Effects of Noninvasive Brain Stimulation on Language Networks and Recovery in Early Poststroke Aphasia

Thiel, Alexander; Hartmann, Alexander; Rubi-Fessen, Ilona; Anglade, Carole; Kracht, Lutz W.; Weiduschat, Nora; Kessler, Josef; Rommel, Thomas; Heiss, Wolf‐Dieter

doi:10.1161/strokeaha.111.000574

Cited by 160 publications

(170 citation statements)

References 35 publications

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“…Patients with temporal lesions improved only in word comprehension and could not reactivate the left supramarginal temporal gyrus. Aphasia recovery after stroke was improved by the use of inhibitory repetitive magnetic stimulation on the right inferior frontal gyrus, which favored recruitment of left-hemispheric language networks: the shift of activation observed in PET correlated to improved performance on aphasia tests (97).…”

Section: Activation Studies In Stroke Patientsmentioning

confidence: 97%

Radionuclide Imaging in Ischemic Stroke

Heiss

2014

J Nucl Med

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) the physiologic and metabolic variables relevant for brain function and the radionuclides and methods to measure these variables in cerebrovascular disease, especially ischemic stroke; (2) the radionuclide methods to determine the thresholds of flow and metabolism relevant for preservation of function and morphology and the obtained values in their relevance to prognosis and potential treatment; and (3) the applications of radionuclide imaging for identifying pathophysiologic changes responsible for extension of ischemic lesions, for defining the hemodynamic reserve in vascular disease, for detecting remote effects outside the primary lesions, and for locating compensatory activation in disturbed functional networks.Financial Disclosure: Dr. Heiss is supported by the Wolf-Dieter Heiss Foundation within the Max Planck Society. The author of this article has indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through November 2017.Ischemic stroke is caused by interruption or significant impairment of blood supply to the brain, which leads to a cascade of metabolic and molecular alterations resulting in functional disturbance and morphologic damage. The changes in regional cerebral blood flow and regional metabolism can be assessed by radionuclide imaging, especially SPECT and PET. SPECT and PET have broadened our understanding of flow and metabolic thresholds critical for maintenance of brain function and morphology: PET was essential in the transfer of the concept of the penumbra to clinical stroke and thereby had a great impact on developing treatment strategies. Receptor ligands can be applied as early markers of irreversible neuronal damage and can predict the size of the final infarcts, which is important for decisions on invasive therapy in large ("malignant") infarction. With SPECT and PET, the reserve capacity of the blood supply can be tested in obstructive arteriosclerosis, which is essential for planning interventions. The effect of a stroke on surrounding and contralateral primarily unaffected tissue can be investigated, helping to understand symptoms caused by disturbance in functional networks. Activation studies are useful to demonstrate alternative pathways to compensate for lesions and to test the effect of rehabilitative therapy. Radioisotope studies help to detect neuroinflammation and its effect on extension of tissue damage. Despite the...

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Section: Activation Studies In Stroke Patientsmentioning

confidence: 97%

Radionuclide Imaging in Ischemic Stroke

Heiss

2014

J Nucl Med

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“…The three experimental studies [33][34][35] have used similar protocols: stimulation of 1Hz, with five to 10 consecutive stimulations at 20 minutes, eight to 10 sessions, totaling two weeks of stimulation. All studies included control groups and multiple diagnoses of aphasia (non-fluent and fluent aphasia).…”

Section: Treatments With Drugsmentioning

confidence: 99%

“…It should be noted that the studies were carried out with small number of participants (10, 26 and 24, respectively), and the replication on larger samples would be important to confirm the findings. Thiel et al 35 and Weiduschat, et al 33 applied, in addition to the rTMS, speech therapy to both groups, thus ensuring an environment that is more close to the real, since therapy speech is the preferential treatment for cases of aphasia 36 .…”

Section: Treatments With Drugsmentioning

confidence: 99%

“…Improvements were recorded in the language, measured by means of specific tests, and also changes in cerebral activation for the study of Thiel et al 35 . This study also aimed to test the protocol of rTMS to start immediately after the stroke and obtained as a result satisfactory performance, that corroborate data in the literature indicating that the immediate start of rehabilitation can promote the rapid improvement of patients 7 .…”

Section: Treatments With Drugsmentioning

confidence: 99%

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Intervenções em afasia: uma revisão integrativa

Fontanesi

Schmidt

2016

Rev. CEFAC

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This review aims to identify, evaluate and discuss articles of aphasia interventions and therapeutic advances, published in free access scientific journals in the last five years. An integrative review was performed on databases SciELO, LILACS, CAPES and PubMed, with the descriptors in English and Portuguese: aphasia, rehabilitation and treatment. Inclusion criteria were as follows: articles describing aphasia treatment or rehabilitation stories, published in English or Portuguese. I was found 96 studies that met the criteria that were read and analyzed according to an integrative review protocol, then categorized resulting in 26 articles included. I t was observed a predominance of quantitative studies. Several studies that tested therapies showed positive results, confirming that aphasia is a condition that responds to a wide variety of treatments. Investigations focused on brain activation demonstrated significant correlations between patients' improvement and brain activation of language areas. It was found that aphasia treatments description did not indicate a superior therapeutic approach compared to another. Most studies did not present good degree of external general, indicating the need for controlled studies with more representative samples. The current literature should support the actions of the professionals, but these should be alert to the characteristics and limitations of the protocols tested. Keywords: Aphasia; /therapy; Rehabilitation; Review RESUMO O objetivo desta revisão foi identificar, avaliar e discutir artigos sobre intervenções e avanços terapêuticos em afasia, publicados periódicos científicos nos últimos cinco anos, em plataformas de livre acesso aos profissionais. Foi realizada uma revisão integrativa nas bases de dados SciELO, LILACS, Periódicos Capes e PubMed, com os descritores em português e inglês: afasia, reabilitação e tratamento. Foram incluí-dos artigos que descrevessem tratamentos para afasia ou histórias de reabilitação, publicados em inglês ou português. Os estudos que atenderam aos critérios foram lidos e analisados segundo instrumento para revisão integrativa, e posteriormente categorizada. Dos 96 artigos levantados 26 foram incluídos na revisão. Houve predominância de estudos quantitativos. De modo geral, diversas pesquisas que testavam terapias mostraram resultados positivos, confirmando que a afasia é uma condição que responde a uma ampla variedade de tratamentos. Nos estudos cujo foco foi a ativação cerebral, foram encontradas correlações importantes entre a melhora dos pacientes e a ativação de áreas cerebrais relacionadas à linguagem. A partir dos resultados, verificou-se que os tratamentos para afasia descritos não indicam a superioridade de uma abordagem terapêutica sobre outra. A maioria dos estudos revisados não apresentava bom grau de generalidade externa, indicando a necessidade de estudos controlados com amostras mais representativas. A literatura atualizada deve fundamentar as ações dos profissionais, porém esses devem estar atentos às característ...

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“…The induced shift of activation to the dominant hemisphere is associated with an improvement in language function. Speech therapy combined with inhibitory rTMS of the area in the non-dominant hemisphere homologous to Broca's area might be a successful treatment for poststroke aphasia [109] .…”

Section: Complex Activation Studiesmentioning

confidence: 99%

PET imaging in ischemic cerebrovascular disease: current status and future directions

Heiss

2014

Neurosci. Bull.

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Cerebrovascular diseases are caused by interruption or significant impairment of the blood supply to the brain, which leads to a cascade of metabolic and molecular alterations resulting in functional disturbance and morphological damage. These pathophysiological changes can be assessed by positron emission tomography (PET), which permits the regional measurement of physiological parameters and imaging of the distribution of molecular markers. PET has broadened our understanding of the fl ow and metabolic thresholds critical for the maintenance of brain function and morphology: in this application, PET has been essential in the transfer of the concept of the penumbra (tissue with perfusion below the functional threshold but above the threshold for the preservation of morphology) to clinical stroke and thereby has had great impact on developing treatment strategies. Radioligands for receptors can be used as early markers of irreversible neuronal damage and thereby can predict the size of the fi nal infarcts; this is also important for decisions concerning invasive therapy in large ("malignant") infarctions. With PET investigations, the reserve capacity of blood supply to the brain can be tested in obstructive arteriosclerosis of the supplying arteries, and this again is essential for planning interventions. The effect of a stroke on the surrounding and contralateral primarily unaffected tissue can be investigated, and these results help to understand the symptoms caused by disturbances in functional networks. Chronic cerebrovascular disease causes vascular cognitive disorders, including vascular dementia. PET permits the detection of the metabolic disturbances responsible for cognitive impairment and dementia, and can differentiate vascular dementia from degenerative diseases. It may also help to understand the importance of neuroinfl ammation after stroke and its interaction with amyloid deposition in the development of dementia. Although the clinical application of PET investigations is limited, this technology had and still has a great impact on research into cerebrovascular diseases.

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Effects of Noninvasive Brain Stimulation on Language Networks and Recovery in Early Poststroke Aphasia

Cited by 160 publications

References 35 publications

Radionuclide Imaging in Ischemic Stroke

Radionuclide Imaging in Ischemic Stroke

Intervenções em afasia: uma revisão integrativa

PET imaging in ischemic cerebrovascular disease: current status and future directions

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