Improved Language in a Chronic Nonfluent Aphasia Patient After Treatment With CPAP and TMS

Abstract

Objective-To present pre-and post-treatment language data for a nonfluent aphasia patient who received two treatment modalities: 1) Continuous Positive Airway Pressure (CPAP) for his sleep apnea, starting 1 year poststroke; and 2) repetitive transcranial magnetic brain stimulation (rTMS), starting 2 years poststroke.Background-Language data were acquired beyond the spontaneous recovery period of 3-6 months poststroke onset (MPO). CPAP restores adequate oxygen flow throughout all stages of sleep, and may improve cognition. A series of slow, 1 Hz rTMS treatments to suppress a posterior portion of right pars triangularis has been shown to improve phrase length and naming in chronic nonfluent aphasia.

Anomia training and brain stimulation in chronic aphasia

“…High-frequency rTMS (≥5 Hz), has been shown to increase cortical excitability, whereas low-frequency rTMS (≤1 Hz) can inhibit "maladaptive" plasticity, which prevents recovery from aphasia (Martin, Naeser, Ho, Doron, et al, 2009). The administration of rTMS to the anterior portion of the right homologue of Broca's area (pars triangularis) improves picture naming in patients with non-fluent aphasia Hamilton et al, 2010;Naeser, Martin, Lundgren, et al, 2010;Naeser, Martin, Nicholas, Baker, Seekins, Helm-Estabrooks, et al, 2005). In a stroke patient with chronic non-fluent aphasia, the same authors reported improvement of language following treatment with continuous positive airway pressure (CPAP) for sleep apnoea, as well as following CPAP plus slow-rTMS, to suppress pars triangularis (Naeser, Martin, Lundgren, et al, 2010).…”

“…The administration of rTMS to the anterior portion of the right homologue of Broca's area (pars triangularis) improves picture naming in patients with non-fluent aphasia Hamilton et al, 2010;Naeser, Martin, Lundgren, et al, 2010;Naeser, Martin, Nicholas, Baker, Seekins, Helm-Estabrooks, et al, 2005). In a stroke patient with chronic non-fluent aphasia, the same authors reported improvement of language following treatment with continuous positive airway pressure (CPAP) for sleep apnoea, as well as following CPAP plus slow-rTMS, to suppress pars triangularis (Naeser, Martin, Lundgren, et al, 2010). Naeser et al (Naeser, Martin, Nicholas, Baker, Seekins, Kobayashi, 2010) argue that low-frequency rTMS over the right pars triangularis suppresses maladaptive right hemisphere frontal activations, and thus allows for the activation of left hemispheric perilesional and perisylvian areas, as well as the left supplementary motor area, which support recovery in non-fluent aphasic patients.…”

“…Specifically, in chronic aphasia patients, non-invasive brain stimulation has been shown to increase the number of correct responses and to reduce response times. Moreover, recent studies suggest that these effects can persist over time (Baker et al, 2010;Fiori et al, 2011;Floel et al, 2011;Fridriksson et al, 2011;Hamilton et al, 2010;Kakuda, Abo, Uruma, et al, 2010b;Martin, Naeser, Ho, Doron, et al, 2009;Martin, Naeser, Ho, Treglia, et al, 2009;Naeser, Martin Lundgren, et al, 2010;Naeser, Martin Nicholas, Baker, Seekins, Helm-Estabrooks, et al, 2005;Naeser, Martin, Nicholas, Baker, Seekins, Kobayashi, et al, 2005;.…”

Intervenções em afasia: uma revisão integrativa

“…The results were significant for the improvement of the language in the case of the study in 2010 and for one of the participants of the study in 2009, indicating that the same protocol may not produce the improvement of language for all patients, depending mainly of injured areas, issue discussed by Martin, et al 38 , and indicated in the Sarasso et al 18 , Fridriksson et al 21 and Fridriksson et al 22 studies. Jung et al 29 and Naeser et al 39 aimed to study the rehabilitation of speech in a case of Global Aphasia with the right dominant hemisphere, and non-fluent Aphasia associated with sleep apnea. Both studies showed improvements in language in tests, but the studies raise discussions such as, for example, the use of fMRI, that may not ensure what the patient is executing at the time of the exam, not providing an accurate description of the effects of treatment in the case of the patient performing other tasks than those requested by the examiner.…”

“…Both studies showed improvements in language in tests, but the studies raise discussions such as, for example, the use of fMRI, that may not ensure what the patient is executing at the time of the exam, not providing an accurate description of the effects of treatment in the case of the patient performing other tasks than those requested by the examiner. This also applies to the research of Naeser et al 39 in that the sequence of treatments (treatment for apnea and TMS) does not guarantee the separation of the effects of each therapy alone, limiting the discussion on the benefits of the same when applied individually.…”