Open AccessA meta-analysis of the effects of repetitive transcranial magnetic stimulation on aphasia rehabilitation in stroke patients
Author(s) -
Mehrnaz Gholami,
Noushin Pourbaghi,
Samaneh Taghvatalab
Publication year - 2021
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.138
H-Index - 16
ISSN - 1823-6138
DOI - 10.54029/2021xjx
Subject(s) - transcranial magnetic stimulation , aphasia , meta analysis , stroke (engine) , medicine , randomized controlled trial , medline , rehabilitation , physical therapy , primary progressive aphasia , physical medicine and rehabilitation , psychiatry , stimulation , dementia , mechanical engineering , disease , political science , law , frontotemporal dementia , engineering
Background & Objective: Aphasia—acquired loss of the ability to understand or express language—is a common and debilitating neurological consequence of stroke. Evidence suggests that transcranial magnetic stimulation (TMS) can signicantly improve language outcomes in patients with aphasia. Repetitive transcranial magnetic stimulation (rTMS) has been reported to improve naming in chronic stroke patients with nonuent aphasia since 2005.Methods: We conducted a systematic review and meta-analyses of TMS treatment studies in patients with aphasia. Eight electronic databases (PubMed, Medline, Embase, Scopus, ScienceDirect, Cochrane Central Register of Controlled Trials, Journals@ Ovid, and clinicaltrials.gov) were searched for articles. Relevant studies were further evaluated and studies that met inclusion criteria were reviewed. We included studies if were: randomized controlled blinded clinical trials, meta-analyses or crossover designs of rTMS alone or with speech therapy or any other therapy tested with rTMS. Standard mean difference (SMD) for changes in picture naming accuracy was estimated.Results: The literature search yielded 423 studies. Fifty articles were further evaluated to be included. Eleven met all inclusion criteria and were chosen for review. Eleven eligible studies involving 301 stroke patients were identied in this meta-analysis. Further analyses demonstrated prominent effects for the naming subtest (SMD = 1.26, 95% CI = 0.80 to 1.71, P=0.01), with heterogeneity (I2 = 69.101%). The meta-analysis continued to show that there was a statistically signicant effect of rTMS compared with sham rTMS on the severity of aphasia. None of the patients from the 11 included articles reported adverse effects from rTMS.Conclusions: There are some strong studies evaluating the efcacy of rTMS in stroke patients but further research is required to fully establish the usefulness of this treatment. This meta-analysis indicates a clinically positive effect of rTMS with or without speech and language therapy (SLT) for patients with aphasia following stroke in overall language function and expressive language, including naming, repetition, writing, and comprehension. Low-frequency (1 Hz) rTMS over the unaffected hemisphere is effective and compatible with the concept of interhemispheric inhibition. Moreover, the treatment of 1 Hz rTMS for patients with aphasia after stroke was safe.