Effects of rTMS Based on Neural Activation in Language Performance in Stroke Patients With Non-fluent Aphasia

Effects of Repetitive Transcranial Magnetic Stimulation Based on Neural Activation in Language Performance in Stroke Patients With Non-fluent Aphasia

The aim of this study is to assess the safety and clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) based on hemodynamic brain activity pattern with functional near infrared spectroscopy (fNIRS) in early poststroke nonfluent aphasia patients.

Most conventional rTMS studies employed an inhibitory low frequency protocol for the contralesional homologs of Broca's area.

In the present randomized controlled trial, investigators will perform fNIRS prior to rTMS treatment to select the stimulation method. Stimulation site (perilesional or contralesional) and frequency (excitatory high or inhibitory low) will be determined by activation pattern from the fNIRS with language task in individual patients.

The patient who shows a dominant neural activity at perilesional Broca's area on fNIRS scanning will be randomly allocated into two groups: high frequency stimulation group and sham stimulation group. If a patient shows a dominant neural activity at contralesional homologs of Broca's area on fNIRS scanning, the patient will be allocated to a low frequency stimulation group.

Inclusion Criteria:

• 18-80 yrs old
• Right-handed
• Radiologically confirmed left hemisphere stroke within 6 months
• Fluent in Korean
• First ever stroke
• Non-fluent (motor-dominant) aphasia
• Written informed consent

Exclusion Criteria:

• Previous medical histories of stroke, cerebral vascular operation,
• Seizure
• Patients with traumatic brain injury
• Unable to perform the language task
• Severe cognitive impairment (MMSE less than 16)
• Skin lesion in the stimulation site of scalp
• Metal implants in the body (cardiac pacemaker or aneurysm clip)
• Pregnancy, breastfeeding