Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this ...

University of Pennsylvania 

Analysis of error types provides useful information about the stages and processes involved in normal and aphasic word production. In picture naming, semantic errors (horse for goat) generally result from something having gone awry in lexical access such that the right concept was mapped to the wrong word. This study used the new lesion analysis technique known as voxel-based lesion-symptom mapping to investigate the locus of lesions that give rise to semantic naming errors. Semantic errors were obtained from 64 individuals with post-stroke aphasia, who also underwent high-resolution structural brain scans. Whole brain voxel-based lesion-symptom mapping was carried out to determine where lesion status predicted semantic error rate. The strongest associations were found in the left anterior to mid middle temporal gyrus. This area also showed strong and significant effects in further analyses that statistically controlled for deficits in pre-lexical, conceptualization processes that might have contributed to semantic error production. This study is the first to demonstrate a specific and necessary role for the left anterior temporal lobe in mapping concepts to words in production. We hypothesize that this role consists in the conveyance of fine-grained semantic distinctions to the lexical system. Our results line up with evidence from semantic dementia, the convergence zone framework and meta-analyses of neuroimaging studies on word production. At the same time, they cast doubt on the classical linkage of semantic error production to lesions in and around Wernicke's area.

Anterior temporal involvement in semantic word retrieval: voxel-based lesion-symptom mapping evidence from aphasia.

Analyse des types d&#39;erreur fournit des informations utiles sur les &eacute;tapes et les processus impliqu&eacute;s dans la production de la parole normale et aphasique. En nommant de photo, les erreurs s&eacute;mantiques (cheval de ch&egrave;vre) g&eacute;n&eacute;ralement r&eacute;sultent de quelque chose ayant qui a mal tourn&eacute; dans acc&egrave;s lexical tel que le bon concept a &eacute;t&eacute; mapp&eacute; sur le mauvais mot. Cette &eacute;tude a utilis&eacute; la technique d&#39;analyse nouvelle l&eacute;sion appel&eacute;e cartographie voxel-based l&eacute;sion-sympt&ocirc;me d&#39;enqu&ecirc;ter sur le locus des l&eacute;sions qui donnent lieu &agrave; des erreurs de noms s&eacute;mantiques. Les erreurs s&eacute;mantiques proviennent de 64 personnes atteintes d&#39;aphasie post-AVC, qui a &eacute;galement subissent les scanners du cerveau structurels haute r&eacute;solution. Cerveau entier voxel-based l&eacute;sion-sympt&ocirc;me cartographie a &eacute;t&eacute; effectu&eacute;e pour d&eacute;terminer o&ugrave; le statut de l&eacute;sion pr&eacute;dit taux d&#39;erreur s&eacute;mantique. Les plus fortes associations ont &eacute;t&eacute; trouv&eacute;es dans la gauche ant&eacute;rieur milieu gyrus temporal moyen. Ce domaine a &eacute;galement montr&eacute; des effets forts et significatifs dans des analyses plus pouss&eacute;es que statistiquement contr&ocirc;l&eacute;e des d&eacute;ficits dans les processus de conceptualisation pre-lexical, qui aurait pu contribuer &agrave; la production de l&#39;erreur s&eacute;mantique. Cette &eacute;tude est la premi&egrave;re &agrave; d&eacute;montrer un r&ocirc;le sp&eacute;cifique et n&eacute;cessaire du lobe temporal ant&eacute;rieur gauche lors du mappage des concepts avec les mots en production. Nous &eacute;mettons l&#39;hypoth&egrave;se que ce r&ocirc;le consiste &agrave; acheminer des distinctions s&eacute;mantiques &agrave; grain fin au syst&egrave;me lexical. Nos r&eacute;sultats s&#39;alignent avec preuve de d&eacute;mence s&eacute;mantique, le cadre de zone de convergence et m&eacute;ta-analyses d&#39;&eacute;tudes de neuroimagerie sur production de la parole. Dans le m&ecirc;me temps, ils en doute le lien classique de production erreur s&eacute;mantique aux l&eacute;sions dans et autour d&#39;aire de Wernicke.

Une implication temporelle ant&eacute;rieure en r&eacute;cup&eacute;ration mot s&eacute;mantique : preuve de cartographie voxel-based l&eacute;sion-sympt&ocirc;me de l&#39;aphasie.

Analisi dei tipi di errore fornisce utili informazioni sulle fasi e processi coinvolti nella produzione di parola normale e afasica. Nella foto di denominazione, errori semantici (cavallo per capra) generalmente il risultato di qualcosa dopo essere andato storto in accesso lessicale tale che il concetto di diritto &egrave; stato mappato la parola sbagliata. Questo studio ha usato la nuova tecnica di analisi di lesione conosciuta come mapping di voxel-based lesione-sintomo per indagare il locus delle lesioni che danno luogo a errori di semantica dei nomi. Gli errori di semantica sono stati ottenuti da 64 persone con afasia post-ictus, che sub&igrave; anche ad alta risoluzione scansioni cerebrali strutturali. Mappatura voxel-based lesione-sintomo intero cervello &egrave; stata condotta per determinare dove lo status di lesione previsto tasso di errore di semantica. Le associazioni pi&ugrave; forti sono state trovate nella parte di sinistra anteriore met&agrave; giro temporale medio. Questa zona ha mostrato anche effetti forti e significativi in ulteriore analisi che statisticamente controllata per deficit nei processi di concettualizzazione pre-lexical, che potrebbero aver contribuito alla produzione di errore semantico. Questo studio &egrave; il primo a dimostrare un ruolo specifico e necessario per il sinistro dei lobi temporali anteriori nella mappatura di concetti per parole in produzione. Ipotizziamo che questo ruolo consiste nel trasporto di distinzioni semantiche fine al sistema lessicale. I nostri risultati in linea con la prova da demenza semantica, il quadro di zona di convergenza e meta-analisi di studi di neuroimaging sulla produzione di parola. Allo stesso tempo, hanno messo in dubbio il collegamento classico di produzione errore semantico per lesioni e dintorni area di Wernicke.

Coinvolgimento temporale anteriore in retrieval semantico della parola: prove di mappatura voxel-based lesione-sintomo da afasia.

Although evidence suggests that patients with left hemisphere strokes and non-fluent aphasia who receive 1Hz repetitive transcranial magnetic stimulation (rTMS) over the intact right inferior frontal gyrus experience persistent benefits in naming, it remains unclear whether the effects of rTMS in these patients generalize to other language abilities. We report a subject with chronic non-fluent aphasia who showed stable deficits of elicited propositional speech over the course of 5 years, and received 1200 pulses of 1Hz rTMS daily for 10 days at a site identified as being optimally responsive to rTMS in this patient. Consistent with prior studies there was improvement in object naming, with a statistically significant improvement in action naming. Improvement was also demonstrated in picture description at 2, 6, and 10 months after rTMS with respect to the number of narrative words and nouns, sentence length, and use of closed class words. Compared to his baseline performance, the patient showed significant improvement on the Western Aphasia Battery (WAB) subscale for spontaneous speech. These findings suggest that manipulation of the intact contralesional cortex in patients with non-fluent aphasia may result in language benefits that generalize beyond naming to include other aspects of language production.

Stimulating conversation: enhancement of elicited propositional speech in a patient with chronic non-fluent aphasia following transcranial magnetic stimulation.

Bien que la preuve indique que recevant avec des traits de l&#39;h&eacute;misph&egrave;re gauche et aphasie non fluente 1Hz la stimulation magn&eacute;tique transcr&acirc;nienne r&eacute;p&eacute;titive (SMTr) sur l&#39;intact droite gyrus frontal ressentir des bienfaits persistants en nommant, on ignore si les effets de la SMTr chez ces patients se g&eacute;n&eacute;raliser aux autres capacit&eacute;s linguistiques. Nous rapportons un sujet avec l&#39;aphasie non fluente chronique qui a montr&eacute; des d&eacute;ficits stables de discours propositionnel ont incit&eacute; au cours des 5 ans et a re&ccedil;u 1200 impulsions de 1Hz SMTr par jour pendant 10 jours &agrave; un site identifi&eacute; comme &eacute;tant parfaitement adapt&eacute; aux SMTr chez ce patient. Compatible avec les &eacute;tudes ant&eacute;rieures, il y a am&eacute;lioration en objet d&#39;affectation de noms, avec une am&eacute;lioration statistiquement significative dans l&#39;action d&#39;affectation de noms. Am&eacute;lioration a &eacute;galement &eacute;t&eacute; d&eacute;montr&eacute; dans la description de la photo &agrave; 2, 6 et 10 mois apr&egrave;s la fermeture de TMC en ce qui concerne le nombre de mots narratives et noms, dur&eacute;e de la peine et l&#39;utilisation de mots de la classe. Par rapport &agrave; sa performance de la ligne de base, le patient a montr&eacute; une am&eacute;lioration significative sur la sous-&eacute;chelle de Western aphasie batterie (WAB) de parole spontan&eacute;e. Ces r&eacute;sultats sugg&egrave;rent que manipulation du cortex CONTRALESIONNELS intacte chez les patients avec aphasie non fluente peut entra&icirc;ner des avantages de langage qui g&eacute;n&eacute;ralisent au-del&agrave; de nommage d&#39;inclure d&#39;autres aspects de la production du langage.

Stimuler la conversation : mise en valeur d&#39;une expression propositionnelle stimul&eacute;e chez un patient pr&eacute;sentant l&#39;aphasie non fluente chronique suite &agrave; la stimulation magn&eacute;tique transcr&acirc;nienne.

Anche se l&#39;evidenza suggerisce che i pazienti con afasia non-fluente ed emisfero sinistro ictus che ricevono 1Hz stimolazione magnetica transcranica ripetitiva (rTMS) sopra il giro frontale inferiore destra intatto esperienza benefici persistenti nella denominazione, rimane poco chiaro se gli effetti della rTMS in questi pazienti generalizzano ad altre abilit&agrave; linguistiche. Riportiamo un soggetto con afasia non-fluente cronica che ha mostrato deficit stabile del discorso proposizionale raccolse nel corso dei 5 anni e ha ricevuto 1200 impulsi di 1Hz rTMS al giorno per 10 giorni presso un sito identificato come sensible a reagire in modo ottimale a rTMS in questo paziente. Coerente con studi precedenti c&#39;&egrave; stato miglioramento in oggetto di denominazione, con un miglioramento statisticamente significativo nella denominazione di azione. Miglioramento &egrave; stato dimostrato anche nella descrizione della foto a 2, 6 e 10 mesi dopo la chiusura di rTMS per quanto riguarda il numero di parole narrativi e sostantivi, lunghezza della frase e uso di parole di classe. Rispetto alle sue prestazioni di base, il paziente ha mostrato un miglioramento significativo sulle subscale Western Aphasia Battery (WAB) per discorso spontaneo. Questi risultati suggeriscono che i benefici di lingua che generalizzano di l&agrave; di denominazione per includere altri aspetti della produzione in lingua possa provocare manipolazione della corteccia intatta contralesional in pazienti con afasia non-fluente.

Stimolare la conversazione: valorizzazione del discorso proposizionale raccolse in un paziente con afasia non-fluente cronica dopo la stimolazione magnetica transcranica.

Semantic errors in aphasia (e.g., naming a horse as "dog") frequently arise from faulty mapping of concepts onto lexical items. A recent study by our group used voxel-based lesion-symptom mapping (VLSM) methods with 64 patients with chronic aphasia to identify voxels that carry an association with semantic errors. The strongest associations were found in the left anterior temporal lobe (L-ATL), in the mid- to anterior MTG region. The absence of findings in Wernicke's area was surprising, as were indications that ATL voxels made an essential contribution to the post-semantic stage of lexical access. In this follow-up study, we sought to validate these results by re-defining semantic errors in a manner that was less theory dependent and more consistent with prior lesion studies. As this change also increased the robustness of the dependent variable, it made it possible to perform additional statistical analyses that further refined the interpretation. The results strengthen the evidence for a causal relationship between ATL damage and lexically-based semantic errors in naming and lend confidence to the conclusion that chronic lesions in Wernicke's area are not causally implicated in semantic error production.

Support for anterior temporal involvement in semantic error production in aphasia: new evidence from VLSM.

Les erreurs s&eacute;mantiques en aphasie (p. ex., nommant un cheval comme &laquo; chien &raquo;) surviennent fr&eacute;quemment d&#39;une cartographie des concepts sur les items lexicaux d&eacute;fectueuse. Une &eacute;tude r&eacute;cente men&eacute;e par notre groupe utilis&eacute; les m&eacute;thodes de mappage (VLSM) l&eacute;sion-sympt&ocirc;me voxel-bas&eacute; avec 64 patients aphasiques chroniques pour identifier voxels qui transportent une association avec des erreurs s&eacute;mantiques. Les plus fortes associations trouv&eacute;es dans le lobe temporal ant&eacute;rieur gauche (L-ATL), dans le vers la r&eacute;gion ant&eacute;rieure de MTG. L&#39;absence de r&eacute;sultats dans l&#39;aire de Wernicke est &eacute;tonnant, comme l&#39;indiquait qu&#39;ATL voxels apport&eacute; une contribution essentielle &agrave; l&#39;&eacute;tape de post-semantic d&#39;acc&egrave;s lexical. Dans cette &eacute;tude de suivi, nous avons cherch&eacute; &agrave; valider ces r&eacute;sultats en red&eacute;finissant les erreurs s&eacute;mantiques d&#39;une mani&egrave;re qui &eacute;tait moins th&eacute;orie d&eacute;pendante et plus compatible avec les &eacute;tudes pr&eacute;alables de l&eacute;sion. Comme ce changement a &eacute;galement augment&eacute; la robustesse de la variable d&eacute;pendante, elle a permis d&#39;effectuer des analyses statistiques suppl&eacute;mentaires que l&#39;interpr&eacute;tation de peaufinage. Les r&eacute;sultats renforcement les preuves d&#39;un lien de causalit&eacute; entre le dommage de l&#39;ATL et lexicalement bas&eacute;e sur les erreurs s&eacute;mantiques en nommant et donnent confiance &agrave; la conclusion que les l&eacute;sions chroniques dans l&#39;aire de Wernicke ne sont pas causalement impliqu&eacute;es dans la production de l&#39;erreur s&eacute;mantique.

Appui &agrave; la participation de temporale ant&eacute;rieure en production erreur s&eacute;mantique dans l&#39;aphasie : new evidence from VLSM.

Gli errori di semantica in afasia (ad es., nome di un cavallo come &quot;cane&quot;) si verificano frequentemente da difettoso mappatura di concetti su elementi lessicali. Un recente studio condotto dal nostro gruppo utilizzati metodi di mapping (VLSM) sintomo-lesione voxel-based con 64 pazienti con afasia cronica per identificare voxels che trasportano un&#39;associazione con gli errori di semantica. Le associazioni pi&ugrave; forti sono state trovate nel lobo temporale anteriore sinistro (L-ATL), nella met&agrave; - alla regione anteriore di MTG. L&#39;assenza di risultati nell&#39;area di Wernicke era sorprendente, come indicazioni che i voxel ATL ha fatto un contributo essenziale alla fase post-semantic di accesso lessicale. In questo studio di follow-up, abbiamo cercato di validare questi risultati da ridefinisce gli errori di semantica in un modo che &egrave; stato meno teoria dipendente e pi&ugrave; coerenza con gli studi di lesione preventiva. Come questo cambiamento anche aumentato la robustezza della variabile dipendente, ha reso possibile eseguire ulteriori analisi statistiche che ulteriormente affinato l&#39;interpretazione. I risultati rafforzare l&#39;evidenza di un nesso causale tra danno ATL e gli errori di semantica basata su lessicalmente nella denominazione e dare fiducia alla conclusione che lesioni croniche nell&#39;area di Wernicke non sono causalmente implicati nella produzione di errore semantico.

Supporto per coinvolgimento temporale anteriore nella produzione di errore semantico in afasia: nuova prova da VLSM.

It is thought that semantic memory represents taxonomic information differently from thematic information. This study investigated the neural basis for the taxonomic-thematic distinction in a unique way. We gathered picture-naming errors from 86 individuals with poststroke language impairment (aphasia). Error rates were determined separately for taxonomic errors ("pear" in response to apple) and thematic errors ("worm" in response to apple), and their shared variance was regressed out of each measure. With the segmented lesions normalized to a common template, we carried out voxel-based lesion-symptom mapping on each error type separately. We found that taxonomic errors localized to the left anterior temporal lobe and thematic errors localized to the left temporoparietal junction. This is an indication that the contribution of these regions to semantic memory cleaves along taxonomic-thematic lines. Our findings show that a distinction long recognized in the psychological sciences is grounded in the structure and function of the human brain.

Neuroanatomical dissociation for taxonomic and thematic knowledge in the human brain.

On croit que la m&eacute;moire s&eacute;mantique repr&eacute;sente des informations taxonomiques diff&eacute;remment des informations th&eacute;matiques. On a &eacute;tudi&eacute; les bases neurales de la distinction taxonomique-th&eacute;matique de fa&ccedil;on unique. Nous nous sommes r&eacute;unis les erreurs d&#39;appellation des photo de 86 personnes avec trouble du langage poststroke (aphasie). Taux d&#39;erreur ont &eacute;t&eacute; d&eacute;termin&eacute;s s&eacute;par&eacute;ment pour Erreurs taxinomiques (&quot;poire&quot; en r&eacute;ponse &agrave; apple) et th&eacute;matiques (&quot;ver&quot; en r&eacute;ponse &agrave; apple), et leur variance commune a r&eacute;gress&eacute; de chaque mesure. Avec les l&eacute;sions segment&eacute;es normalis&eacute;e selon un mod&egrave;le commun, nous avons effectu&eacute; de voxel-bas&eacute; de l&eacute;sion-sympt&ocirc;me de cartographie s&eacute;par&eacute;ment sur chaque type d&#39;erreur. Nous avons trouv&eacute; que les erreurs taxinomiques localis&eacute;e &agrave; la gauche anterior temporal lobe et th&eacute;matiques Erreurs localis&eacute;es &agrave; la jonction temporo gauche. Il s&#39;agit d&#39;une indication selon laquelle la contribution de ces r&eacute;gions &agrave; la m&eacute;moire s&eacute;mantique se fend le long de lignes th&eacute;matiques-taxonomiques. Nos r&eacute;sultats montrent qu&#39;une distinction depuis longtemps reconnue en sciences psychologiques repose sur la structure et le fonctionnement du cerveau humain.

Dissociation neuroanatomique aux connaissances taxonomiques et th&eacute;matiques dans le cerveau humain.

Si pensa che memoria semantica rappresenta informazioni tassonomiche diversamente dalle informazioni tematiche. Questo studio ha indagato la base neurale per la distinzione tassonomica tematica in un modo unico. Abbiamo raccolto foto di denominazione errori da 86 individui con disabilit&agrave; poststroke linguaggio (afasia). Tassi di errore sono stati determinati separatamente per errori tassonomiche (&quot;pera&quot; in risposta ad apple) e tematiche (&quot;verme&quot; in risposta ad apple), e loro varianza condivisa era regredito fuori di ogni misura. Con le lesioni segmentate normalizzate a un modello comune, abbiamo effettuato voxel-based lesione-sintomo mappatura separatamente su ogni tipo di errore. Abbiamo trovato che errori tassonomici localizzate al lobo temporale anteriore sinistro e tematiche errori localizzati alla giunzione tempoparietale sinistra. Questa &egrave; un&#39;indicazione che il contributo di queste regioni di memoria semantica si fende lungo linee tassonomiche tematiche. I nostri risultati mostrano che una distinzione molto tempo riconosciuta nelle scienze psicologiche &egrave; radicata nella struttura e nella funzione del cervello umano.

Dissociazione neuroanatomiche per conoscenza tassonomica e tematica nel cervello umano.

Neurologists and aphasiologists have debated for over a century whether right hemisphereÂ recruitment facilitates or impedes recovery from aphasia. Here we present a well-characterized patient with sequential left and right hemisphere strokes whose case substantially informs this debate. A 72-year-old woman with chronic nonfluent aphasia was enrolled in a trial of transcranial magnetic stimulation (TMS). She underwent 10 daily sessions of inhibitory TMS to the right pars triangularis. Brain activity was measured during picture naming using functional magnetic resonance imaging (fMRI) prior to TMS exposure and before and after TMS on the first day of treatment. Language and cognition were tested behaviorally three times prior to treatment, and at 2 and 6Â months afterward. Inhibitory TMS to the right pars triangularis induced immediate improvement in naming, which was sustained 2Â months later. fMRI confirmed a local reduction in activity at the TMS target, without expected increased activity in corresponding left hemisphere areas. Three months after TMS, the patient suffered a right hemisphere ischemic stroke, resulting in worsening of aphasia without other clinical deficits. Behavioral testing 3Â months later confirmed that language function was impacted more than other cognitive domains. The paradoxical effects of inhibitory TMS and the stroke to the right hemisphere demonstrate that even within a single patient, involvement of some right hemisphere areas may support recovery, while others interfere. The behavioral evidence confirms that compensatory reorganization occurred within the right hemisphere after the original stroke. No support is found for interhemispheric inhibition, the theoretical framework on which most therapeutic brain stimulation protocols for aphasia are based.

The right hemisphere is not unitary in its role in aphasia recovery.

Neurologues et aphasiologists ont d&eacute;battu pour plus d&#39;un si&egrave;cle si bon h&eacute;misph&egrave;re recrutement favorise ou entrave la r&eacute;cup&eacute;ration de l&#39;aphasie. Nous pr&eacute;sentons ici un patient bien caract&eacute;ris&eacute; avec des traits s&eacute;quentielle h&eacute;misph&egrave;re gauche et droit dont le cas informe substantiellement ce d&eacute;bat. Une femme de 72 ans avec aphasie nonfluent chronique &eacute;tait inscrit &agrave; une &eacute;preuve de stimulation magn&eacute;tique transcr&acirc;nienne (SMT). Elle a subi 10 s&eacute;ances quotidiennes de TMS inhibitrice &agrave; la droite de pars triangularis. Activit&eacute; c&eacute;r&eacute;brale a &eacute;t&eacute; mesur&eacute;e au cours de l&#39;image &agrave; l&#39;aide de l&#39;imagerie par r&eacute;sonance magn&eacute;tique fonctionnelle (IRMf) avant l&#39;exposition au TMS et avant et apr&egrave;s les TMS sur le premier jour du traitement. Langage et cognition ont &eacute;t&eacute; test&eacute;s sur le plan comportemental trois fois avant le traitement et &agrave; 2 et 6 mois par la suite. TMS inhibitrice &agrave; la droite de pars triangularis induit une am&eacute;lioration imm&eacute;diate en nommant, qui a &eacute;t&eacute; soutenues &agrave; 2 mois plus tard. IRMf ont confirm&eacute; une r&eacute;duction locale en activit&eacute; sur la cible TMS, sans activit&eacute; accrue dans les zones correspondantes d&#39;h&eacute;misph&egrave;re gauche. Trois mois apr&egrave;s le TMS, le patient a subi un accident vasculaire c&eacute;r&eacute;bral isch&eacute;mique h&eacute;misph&egrave;re droit, ayant pour r&eacute;sultat une aggravation de l&#39;aphasie sans autres d&eacute;ficits cliniques. Behavioral essais 3 mois plus tard confirm&eacute; que fonction de la langue a &eacute;t&eacute; touch&eacute;e plus que les autres domaines cognitifs. Les effets paradoxaux de TMS inhibitrices et la course &agrave; l&#39;h&eacute;misph&egrave;re droit d&eacute;montrent que m&ecirc;me au sein d&#39;un seul patient, la participation de certaines r&eacute;gions de l&#39;h&eacute;misph&egrave;re droit peut prendre en charge r&eacute;cup&eacute;ration, tandis que d&#39;autres s&#39;immiscer. La preuve comportementale confirme que compensatoire r&eacute;organisation a eu lieu au sein de l&#39;h&eacute;misph&egrave;re droit apr&egrave;s le stroke d&#39;origine. Aucune prise en charge ne se trouve pour l&#39;inhibition interh&eacute;misph&eacute;rique, le cadre th&eacute;orique sur laquelle reposent les protocoles de stimulation de cerveau plus th&eacute;rapeutiques pour l&#39;aphasie.

L&#39;h&eacute;misph&egrave;re droit n&#39;est pas unitaire dans son r&ocirc;le dans la r&eacute;cup&eacute;ration de l&#39;aphasie.

Neurologi e aphasiologists hanno dibattuto per oltre un secolo se giusto emisfero assunzione facilita o ostacola il recupero da afasia. Presentiamo qui un paziente ben caratterizzato con tratti sequenziale dell&#39;emisfero destro e sinistro cui caso sostanzialmente informa questo dibattito. Una donna di 72 anni con afasia nonfluent cronica &egrave; stato iscritto in un processo di stimolazione magnetica transcranica (TMS). Ha subito 10 sessioni giornaliere di inibitoria TMS per la destra pars triangularis. Attivit&agrave; cerebrale &egrave; stata misurata durante foto denominazione utilizzando la risonanza magnetica funzionale (fMRI) prima dell&#39;esposizione TMS e prima e dopo la TMS il primo giorno di trattamento. Linguaggio e cognizione sono stati testati comportamentale tre volte prima del trattamento e a 2 e 6 mesi dopo. Inibitorio TMS per la destra pars triangularis indotto immediato miglioramento nella denominazione, che &egrave; stati sostenuti 2 mesi pi&ugrave; tardi. fMRI ha confermato una riduzione locale in attivit&agrave; presso la porta TMS, senza il previsto aumento di attivit&agrave; nelle aree corrispondenti dell&#39;emisfero sinistro. Tre mesi dopo il TMS, il paziente ha subito un ictus ischemico dell&#39;emisfero destro, con conseguente peggioramento della afasia senza altri deficit clinico. Comportamentale prove 3 mesi pi&ugrave; tardi ha confermato che la funzione del linguaggio &egrave; stato influenzato pi&ugrave; di altri domini cognitivi. Gli effetti paradossali della TMS inibitorio e l&#39;ictus all&#39;emisfero destro dimostrano che anche all&#39;interno di un singolo paziente, coinvolgimento di alcune aree dell&#39;emisfero destro pu&ograve; sostenere la ripresa, mentre gli altri interferire. Le prove del comportamento confermano che compensativo riorganizzazione si &egrave; verificato all&#39;interno dell&#39;emisfero destro dopo il tratto originale. Nessun supporto &egrave; trovato per inibizione interemisferica, il quadro teorico su cui si basano i protocolli di stimolazione cerebrale pi&ugrave; terapeutici per afasia.

L&#39;emisfero destro non &egrave; unitario nel suo ruolo nel recupero di afasia.

Meaningful speech, as exemplified in object naming, calls on knowledge of the mappings between word meanings and phonological forms. Phonological errors in naming (e.g. GHOST named as 'goath') are commonly seen in persisting post-stroke aphasia and are thought to signal impairment in retrieval of phonological form information. We performed a voxel-based lesion-symptom mapping analysis of 1718 phonological naming errors collected from 106 individuals with diverse profiles of aphasia. Voxels in which lesion status correlated with phonological error rates localized to dorsal stream areas, in keeping with classical and contemporary brain-language models. Within the dorsal stream, the critical voxels were concentrated in premotor cortex, pre- and postcentral gyri and supramarginal gyrus with minimal extension into auditory-related posterior temporal and temporo-parietal cortices. This challenges the popular notion that error-free phonological retrieval requires guidance from sensory traces stored in posterior auditory regions and points instead to sensory-motor processes located further anterior in the dorsal stream. In a separate analysis, we compared the lesion maps for phonological and semantic errors and determined that there was no spatial overlap, demonstrating that the brain segregates phonological and semantic retrieval operations in word production.

The dorsal stream contribution to phonological retrieval in object naming.

Discours significatif, comme l&#39;a d&eacute;montr&eacute; en objet d&#39;affectation de noms, appelle sur la connaissance des mappages entre les significations des mots et formes phonologiques. Erreurs phonologiques en nommant (p. ex. fant&ocirc;me nomm&eacute; &laquo; goath &raquo;) sont fr&eacute;quemment observ&eacute;es dans l&#39;aphasie post-accident vasculaire c&eacute;r&eacute;bral persistant et sont cens&eacute;s d&eacute;ficience dans la r&eacute;cup&eacute;ration d&#39;informations de la forme phonologique du signal. Nous avons effectu&eacute; une analyse de cartographie voxel-based l&eacute;sion-sympt&ocirc;me de 1718 phonologiques erreurs d&#39;attribution de noms provenant de 106 personnes souffrant de divers profils d&#39;aphasie. Voxels dans lequel statut de l&eacute;sion en corr&eacute;lation avec les taux d&#39;erreurs phonologiques localis&eacute;es aux zones de jet dorsal, conform&eacute;ment aux mod&egrave;les de cerveau-langue classique et contemporain. Dans le flux de dorsal, les voxels critiques &eacute;taient concentr&eacute;s dans le cortex pr&eacute;moteur, pr&eacute;- et postcentral gyri et gyrus supramarginal avec extension minimale dans le cortex temporal et temporo-pari&eacute;tal post&eacute;rieur auditifs li&eacute;s. Ce d&eacute;fis l&#39;id&eacute;e populaire que phonologique sans erreur r&eacute;cup&eacute;ration n&eacute;cessite des conseils de traces sensorielles stock&eacute;s dans des r&eacute;gions auditives post&eacute;rieures et pointe plut&ocirc;t vers des processus sensori-moteur situ&eacute; plus loin ant&eacute;rieur dans le flux de la dorsal. Dans une analyse distincte, nous avons compar&eacute; les cartes de la l&eacute;sion pour Erreurs phonologiques et s&eacute;mantiques et d&eacute;termin&eacute; qu&#39;il n&#39;existe aucun chevauchement spatial, ce qui d&eacute;montre que le cerveau s&eacute;pare les op&eacute;rations d&#39;extraction phonologique et s&eacute;mantique dans la production de la parole.

La contribution de la dorsale de flux &agrave; r&eacute;cup&eacute;ration phonologique en objet d&#39;affectation de noms.

Discorso significativo, come esemplificato nella denominazione oggetto, chiama sulla conoscenza dei mapping tra i significati di parola e forme fonologiche. Fonologici errori nella denominazione (ad esempio fantasma di nome come &#39;goath&#39;) sono comunemente visto in persistenza afasia post-ictus e si pensiero alla svalutazione nel reperimento di informazioni fonologiche forma del segnale. Abbiamo effettuato un&#39;analisi di mappatura voxel-based lesione-sintomo di 1718 fonologici errori di denominazione raccolti da 106 individui con diversi profili di afasia. Voxel in cui lo status di lesione correlato con tassi di errore fonologico localizzati nelle aree di flusso dorsale, in sintonia con i modelli di cervello-lingua classica e contemporanea. All&#39;interno del flusso dorsale, i voxel critici erano concentrati nella corteccia premotoria, circonvoluzioni pre e postcentral e circonvoluzione sopramarginale con estensione minima in uditivi correlati posteriore temporo-parietale e temporale cortecce. Questo sfide la nozione popolare che recupero senza errore fonologico richiede orientamento da tracce sensoriali archiviate nelle regioni posteriori uditive e punta invece a processi di sensory-motor si trova ulteriormente anteriore nel flusso dorsale. In un&#39;analisi separata, abbiamo confrontato le mappe di lesione per gli errori di semantici e fonologici e determinato che non non c&#39;era nessuna sovrapposizione spaziale, dimostrando che il cervello segrega le operazioni di recupero fonologica e semantica nella produzione di parola.

Il contributo di flusso dorsale al recupero fonologico in oggetto di denominazione.

BACKGROUND: Loss of fluency is a significant source of functional impairment in many individuals with aphasia. Repetitive transcranial magnetic stimulation (rTMS) administered to the right inferior frontal gyrus (IFG) has been shown to facilitate naming in persons with chronic left hemisphere stroke and non-fluent aphasia. However, changes in fluency in aphasic subjects receiving rTMS have not been adequately explored. AIMS: To determine whether rTMS improves fluency in individuals with chronic nonfluent aphasia, and to identify aspects of fluency that are modulated in persons who respond to rTMS. METHODS #ENTITYSTARTX00026; PROCEDURES: Ten individuals with left hemisphere MCA strokes and mild to moderate non-fluent aphasia participated in the study. Before treatment, subjects were asked to describe the Cookie Theft picture in three separate sessions. During treatment, all subjects received 1200 pulses of 1 Hz rTMS daily in 10 sessions over two weeks at a site that had previously been shown to improve naming. Subjects repeated the Cookie Theft description two months after treatment. Five subjects initially received sham stimulation instead of real TMS. Two months after sham treatment, these individuals received real rTMS. Performance both at baseline and after stimulation was coded using Quantitative Production Analysis (Saffran, Berndt & Schwartz, 1989) and Correct Information Unit (Nicholas & Brookshire, 1993) analysis. OUTCOMES #ENTITYSTARTX00026; RESULTS: Across all subjects (n=10), real rTMS treatment resulted in a significant increase in multiple measures of discourse productivity compared to baseline performance. There was no significant increase in measures of sentence productivity or grammatical accuracy. There was no significant increase from baseline in the sham condition (n=5) on any study measures. CONCLUSIONS: Stimulation of the right IFG in patients with chronic non-fluent aphasia facilitates discourse production. We posit that this effect may be attributable to improved lexical-semantic access.

Finding the Right Words: Transcranial Magnetic Stimulation Improves Discourse Productivity in Non-fluent Aphasia After Stroke.

Rappel des faits : Perte de la ma&icirc;trise est une importante source de handicap fonctionnel chez de nombreuses personnes atteintes d&#39;aphasie. Stimulation magn&eacute;tique transcr&acirc;nienne r&eacute;p&eacute;titive (SMTr) administr&eacute;e vers la droite gyrus frontal inf&eacute;rieur (IFG) a &eacute;t&eacute; &eacute;tabli pour faciliter la d&eacute;signation chez les personnes atteintes de maladies chroniques h&eacute;misph&egrave;re gauche et aphasie non fluente. Toutefois, les changements dans la ma&icirc;trise des sujets aphasiques ayant re&ccedil;u des SMTr n&#39;ont pas &eacute;t&eacute; suffisamment explor&eacute;es. BUTS : Pour d&eacute;terminer si SMTr am&eacute;liore couramment chez les personnes atteintes d&#39;aphasie nonfluent chronique et d&#39;identifier les aspects de la ma&icirc;trise qui sont modul&eacute;s chez les personnes qui r&eacute;pondent &agrave; la SMTr. M&Eacute;THODES #ENTITYSTARTX00026 ; PROC&Eacute;DURES : Dix personnes &agrave; coups de MCA h&eacute;misph&egrave;re gauche et l&eacute;g&egrave;re &agrave; mod&eacute;r&eacute;e d&#39;aphasie non fluente a particip&eacute; &agrave; l&#39;&eacute;tude. Avant le traitement, les sujets devaient d&eacute;crire la photo vol de Cookie en trois sessions distinctes. Pendant le traitement, tous les sujets a re&ccedil;u 1200 impulsions de 1Hz SMTr quotidiennement en 10 s&eacute;ances sur une p&eacute;riode de deux semaines sur un site qui avait d&eacute;j&agrave; &eacute;t&eacute; montr&eacute; pour am&eacute;liorer d&#39;affectation de noms. Sujets r&eacute;p&egrave;tent la description de vol de Cookie, deux mois apr&egrave;s le traitement. Cinq sujets initialement re&ccedil;u imposture stimulation au lieu de TMS r&eacute;el. Deux mois apr&egrave;s le traitement de l&#39;imposture, ces individus ont re&ccedil;u des SMTr r&eacute;el. Performances tant au niveau de base et apr&egrave;s stimulation a &eacute;t&eacute; cod&eacute;e &agrave; l&#39;aide d&#39;analyse Quantitative de la Production (Saffran, Berndt &amp; Schwartz, 1989) et groupe de l&#39;Information correcte (Nicholas &amp; Brookshire, 1993) analyse. R&Eacute;SULTATS #ENTITYSTARTX00026 ; R&Eacute;SULTATS : sur tous les sujets (n = 10), SMTr r&eacute;el traitement a entra&icirc;n&eacute; une augmentation significative dans plusieurs mesures de la productivit&eacute; de discours par rapport aux performances de base. Il n&#39;y n&#39;avait aucune augmentation significative des mesures de la productivit&eacute; de la phrase ou de l&#39;exactitude grammaticale. Il n&#39;y n&#39;avait aucune augmentation significative par rapport &agrave; la condition de l&#39;imposture (n = 5) sur une &eacute;tude des mesures. CONCLUSIONS : Stimulation du droit IFG chez les patients avec une aphasie non fluente chronique facilite la production de discours. Nous affirmons que cet effet peut &ecirc;tre attribuable &agrave; l&#39;am&eacute;lioration de l&#39;acc&egrave;s lexico-s&eacute;mantique.

Trouver les mots justes : Stimulation magn&eacute;tique transcr&acirc;nienne accro&icirc;t l&#39;efficacit&eacute; du discours dans l&#39;aphasie Non fluente apr&egrave;s accident vasculaire c&eacute;r&eacute;bral.

SFONDO: Perdita di fluidit&agrave; &egrave; una fonte significativa di compromissione funzionale in molti individui con afasia. Stimolazione magnetica transcranica ripetitiva (rTMS) somministrato a destra Giro frontale inferiore (IFG) ha dimostrato di facilitare la denominazione in soggetti con stroke cronico emisfero sinistro e afasia non-fluente. Tuttavia, le modifiche in scioltezza in soggetti afasica ricevendo rTMS non sono state adeguatamente esplorate. OBIETTIVI: Determinare se rTMS migliora fluidit&agrave; in individui con afasia nonfluent cronica e per identificare gli aspetti di fluidit&agrave; che sono modulati in persone che rispondono alla rTMS. METODI #ENTITYSTARTX00026; PROCEDURE: Dieci individui con tratti MCA emisfero sinistro e lieve a moderata afasia non-fluente ha partecipato allo studio. Prima del trattamento, soggetti sono stati invitati a descrivere la foto di furto di Cookie in tre sessioni separate. Durante il trattamento, tutti i soggetti hanno ricevuto 1200 impulsi di 1 Hz rTMS quotidianamente in 10 sessioni per due settimane presso un sito che in precedenza aveva dimostrato di migliorare la denominazione. Soggetti ripetono descrizione del furto di Cookie due mesi dopo il trattamento. Cinque soggetti inizialmente ricevuto stimolazione sham invece reale TMS. Due mesi dopo il trattamento di sham, questi individui hanno ricevuto rTMS reale. Prestazioni sia al basale e dopo stimolazione &egrave; stata codificata utilizzando analisi quantitativa di produzione (SDA, Berndt &amp; Schwartz, 1989) e unit&agrave; di informazione corretta (Nicholas &amp; Brookshire, 1993) analisi. ESITI #ENTITYSTARTX00026; RISULTATI: in tutti i soggetti (n = 10), trattamento rTMS reale ha portato ad un aumento significativo in pi&ugrave; misure di produttivit&agrave; discorso rispetto alla baseline performance. C&#39;&egrave; stato alcun aumento significativo di misure di produttivit&agrave; di frase o accuratezza grammatica. C&#39;&egrave; stato alcun aumento significativo rispetto al basale in condizione di sham (n = 5) su qualsiasi studiare misure. CONCLUSIONI: La stimolazione della destra IFG in pazienti con afasia non-fluente cronica facilita la produzione di discorso. Si presuppone che questo effetto potrebbe essere attribuibile al miglioramento dell&#39;accesso lessicale-semantico.

Trovare le parole giuste: stimolazione magnetica transcranica migliora la produttivit&agrave; di discorso in afasia Non-fluente dopo ictus.

ABSTRACT. Transcranial magnetic stimulation (TMS) modulates processing in the human brain and is therefore of interest as a treatment modality for neurologic conditions. During TMS administration, an electric current passing through a coil on the scalp creates a rapidly varying magnetic field that induces currents in the cerebral cortex. The effects of low-frequency (1Â Hz), repetitive TMS (rTMS) on motor cortex cerebral blood flow (CBF) and tissue oxygenation in seven healthy adults, during/after 20Â min stimulation, is reported. Noninvasive optical methods are employed: diffuse correlation spectroscopy (DCS) for blood flow and diffuse optical spectroscopy (DOS) for hemoglobin concentrations. A significant increase in median CBF (33%) on the side ipsilateral to stimulation was observed during rTMS and persisted after discontinuation. The measured hemodynamic parameter variations enabled computation of relative changes in cerebral metabolic rate of oxygen consumption during rTMS, which increased significantly (28%) in the stimulated hemisphere. By contrast, hemodynamic changes from baseline were not observed contralateral to rTMS administration (all parameters, p&gt;0.29). In total, these findings provide new information about hemodynamic/metabolic responses to low-frequency rTMS and, importantly, demonstrate the feasibility of DCS/DOS for noninvasive monitoring of TMS-induced physiologic effects.

Blood flow and oxygenation changes due to low-frequency repetitive transcranial magnetic stimulation of the cerebral cortex.

ABSTRAIT. Stimulation magn&eacute;tique transcr&acirc;nienne (SMT) module de traitement dans le cerveau humain et n&#39;est donc d&#39;int&eacute;r&ecirc;t comme une modalit&eacute; de traitement pour les troubles neurologiques. Au cours de l&#39;administration de TMS, un courant &eacute;lectrique passant &agrave; travers une bobine sur le cuir chevelu cr&eacute;e un champ magn&eacute;tique plus rapidement ou qui induit des courants dans le cortex c&eacute;r&eacute;bral. Les effets de basse fr&eacute;quence (1 Hz), TMS r&eacute;p&eacute;titive (SMTr) sur le cortex moteur du d&eacute;bit sanguin c&eacute;r&eacute;bral (DSC) et l&#39;oxyg&eacute;nation des tissus en sept adultes en bonne sant&eacute;, pendant et apr&egrave;s 20 min de stimulation, est signal&eacute;e. On utilise des m&eacute;thodes optiques non invasives : diffuser la spectroscopie de corr&eacute;lation (DCS) pour la circulation sanguine et diffuse la spectroscopie optique (DOS) pour les concentrations d&#39;h&eacute;moglobine. Une augmentation significative de la m&eacute;diane CBF (33 %) du c&ocirc;t&eacute; ipsilat&eacute;ral &agrave; la stimulation a &eacute;t&eacute; observ&eacute;e au cours de la SMTr et a persist&eacute; apr&egrave;s l&#39;arr&ecirc;t. Les variations des param&egrave;tres h&eacute;modynamiques mesur&eacute;e activ&eacute; calcul des variations relatives du m&eacute;tabolisme c&eacute;r&eacute;bral de consommation d&#39;oxyg&egrave;ne au cours de TMC, qui a augment&eacute; consid&eacute;rablement (28 %) dans l&#39;h&eacute;misph&egrave;re stimul&eacute;e. En revanche, les modifications h&eacute;modynamiques de base n&#39;a &eacute;t&eacute; observ&eacute;es controlat&eacute;rale &agrave; l&#39;administration de SMTr (tous les param&egrave;tres, p &amp;gt; 0,29). Au total, ces r&eacute;sultats fournissent des informations nouvelles sur les r&eacute;ponses h&eacute;modynamiques/m&eacute;tabolique &agrave; basse fr&eacute;quence SMTr et, surtout, de d&eacute;montrer la faisabilit&eacute; de DCS/DOS de surveillance non invasive des effets physiologiques induits par les TMS.

Circulation et l&#39;oxyg&eacute;nation des changements en raison de la stimulation magn&eacute;tique transcr&acirc;nienne r&eacute;p&eacute;t&eacute;e de basse fr&eacute;quence du cortex c&eacute;r&eacute;bral de sang.

The dual-route interactive two-step model explains the variation in the error patterns of aphasic speakers in picture naming, and word and nonword repetition tasks. The model has three parameters that can vary across individuals: the efficiency of the connections between semantic and lexical representations (s-weight), between lexical and phonological representations (p-weight), and between representations of auditory input and phonological representations (nl-weight). We determined these parameter values in 103 participants with chronic aphasia from left hemisphere stroke whose lesion locations had been determined. Then, using voxel-based lesion-parameter mapping, we mapped the parameters onto the brain, thus determining the neural correlates of the model's mechanisms. The maps and the behavioral findings supported the model's central claim that word repetition is affected by both the p and nl parameters. We propose that these two parameters constitute the model's analogue of the "dorsal stream" component of neurocognitive models of language processing.

Voxel-based lesion-parameter mapping: Identifying the neural correlates of a computational model of word production.

Le mod&egrave;le dual-route interactive en deux &eacute;tapes explique la variation dans les sch&eacute;mas d&#39;erreurs de locuteurs aphasiques dans photo d&eacute;signation et t&acirc;ches de r&eacute;p&eacute;tition de mot et non alphab&eacute;tique. Le mod&egrave;le a trois param&egrave;tres qui peuvent varier selon les individus : l&#39;efficacit&eacute; des connexions entre les repr&eacute;sentations s&eacute;mantiques et lexicales (s-poids), entre les repr&eacute;sentations lexicales et phonologiques (p-poids) et entre les repr&eacute;sentations d&#39;entr&eacute;e auditive et repr&eacute;sentations phonologiques (nl-poids). Nous avons d&eacute;termin&eacute; ces valeurs de param&egrave;tre dans 103 participants avec aphasie chronique d&#39;AVC h&eacute;misph&egrave;re gauche dont emplacements de l&eacute;sion avaient &eacute;t&eacute; d&eacute;termin&eacute;s. Puis, &agrave; l&#39;aide de voxel-based l&eacute;sion-param&egrave;tre mappage, nous avons cartographi&eacute; les param&egrave;tres sur le cerveau, d&eacute;terminant ainsi les corr&eacute;lats neurones de m&eacute;canismes du mod&egrave;le. Les cartes et les conclusions comportementales, prise en charge du mod&egrave;le central demande mot r&eacute;p&eacute;tition est conditionn&eacute;e par les param&egrave;tres p tant nl. Nous proposons que ces deux param&egrave;tres constituent analogique du mod&egrave;le du composant &laquo; dorsale stream &raquo; des mod&egrave;les neurocognitifs du traitement du langage.

Cartographie de la l&eacute;sion-param&egrave;tre voxel-based : identifier les corr&eacute;lations neuronales d&#39;un mod&egrave;le de calcul de la production de la parole.

Olufunsho Faseyitan

Department of Neurology,
Perelman School of Medicine,
Center for Cognitive Neuroscience,
Department of Neurology, Perelman School of Medicine

University of Pennsylvania

Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

Olufunsho Faseyitan

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Department of Neurology,Perelman School of Medicine,Center for Cognitive Neuroscience,Department of Neurology, Perelman School of Medicine

University of Pennsylvania

Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

Department of Neurology,
Perelman School of Medicine,
Center for Cognitive Neuroscience,
Department of Neurology, Perelman School of Medicine