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Transcranial direct current stimulation facilitates reading training in participants with post-stroke central alexia
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Abstracts / Brain Stimulation 10 (2017) 346e540
differences in the post-treatment subsection score of spontaneous speech (p¼0.033) and auditory comprehension (P¼0.022) among the three interventional groups. Discussion: Individual application of sequential TBS could bring similar effects as combined with ST and as ST only to post-stroke aphasia in Chinese patients. Language recovery after receiving sequential TBS might be modulated through the whole brain network, not only the stimulated Broca’s area. TBS may have the potential to improve auditory comprehension and spontaneous speech significantly. Keywords: Theta Burst Stimulation, Aphasia, Stroke [0110] THE EFFICACY OF SELECTIVE TRANSCRANIAL MAGNETIC STIMULATION WITH FUNCTIONAL NEAR-INFRARED SPECTROSCOPY AND INTENSIVE SPEECH THERAPY ON INDIVIDUALS WITH POST-STROKE APHASIA T. Hara*1, M. Abo 1, K. Kakita 2. 1 The Jikei University School of Medicine, Japan; 2 Kyoto Ohara Memorial Hospital, Japan Introduction: To examine the efficacy of selective repetitive transcranial magnetic stimulation (rTMS) therapy guided by functional near-infrared spectroscopy (fNIRS) combined with intensive speech therapy(ST) on poststroke patients with aphasia, and right hemisphere high-frequency rTMS combined with intensive ST on patients who were right hemisphereactivated in a language task. Methods: Eight right-handed patients with aphasia in the chronic stage after stroke were grouped into left and right hemisphere-activated for a language task based on pre-intervention fNIRS. Those with left hemisphere activation received 1-Hz TMS to the right inferior frontal gyrus (RtIFG; LFS group), and those with right hemisphere activation received 10-Hz TMS to the RtIFG (HFS group). The patients underwent an 11-day program of rTMS and intensiveST. Assessments of language function and fNIRS were performed at admission and at 3 months following discharge. Results: Both groups showed a significant improvement in language function as measured by Standard Language Test of Aphasia (SLTA) total score at post-intervention relative to pre-intervention. Furthermore, the pre-to-post SLTA change scores were not statistically different between the groups. Comparison of pre- and post-intervention fNIRS revealed a resolution of the imbalance of interhemispheric inhibition in the LFS group and activation of the target hemisphere in the HFS group. Discussion: This study is the first to use fNIRS to localize language activation regions, and we observed an improvement of language function following selective rTMS combined with intensive ST. This study is also the first to administer HFS to patients with preintervention fNIRS right hemisphere language activation and to demonstrate language improvement at a degree comparable to patients who received LFS. Furthermore, an examination of pre- to post-intervention fNIRS in the LFS group showed results similar to those of previous LFS studies. Conversely, in the HFS group, we observed an increase in brain activity in the contralesional hemisphere. Keywords: Aphasia, Stroke, Near-Infrared Spectroscopy, Transcranial magnetic stimulation [0111] TRANSCRANIAL DIRECT CURRENT STIMULATION FACILITATES READING TRAINING IN PARTICIPANTS WITH POST-STROKE CENTRAL ALEXIA S.J. Kerry*1, Z.V.J. Woodhead 1, O.M. Aguilar 1, 2, Y. Ong Hoon 1, J.S. Hogan 1, K. Pappa 1, A.P. Leff 1, J. Crinion 1. 1 University College London, UK; 2 Pontificia Universidad Javeriana, Colombia Introduction: Central alexia is an acquired reading disorder co-occurring with a generalised language deficit (aphasia). We tested the effects of anodal transcranial Direct Current Stimulation targeted at the left inferior frontal gyrus applied in conjunction with a reading training App, called iReadMore, designed to improve word reading accuracy. Methods: A group of 21 patients with central alexia in the chronic poststroke phase participated in the study. In a double blind, cross-over design participants completed two four-week therapy blocks. Participants were assigned to one of two groups, matched for lesion size, and baseline reading performance. G1 received 2 mA of
anodal tDCS in Block1 and sham tDCS in Block2. G2 group received the stimulation conditions in the opposite order. Participants attended three face-to-face sessions per week. They completed 40 minutes of training; 20 minutes with online tDCS, followed by 20 minutes without stimulation. Participants were asked to complete a total of 35 hours of training in each block. Reading accuracy was assessed for the 150 trained items in each therapy block at three time points; before and after Block1 and after Block2. Results: The percentage change in accuracy was calculated for each block (Figure 1) and entered into a 2x2 repeated measures ANOVA with withinsubject factors Block and Word-List and between-subjects factor tDCS group. Significant tDCS x Block (F(19,1)¼5.31, p<0.05) and Block x WordList (F(19, 1)¼23.30, p<0.05) interactions were observed. This suggests the effects of iReadMore therapy alone were restricted to trained items but the effect of tDCS generalised to untrained items. Averaging across both WordLists and Blocks, accuracy improved by 2.8% more during tDCS than sham. Discussion: Anodal tDCS had a small but significant facilitatory effect on word reading accuracy. Importantly, this generalised to untrained words suggesting that tDCS affects different cognitive systems to reading training alone. Keywords: tDCS, Reading Therapy, Aphasia, Cognitive Neuroscience
Figure 1. Ă
[0114] ALTERED FUNCTIONAL CONNECTIVITY OF THE SUBTHALAMUS AND THE BED NUCLEUS OF THE STRIA TERMINALIS IN OBSESSIVE-COMPULSIVE DISORDER 1, E. Real 1, C. M. Cano*1, P. Alonso 1, I. Martínez-Zalacaín 1, M. Subira 1 2 3 1 Segalas , J. Pujol , N. Cardoner , J.M. Menchon , C. SorianoMas 1. 1 Bellvitge University Hospital-IDIBELL, Spain; 2 Hospital del Mar, Spain; 3 Parc Taulí Sabadell, Spain Background: The clinical improvement observed in patients with obsessive-compulsive disorder (OCD) after deep brain stimulation (DBS) of the nucleus accumbens (NA) has been related to a normalization of the functional connectivity (FC) within the ventral fronto-striatal circuits. However, the possible FC alterations of other clinically-effective DBS targets have not been explored. Here we evaluated the FC patterns of the subthalamic nucleus (STN) and the bed nucleus of the stria terminalis (BNST) in patients with OCD, as well as their association with symptom severity.
Abstracts / Brain Stimulation 10 (2017) 346e540
differences in the post-treatment subsection score of spontaneous speech (p¼0.033) and auditory comprehension (P¼0.022) among the three interventional groups. Discussion: Individual application of sequential TBS could bring similar effects as combined with ST and as ST only to post-stroke aphasia in Chinese patients. Language recovery after receiving sequential TBS might be modulated through the whole brain network, not only the stimulated Broca’s area. TBS may have the potential to improve auditory comprehension and spontaneous speech significantly. Keywords: Theta Burst Stimulation, Aphasia, Stroke [0110] THE EFFICACY OF SELECTIVE TRANSCRANIAL MAGNETIC STIMULATION WITH FUNCTIONAL NEAR-INFRARED SPECTROSCOPY AND INTENSIVE SPEECH THERAPY ON INDIVIDUALS WITH POST-STROKE APHASIA T. Hara*1, M. Abo 1, K. Kakita 2. 1 The Jikei University School of Medicine, Japan; 2 Kyoto Ohara Memorial Hospital, Japan Introduction: To examine the efficacy of selective repetitive transcranial magnetic stimulation (rTMS) therapy guided by functional near-infrared spectroscopy (fNIRS) combined with intensive speech therapy(ST) on poststroke patients with aphasia, and right hemisphere high-frequency rTMS combined with intensive ST on patients who were right hemisphereactivated in a language task. Methods: Eight right-handed patients with aphasia in the chronic stage after stroke were grouped into left and right hemisphere-activated for a language task based on pre-intervention fNIRS. Those with left hemisphere activation received 1-Hz TMS to the right inferior frontal gyrus (RtIFG; LFS group), and those with right hemisphere activation received 10-Hz TMS to the RtIFG (HFS group). The patients underwent an 11-day program of rTMS and intensiveST. Assessments of language function and fNIRS were performed at admission and at 3 months following discharge. Results: Both groups showed a significant improvement in language function as measured by Standard Language Test of Aphasia (SLTA) total score at post-intervention relative to pre-intervention. Furthermore, the pre-to-post SLTA change scores were not statistically different between the groups. Comparison of pre- and post-intervention fNIRS revealed a resolution of the imbalance of interhemispheric inhibition in the LFS group and activation of the target hemisphere in the HFS group. Discussion: This study is the first to use fNIRS to localize language activation regions, and we observed an improvement of language function following selective rTMS combined with intensive ST. This study is also the first to administer HFS to patients with preintervention fNIRS right hemisphere language activation and to demonstrate language improvement at a degree comparable to patients who received LFS. Furthermore, an examination of pre- to post-intervention fNIRS in the LFS group showed results similar to those of previous LFS studies. Conversely, in the HFS group, we observed an increase in brain activity in the contralesional hemisphere. Keywords: Aphasia, Stroke, Near-Infrared Spectroscopy, Transcranial magnetic stimulation [0111] TRANSCRANIAL DIRECT CURRENT STIMULATION FACILITATES READING TRAINING IN PARTICIPANTS WITH POST-STROKE CENTRAL ALEXIA S.J. Kerry*1, Z.V.J. Woodhead 1, O.M. Aguilar 1, 2, Y. Ong Hoon 1, J.S. Hogan 1, K. Pappa 1, A.P. Leff 1, J. Crinion 1. 1 University College London, UK; 2 Pontificia Universidad Javeriana, Colombia Introduction: Central alexia is an acquired reading disorder co-occurring with a generalised language deficit (aphasia). We tested the effects of anodal transcranial Direct Current Stimulation targeted at the left inferior frontal gyrus applied in conjunction with a reading training App, called iReadMore, designed to improve word reading accuracy. Methods: A group of 21 patients with central alexia in the chronic poststroke phase participated in the study. In a double blind, cross-over design participants completed two four-week therapy blocks. Participants were assigned to one of two groups, matched for lesion size, and baseline reading performance. G1 received 2 mA of
anodal tDCS in Block1 and sham tDCS in Block2. G2 group received the stimulation conditions in the opposite order. Participants attended three face-to-face sessions per week. They completed 40 minutes of training; 20 minutes with online tDCS, followed by 20 minutes without stimulation. Participants were asked to complete a total of 35 hours of training in each block. Reading accuracy was assessed for the 150 trained items in each therapy block at three time points; before and after Block1 and after Block2. Results: The percentage change in accuracy was calculated for each block (Figure 1) and entered into a 2x2 repeated measures ANOVA with withinsubject factors Block and Word-List and between-subjects factor tDCS group. Significant tDCS x Block (F(19,1)¼5.31, p<0.05) and Block x WordList (F(19, 1)¼23.30, p<0.05) interactions were observed. This suggests the effects of iReadMore therapy alone were restricted to trained items but the effect of tDCS generalised to untrained items. Averaging across both WordLists and Blocks, accuracy improved by 2.8% more during tDCS than sham. Discussion: Anodal tDCS had a small but significant facilitatory effect on word reading accuracy. Importantly, this generalised to untrained words suggesting that tDCS affects different cognitive systems to reading training alone. Keywords: tDCS, Reading Therapy, Aphasia, Cognitive Neuroscience
Figure 1. Ă
[0114] ALTERED FUNCTIONAL CONNECTIVITY OF THE SUBTHALAMUS AND THE BED NUCLEUS OF THE STRIA TERMINALIS IN OBSESSIVE-COMPULSIVE DISORDER 1, E. Real 1, C. M. Cano*1, P. Alonso 1, I. Martínez-Zalacaín 1, M. Subira 1 2 3 1 Segalas , J. Pujol , N. Cardoner , J.M. Menchon , C. SorianoMas 1. 1 Bellvitge University Hospital-IDIBELL, Spain; 2 Hospital del Mar, Spain; 3 Parc Taulí Sabadell, Spain Background: The clinical improvement observed in patients with obsessive-compulsive disorder (OCD) after deep brain stimulation (DBS) of the nucleus accumbens (NA) has been related to a normalization of the functional connectivity (FC) within the ventral fronto-striatal circuits. However, the possible FC alterations of other clinically-effective DBS targets have not been explored. Here we evaluated the FC patterns of the subthalamic nucleus (STN) and the bed nucleus of the stria terminalis (BNST) in patients with OCD, as well as their association with symptom severity.