Int J Neurosci, 2010120(1):60-66.
32.	Huang YZ, Edwards M, Rounis E, et al. Theta burst stimulation report of the human motor cortex. Neuron, 2005, 20(45):201-206.

1. Allen L, Mehta S, McClure JA, et al. Therapeutic interventions for aphasia initiated more than six months post stroke:a review of the evidence. Top Stroke Rehabil, 2012, 19(6):523-535.
2. Bersano A, Burgio F, Gattinoni M, et al. Aphasia burden to hospitalized acute stroke patients:need for an early rehabilitation programme. Int J Stroke, 2009, 4(6):443-447.
3. Shah, PP, Szaflarski JP, et al. Induction of neuroplasticity and recovery in post-stroke aphasia by non-invasive brain stimulation. Front Hum Neurosci, 2013, 7:888.
4. 高素荣, 主编.失语症.第2版.北京:北京大学医学出版社, 2006:191-206.
5. Salter K, Teasell R, Bhogal S, et al. Module14:The Evidence-Based Review of Stroke Rehabilitation (EBRSR) reviews current practices in stroke rehabilitation. 2rd edition Available at:http://www.ebrsr.com July 2012.
6. Naeser MA, Martin PI, Ho M, et al. Transcranial Magnetic Stimulation and Aphasia rehabilitaion. Arch Phys Med Rehabil, 2012, 93(1):26-34.
7. Wong IS, Tsang HW. A review on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on post-stroke aphasia. Rev Neurosci, 2013, 24(1):105-114.
8. World Health Organization. Cerebrovascular Disorder:A Clinical Research and Classification. Geneva:World Health Organization. 1978.
9. Rossi S, Hallett M, Rossini PM, et al. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophusiol, 2009, 120(12):2008-2039.
10. Barwood CH, Murdoch BE, Whelan BM, et al. The effects of low frequency repetitive transcranial magnetic stimulation (rTMS) and sham condition rTMS on behavioural language in chronic non-fluent aphasia:Short term outcomes. Neuro Rehabilitation, 2011, 28(2):113-128.
11. Barwood CH, Murdoch BE, Whelan BM, et al. Improved language performance subsequent to low-frequency rTMS in patients with chronic non-fluent aphasia post-stroke. Eur J Neurol, 2011, 18(7):935-943.
12. Barwood CH, Murdoch BE, Whelan BM, et al. Modulation of N400 in chronic non-fluent aphasia using low frequency Repetitive Transcranial Magnetic Stimulation (rTMS). Brain Lang, 2011, 116(3):125-135.
13. Weiduschat N, Thiel A, Rubi-Fessen A, et al. Effects of repetitive transcranial magnetic stimulation in aphasic:a randomized controlled pilot study. Stroke, 2011, 42(2):409-415.
14. Waldowski K, Seniów J, Leśniak M, et al. Effect of low-frequency repetitive transcranial magnetic stimulation on naming abilities in early-stroke aphasic patients:a prospective, randomized, double-blind sham-controlled study. Scientific World Journal, 2012, 2012:1-8.
15. Thiel A, Hartmann A, Rubi-Fessen I, et al. Effects of noninvasive brain stimulation on language networks and recovery in early post-stroke aphasia. Stroke, 2013, 44(8):2240-2246.
16. Seniów J, Waldowski K, Leśniak M, et al. Transcranial magnetic stimulation combined with speech and language training in early aphasia rehabilitation:a randomized double-blind controlled pilot study. Top Stroke Rehabil, 2013, 20(3):250-261.
17. Barwood CH, Murdoch BE, Riek S, et al. Long term language recovery subsequent to low frequency rTMS in chronic non-fluent Aphasia. Neuro Rehabilitation, 2013, 32(4):915-928.
18. Mirowska-Guzel D, Gromadzka G, Seniow J, et al. Association between BDNF-196 G>A and BDNF-270 C>T poymorphisms, BDNF concentration, and rTMS-supported long-term rehabilitation outcome after ischemic stroke. Neuro Rehabilitation, 2013, 32(3):573-582.
19. Physiotherapy Evidence Database (PEDro) (1999). PEDro scale. Retrieved November 3, 2010. Available at:http://www.pedro.org.au/english/downloads/pedro-scale/ .
20. Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther, 2003; 83(8):713-721.
21. 曾宪涛, 包翠萍, 曹世义, 等. Meta分析系列之三:随机对照试验的质量评价工具.中国循证心血管杂志, 2013, 4(3):182-185.
22. Cohen LG, Roth BJ, Nilsson J, et al. Effects of coil design on delivery of focal magnetic stimulation. Technical considerations. Electroencephalogr Clin Neurophysiol, 1990, 75(4):350-357.
23. Mark SG, Robert HB, Transcranial Magnetic Stimulation in Clinical Psychiatry Beijing:Peking University Medical Press. 2010:1-41.
24. Margaret AN, Paula IM, Hugo T, et al. TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia. Brain Lang, 2011, 119(3):206-213.
25. Vuksanović J, Jelić MB, Milanović SD, et al. Improvement of language functions in a chronic non-fluent post-stroke aphasic patient following bilateral sequential theta burst magnetic stimulation. Neurocase, 2014. Available at:http://dx.doi.org/doi:10.1080/13554794.2014.890731.
26. Talelli P, Greenwood RJ, Rothwell JC, et al. Exploring Theta Burst Stimulation as an intervention to improve motor recovery in chronic stroke. Clin Neurophysiol, 2007, 118(2):333-342.
27. 孔莉.脑卒中后不同类型失语症的自然恢复状况研究.中国康复医学杂志, 2006, 6(21):532-534.
28. Naeser MA, Martin PI, Baker EH, et al. Overt propositional speech in chronic nonfluent aphasia studied with the dynamic susceptibility contrast fMRI method. Neuroimage, 2004, 22(1):29-41.
29. 程亦男, 汪洁, 宋为群, 等.低频重复经颅磁刺激治疗卒中后失语症的临床应用进展.中国脑血管病杂志, 2012, 9(11):604-607.
30. Málly J. Non-invasive brain stimulation (rTMS and tDCS) in patients with aphasia:Mode of action at the cellular level. Brain Res Bull, 2013, 98:30-35.
31. Kakuda W, Abo M, Kaito N, et al. Functional MRI-based therapeutic rTMS strategy for aphasic stroke patients:a case series pilot study. Int J Neurosci, 2010120(1):60-66.
32. Huang YZ, Edwards M, Rounis E, et al. Theta burst stimulation report of the human motor cortex. Neuron, 2005, 20(45):201-206.

Chinese Journal of Evidence-Based Medicine

Effects of Repetitive Transcranial Magnetic Stimulation on Stroke Patients with Aphasia: A Systematic Review

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