Acessibilidade / Reportar erro

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

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

Abstracts

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.

aphasia; transcranial magnetic stimulation; rehabilitation


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.

afasia; estimulação magnética transcraniana; reabilitação


Texto completo disponível apenas em PDF.

Full text available only in PDF format.

  • 1
    Rasmussen T, Milner B. The role of early left-brain injury in determining lateralization of cerebral speech functions. Ann N Y Acad Sci 1977;299: 355-369
  • 2
    Lecours AR, Mehler J, Parente MA, et al. Illiteracy and brain damage. 3: A contribution to the study of speech and language disorders in illiterates with unilateral brain damage (initial testing). Neuropsychologia 1988;26:575-589.
  • 3
    Zou L, Abutalebi J, Zinszer B, et al. Second language experience modulates functional brain network for the native language production in bimodal bilinguals. Neuroimage 2012;62:1367-1375.
  • 4
    Bloch C, Kaiser A, Kuenzli E, et al. The age of second language acquisition determines the variability in activation elicited by narration in three languages in Broca's and Wernicke's area. Neuropsychologia 2009;47:625-633.
  • 5
    Destrieux C, Hommet C, Domengie F, et al. Influence of age on the dynamics of fMRI activations during a semantic fluency task. J Neuroradiol 2012;39:158-166.
  • 6
    Scherer LC, Fonseca RP, Giroux F, et al. Neurofunctional (re)organization underlying narrative discourse processing in aging: evidence from fNIRS. Brain Lang 2012;121:174-184.
  • 7
    Wong IS, Tsang HW. A review on the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on post-stroke aphasia. Rev Neurosci 2013;24:105-114.
  • 8
    Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving aphasia in patients after stroke. Cochrane Database Syst Rev 2013; 6:CD009760.
  • 9
    Saur D, Lange R, Baumgaertner A, Schraknepper V, Willmes K, Rijntjes M et al. Dynamics of language reorganization after stroke. Brain 2006;129:1371-1384.
  • 10
    Thiel A, Schumacher B, Wienhard K, et al. Direct demonstration of transcallosal disinhibition in language networks. J Cereb Blood Flow Metab 2006;26:1122-1127.
  • 11
    Calvert GA, Brammer MJ, Morris RG, Williams SC, King N, Matthews PM. Using fMRI to study recovery from acquired dysphasia. Brain Lang 2000;71:391-399.
  • 12
    Heiss WD, Thiel A. A proposed regional hierarchy in recovery of post-stroke aphasia. Brain Lang 2006; 98:118-123.
  • 13
    Karbe H, Thiel A, Weber-Luxenburger G, Herholz K, Kessler J, Heiss WD. Brain plasticity in poststroke aphasia: what is the contribution of the right hemisphere? Brain Lang 1998;64:215-230.
  • 14
    van Oers CA, Vink M, van Zandvoort MJ, et al. Contribution of the left and right inferior frontal gyrus in recovery from aphasia. A functional MRI study in stroke patients with preserved hemodynamic responsiveness. Neuroimage 2010;49:885-893.
  • 15
    Vargha-Khadem F, Carr LJ, Isaacs E, Brett E, Adams C, Mishkin M. Onset of speech after left hemispherectomy in a nine-year-old boy. Brain 1997;120:159-182.
  • 16
    Basso A, Gardelli M, Grassi MP, Mariotti M. The role of the right hemisphere in recovery from aphasia. Two case studies. Cortex 1989; 25: 555-566.
  • 17
    Thiel A, Habedank B, Herholz K, et al. From the left to the right: How the brain compensates progressive loss of language function. Brain Lang 2006;98:57-65.
  • 18
    Crosson B, Moore AB, Gopinath K, et al. Role of the right and left hemispheres in recovery of function during treatment of intention in aphasia. J Cogn Neurosci 2005;17:392-406.
  • 19
    Szaflarski JP, Allendorfer JB, Banks C, Vannest J, Holland SK. Recovered vs. not- recovered from post-stroke aphasia: the contributions from the dominant and non-dominant hemispheres. Restor Neurol Neurosci 2013;31:347-360.
  • 20
    Hillis AE. Aphasia: progress in the last quarter of a century. Neurology 2007;69:200-213.
  • 21
    Heiss WD, Thiel A. A proposed regional hierarchy in recovery of post-stroke aphasia. Brain Lang 2006;98:118-123.
  • 22
    Rosen HJ, Petersen SE, Linenweber MR, et al. Neural correlates of recovery from aphasia after damage to left inferior frontal cortex. Neurology 2000;55:1883-1894.
  • 23
    Anglade C, Thiel A, Ansaldo AI. The complementary role of the cerebral hemispheres in recovery from aphasia after stroke: a critical review of literature. Brain Inj 2014;28:138-145.
  • 24
    Wang J, Wu D, Chen Y, Yuan Y, Zhang M. Effects of transcranial direct current stimulation on language improvement and cortical activation in nonfluent variant primary progressive aphasia. Neurosci Lett 2013;549:29-33.
  • 25
    Naeser MA, Martin PI, Nicholas M, et al. Improved picture naming in chronic aphasia after TMS to part of right Broca's area: an open-protocol study. Brain Lang 2005;93:95-105.
  • 26
    Volpato C, Cavinato M, Piccione F, Garzon M, Meneghello F, Birbaumer N. Transcranial direct current stimulation (tDCS) of Broca's area in chronic aphasia: a controlled outcome study. Behav Brain Res 2013; 247:211-216.
  • 27
    Baker JM, Rorden C, Fridriksson J. Using transcranial direct-current stimulation to treat stroke patients with aphasia. Stroke 2010;41:1229-1236.
  • 28
    Szaflarski JP, Vannest J, Wu SW, DiFrancesco MW, Banks C, Gilbert DL. Excitatory repetitive transcranial magnetic stimulation induces improvements in chronic post-stroke aphasia. Med Sci Monit 2011;17:CR132-9.
  • 29
    Marangolo P, Fiori V, Campana S, et al. Something to talk about: enhancement of linguistic cohesion through tdCS in chronic non fluent aphasia. Neuropsychologia 2014;53:246-256.
  • 30
    Fiori V, Cipollari S, Di Paola M, Razzano C, Caltagirone C, Marangolo P. tDCS stimulation segregates words in the brain: evidence from aphasia. Front Hum Neurosci 2013;7:269.
  • 31
    Weiduschat N, Thiel A, Rubi-Fessen I, et al. Effects of repetitive transcranial magnetic stimulation in aphasic stroke: a randomized controlled pilot study. Stroke 2011;42:409-415.
  • 32
    Barwood CH, Murdoch BE, Whelan BM, et al. The effects of low frequency Repetitive Transcranial Magnetic Stimulation (rTMS) and sham condition rTMS on behavioural language in chronic non-fluent aphasia: Short term outcomes. NeuroRehabilitation 2011;28:113-128.
  • 33
    Hamilton RH, Sanders L, Benson J, et al. Stimulating conversation: enhancement of elicited propositional speech in a patient with chronic non-fluent aphasia following transcranial magnetic stimulation. Brain Lang 2010;113:45-50.
  • 34
    Winhuisen L, Thiel A, Schumacher B, et al. Role of the contralateral inferior frontal gyrus in recovery of language function in poststroke aphasia: a combined repetitive transcranial magnetic stimulation and positron emission tomography study. Stroke 2005;36:1759-1763.
  • 35
    Martin PI, Naeser MA, Ho M, et al. Research with transcranial magnetic stimulation in the treatment of aphasia. Curr Neurol Neurosci Rep 2009;9:451-458.
  • 36
    Martin PI, Naeser MA, Ho M, et al. Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS. Brain Lang 2009;111:20-35.
  • 37
    Naeser MA, Martin PI, Treglia E, et al. Research with rTMS in the treatment of aphasia. Restor Neurol Neurosci 2010;28:511-529.
  • 38
    Hartwigsen G, Price CJ, Baumgaertner A, et al.The right posterior inferior frontal gyrus contributes to phonological word decisions in the healthy brain: evidence from dual-site TMS. Neuropsychologia 2010;48:3155-3163.
  • 39
    Poldrack RA, Wagner AD, Prull MW, Desmond J E, Glover GH, Gabrieli JD. Functional specialization for semantic and phonological processing in the left inferior prefrontal cortex. Neuroimage 1999;10:15-35.
  • 40
    Devlin JT, Matthews PM, Rushworth MF. Semantic processing in the left inferior prefrontal cortex: A combined functional magnetic resonance imaging and transcranial magnetic stimulation study. J Cogn Neurosci 2003;15:71-84.
  • 41
    Saur D, Kreher BW, Schnell S, et al. Ventral and dorsal pathways for language. Proc Natl Acad Sci 2008;105:18035-18040.
  • 42
    Kaplan E, Naeser MA, Martin PI, et al.Horizontal portion of arcuate fasciculus fibers track to pars opercularis, not pars triangularis, in right and left hemispheres: a DTI study. Neuroimage 2010;52:436-444.
  • 43
    Turkeltaub PE, Messing, S, Norise C, Hamilton RH. Are networks for residual language function and recovery consistent across aphasic patients? Neurology 2011;76:1726-1734.
  • 44
    Kakuda W, Abo M, Kaito N, Watanabe M, Senoo A. Functional MRI-based therapeutic rTMS strategy for aphasic stroke patients: a case series pilot study. Int J Neurosci 2010;120:60-66.
  • 45
    Garcia G, Norise C, Faseyitan O, Naeser MA, Hamilton RH. Utilizing repetitive transcranial magnetic stimulation to improve language function in stroke patients with chronic non-fluent aphasia. J Vis Exp 2013; 77:e50228.
  • 46
    Turkeltaub PE, Coslett HB, Thomas AL, et al. The right hemisphere is not unitary in its role in aphasia recovery. Cortex 2012;48 :1179-1186.
  • 47
    Heiss WD, Hartmann A, Rubi-Fessen I, et al. Noninvasive brain stimulation for treatment of right- and left-handed poststroke aphasics. Cerebrovasc Dis 2013;36:363-372.
  • 48
    Polanowska KE, Lesniak MM, Seniów JB, Czepiel W, Czlonkowska A. Anodal transcranial direct current stimulation in early rehabilitation of patients with post-stroke non-fluent aphasia: a randomized, double-blind, sham-controlled pilot study. Restor Neurol Neurosci 2013;31:761-771.
  • 49
    Seniów J, Waldowski K, Lesniak M, Iwanski S, Czepiel W, Czlonkowska A. Transcranial magnetic stimulation combined with speech and language training in early aphasia rehabilitation: a randomized double-blind controlled pilot study. Top Stroke Rehabil 2013;20:250-261.
  • 50
    Weiduschat N, Thiel A, Rubi-Fessen I, et al. Effects of repetitive transcranial magnetic stimulation in aphasic stroke: a randomized controlled pilot study. Stroke 2011;42:409-415.
  • 51
    Heiss WD, Hartmann A, Rubi-Fessen I, et al. Noninvasive brain stimulation for treatment of right- and left-handed poststroke aphasics. Cerebrovasc Dis 2013;36:363-372.
  • 52
    Thiel A, Hartmann A, Rubi-Fessen I, et al. Effects of noninvasive brain stimulation on language networks and recovery in early poststroke aphasia. Stroke 2013;44:2240-2246.
  • 53
    Winhuisen L, Thiel A, Schumacher B, et al. Role of the contralateral inferior frontal gyrus in recovery of language function in poststroke aphasia: a combined repetitive transcranial magnetic stimulation and positron emission tomography study. Stroke 2005;36:1759-1763.
  • 54
    Winhuisen L, Thiel A, Schumacher B, et al. The right inferior frontal gyrus and poststroke aphasia: a follow-up investigation. Stroke 2007;38:1286-1292.
  • 55
    Humm JL, Kozlowski DA, James DC, Gotts JE, Schallert T. Use-dependent exacerbation of brain damage occurs during an early post-lesion vulnerable period. Brain Res 1998;783:286-292.
  • 56
    Farrell R, Evans S, Corbett D. Environmental enrichment enhances recovery of function but exacerbates ischemic cell death. Neuroscience 2001;107:585-592.
  • 57
    Kleim JA, Jones TA, Schallert T. Motor enrichment and the induction of plasticity before or after brain injury. Neurochem Res 2003;28:1757-1769.
  • 58
    Woodlee MT, Schallert T. The interplay between behavior and neurodegeneration in rat models of Parkinson's disease and stroke. Restor Neurol Neurosci 2004;22:153-161.
  • 59
    Schallert T, Kozlowski DA, Humm JL, Cocke RR. Use-dependent structural events in recovery of function. Adv Neurol 1997;73:229-238.
  • 60
    DeBow SB, McKenna JE, Kolb B, Colbourne F. Immediate constraint-induced movement therapy causes local hyperthermia that exacerbates cerebral cortical injury in rats. Can J Physiol Pharmacol 2004;82:231-237.
  • 61
    Lendrem W, Lincoln NB. Spontaneous recovery of language in patients with aphasia between 4 and 34 weeks after stroke. J Neurol Neurosurg Psychiatry 1985;48:743-748.
  • 62
    Robey RR. A meta-analysis of clinical outcomes in the treatment of aphasia. J Speech Lang Hear Res 1998;41:172-187.
  • 63
    Bhogal SK, Teasell RW, Foley NC, Speechley MR. Community reintegration after stroke. Top Stroke Rehabil 2003;10:107-129.
  • 64
    Hubel DH, Wiesel TN. Binocular teraction in strate cortex of kittens reared with artificial squint. J Neurophysiol 1965;28:1041-1059.
  • 65
    Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res 2008;51:S225-239.
  • 66
    Baker JM, Rorden C, Fridriksson J. Using transcranial direct-current stimulation to treat stroke patients with aphasia. Stroke 2010;41:1229-1236.
  • 67
    Abo M, Kakuda W. Neuroimaging and neurorehabilitation for aphasia. Brain Nerve 2010;62:141-149.
  • 68
    Hamilton RH, Chrysikou EG, Coslett B. Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation. Brain Lang 2011;118:40-50.
  • 69
    Cappa SF. The neural basis of aphasia rehabilitation: evidence from neuroimaging and neurostimulation. Neuropsychol Rehabil 2011;21:742-754.

Publication Dates

  • Publication in this collection
    Sept 2014

History

  • Received
    02 Feb 2014
  • Accepted
    03 Apr 2014
Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br