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Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.8 no.3 São Paulo Sept. 2014

http://dx.doi.org/10.1590/S1980-57642014DN83000003 

Views & Reviews

Transcranial brain stimulation (TMS and tDCS) for post-stroke aphasia rehabilitation: Controversies

Estimulação cerebral transcraniana (EMT E ETCC) na reabilitação de afasia: controvérsias

Lucia Iracema Zanotto de Mendonça 1  

1MD, PhD. Mestre e Doutora em Neurologia - Faculdade de Medicina da Universidade de São Paulo, SP, Brazil

ABSTRACT

Transcranial brain stimulation (TS) techniques have been investigated for use in the rehabilitation of post-stroke aphasia. According to previous reports, functional recovery by the left hemisphere improves recovery from aphasia, when compared with right hemisphere participation. TS has been applied to stimulate the activity of the left hemisphere or to inhibit homotopic areas in the right hemisphere. Various factors can interfere with the brain's response to TS, including the size and location of the lesion, the time elapsed since the causal event, and individual differences in the hemispheric language dominance pattern. The following questions are discussed in the present article: [a] Is inhibition of the right hemisphere truly beneficial?; [b] Is the transference of the language network to the left hemisphere truly desirable in all patients?; [c] Is the use of TS during the post-stroke subacute phase truly appropriate? Different patterns of neuroplasticity must occur in post-stroke aphasia.

Key words: aphasia; transcranial magnetic stimulation; rehabilitation

RESUMO

As técnicas de estimulação cerebral transcraniana (ET) têm sido estudadas como recurso na reabilitação da afasia resultante de acidente vascular cerebral. Tem sido apontado que melhor recuperação da afasia ocorre quando o hemisfério esquerdo reassume a função da linguagem, quando comparado à participação do hemisfério direito. A ET pode estimular a atividade do hemisfério esquerdo ou inibir a atividade de áreas homotópicas do hemisfério direito. Vários fatores podem interferir na resposta à ET, como o tamanho e local da lesão, o tempo decorrido do evento causal e diferenças individuais no padrão de dominância hemisférica para a linguagem. Este artigo discute as seguintes questões: [a] Realmente é benéfico inibir o hemisfério direito? [b] Realmente é desejável a transferência para a esquerda da função da linguagem em todos os casos? [c] Realmente é adequada a aplicação da TS na fase subaguda pós AVC? Diferentes padrões de reorganização cerebral devem ocorrer frente à presença de afasia decorrente de AVC.

Palavras-Chave: afasia; estimulação magnética transcraniana; reabilitação

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Received: February 02, 2014; Accepted: April 03, 2014

Lucia I. Z. de Mendonça. Rua André Dreifus, 264 - 01252-010 São Paulo SP - Brazil. E-mail: lucia.iracema@terra.com.br

Disclosure: The authors report no conflicts of interest.

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