The results of this study provide evidence that inhibitory rTMS, through downregulating the circuitry of the right pars triangularis (PTr), achieves a persistent and broadly modulating effect, irrespective of aphasia severity and subtype. Patients who show lower rMT in the right motor system would seem to benefit the most from inhibitory rTMS.

Background and Purpose-Although multiple studies have suggested that repetitive transcranial magnetic stimulation (rTMS) may facilitate recovery after stroke, the efficacy of synchronous speech therapy integrated with an rTMS protocol has yet to be determined. We investigated language responses to this strategy and determined the longevity of the resulting therapeutic outcomes. Methods-Forty-five patients with stroke who presented with nonfluent aphasia were randomly assigned to the TMS syn group and underwent synchronous picture-naming training together with contralesional 1 Hz-rTMS for 10 daily sessions. The TMS sub group underwent subsequent picture-naming activity after the primed 1 Hz-rTMS, and the TMS sham group received concurrent naming task along with the sham 1 Hz-rTMS. The Concise Chinese Aphasia test and the picturenaming test were performed before, immediately, and after 3 months of the intervention. Results-TMS syn showed significantly superior results in Concise Chinese Aphasia test score (P<0.001), expression and description subtests (P<0.001), and action (P=0.02) and object naming activity (P=0.008); the superior results lasted for 3 months (P=0.005), in comparison with the TMS sub and TMS sham groups. Conclusions-We established a real-time model that involved implementing verbal tasks together with the rTMS protocol.Our results confirmed that the strategy yielded favorable outcomes that were of considerable longevity. The results also indicated that the rTMS protocol and language training can be combined to achieve outcomes superior to those obtained when used separately. we hypothesized that temporal synchronous modulation (online model) in the Broca area through rTMS modulation and concurrent language system activation can result in greater synaptic strength than the separate application of these interventions (offline model).We investigated the efficacy of low-frequency rTMS coupled with a simultaneous picture-naming activity for treating chronic nonfluent aphasic patients and evaluated the resulting effects for a 3-month period. Methods ParticipantsSeventy-six patients with stroke who were admitted to the stroke unit of a tertiary medical center or who attended follow-up visits at outpatient clinics were evaluated consecutively for participation in this study. Three patients approached declined to participate ( Figure 1); and 45 right-handed patients met the inclusion criteria: (1) a diagnosis of nonfluent aphasia resulting from a first-ever left middle cerebral artery infarction that had been confirmed by MRI; (2) >6 months of poststroke duration with a plateau in aphasic condition; (3) no current depression as evaluated using the Aphasic Depression Rating Scale 12 ; (4) an absence of spatial neglect or visual field deficits; and (5) an absence of TMS contraindications. Forty-three patients completed the 3-month assessment. The study was approved by the local institutional review board, and all patients gave their written informed consent before participating.The biographical data of the e...