TITLE
Treatment of Dysphasia with rTMS and Language Therapy After Childhood Stroke: Multimodal Imaging of Plastic Change
AUTHORS
Carlson HL; Jadavji Z; Mineyko A; Damji O; Hodge J; Saunders J; Hererro M; Nowak M; Patzelt R; Mazur-Mosiewicz A; MacMaster FP; Kirton A. Institution Carlson, Helen L. Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada; Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Neurosciences, Alberta Children’s Hospital, Calgary, AB, Canada. Jadavji, Zeanna. Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada. Mineyko, Aleksandra. Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada; Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Neurosciences, Alberta Children’s Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada. Damji, Omar. Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada; Department of Neurosciences, Alberta Children’s Hospital, Calgary, AB, Canada. Hodge, Jacquie. Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada. Saunders, Jenny. Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada. Hererro, Mia. Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada; Department of Neurosciences, Alberta Children’s Hospital, Calgary, AB, Canada. Nowak, Michele. Department of Neurosciences, Alberta Children’s Hospital, Calgary, AB, Canada. Patzelt, Rebecca. Department of Neurosciences, Alberta Children’s Hospital, Calgary, AB, Canada. Mazur-Mosiewicz, Anya. Department of Clinical Psychology, Chicago School of Professional Psychology, Chicago, IL, USA. MacMaster, Frank P. Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, AB, Canada; The Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada; Child and Adolescent Imaging Research (CAIR) Programs, Alberta Children’s Hospital, Calgary, AB, Canada. Kirton, Adam. Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada; Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Neurosciences, Alberta Children’s Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
ELECTRONIC ADDRESS
Helen.carlson@albertahealthservices.ca.
SOURCE
Brain & Language. 159:23-34, 2016 Aug.
ABSTRACT
Expressive dysphasia accompanies left inferior frontal gyrus (IFG/Broca) injury. Recovery may relate to interhemispheric balance with homologous, contralesional IFG but is unexplored in children. We evaluated effects of inhibitory rTMS to contralesional IFG combined with intensive speech therapy (SLT). A 15year-old, right-handed male incurred a left middle cerebral artery stroke. After 30months, severe non-fluent dysphasia impacted quality of life. Language networks, neuronal metabolism and white matter pathways were explored using MRI. Language function was measured longitudinally. An intensive SLT program was combined with contralesional inhibitory rTMS of right pars triangularis. Procedures were well tolerated. Language function improved persisting to four months. Post-treatment fMRI demonstrated increased left perilesional IFG activations and connectivity at rest. Bilateral changes in inositol and glutamate metabolism were observed. Contralesional, inhibitory rTMS appears safe in childhood stroke-induced dysphasia. We observed clinically significant improvements after SLT coupled with rTMS. Advanced neuroimaging can evaluate intervention-induced plasticity.
Copyright © 2016 Elsevier Inc. All rights reserved.
