TMS in Aphasia Recovery

A Blinded Randomized Sham-Controlled Incomplete Crossover Trial of Low-Frequency Contralesional Repetitive Transcranial Magnetic Stimulation in the Treatment of Aphasia in Patients With Chronic Stroke

Stroke often causes substantial problems in speaking or understanding speech. Treatments for these problems are currently very limited. Limited studies to date suggest that repetitive Transcranial Magnetic Stimulation (TMS) to the side of the brain opposite to the side on which the stroke occurred may improve language function. The investigators are testing this hypothesis by giving daily 20 minute sessions of repeated TMS to the right (unaffected) side of the brain; the investigators test language function with a variety of tests both before and after the treatment with TMS and subjects are required to undergo functional MRI scans before and after treatment. TMS is a procedure in which a coil is placed next to the head of the subject and an electrical current passes through the coil causing a magnetic field that, in turn, causes a small electric current in the portion of the brain underneath the coil.

Inclusion Criteria:

• Aphasic patients will have had single, unilateral left hemisphere ischemic stroke, which spared the supplementary motor area (SMA)
• With the exception of lacunar infarcts less than ≤ 1.5 cm (as measured by neuroimaging), the stroke causing the patients' impairments must be the only stroke.
• Aphasic patients will be at least 6 months post-stroke and have mild-severe, non-fluent speech
• Participants must be able to understand the nature of the study, and give informed consent

Exclusion Criteria:

• Patients with more than one stroke
• Primary hemorrhagic stroke. Note: It is recognized that some ischemic strokes may have a minor amount of hemosiderin in the parenchyma. If this occurs, this is not considered a "hemorrhagic stroke" referred to in this exclusion criterion.
• Intracranial metallic bodies from prior neurosurgical procedure
• Signs of increased intracranial pressure as assessed by ophthalmic exam and patient symptoms
• Implanted pacemaker, medication pump, vagal nerve stimulator, deep brain stimulator, TENS unit or ventriculoperitoneal shunt
• History of seizure or unexplained loss of consciousness during the year prior to the initiation of the study
• Pregnancy. If the patient cannot rule out pregnancy then a pregnancy test will be conducted prior to inclusion into the study
• Family history of epilepsy
• Acute, unstable medical conditions
• History of substance abuse within the last 6 months
• Abnormal neurologic exam other than as signs of the condition studied in the present protocol
• History of known structural brain abnormality other than as signs of the condition studied in the present protocol
• History of tinnitus
• History of bipolar disorder
• Consumption of medicines known to lower the seizure threshold
• History of head injury with unconsciousness lasting more than 5 minutes
• Previous brain surgery
• Other medical or neurologic conditions, aside from stroke, in which the likelihood of developing a seizure is known to be increased
• Other medical or neurologic conditions, in which a seizure would be particularly harmful
• Significant cardiac disease
• Intracardiac lines of any type
• Current serious or unstable medical illness, including renal, hepatic, cardiovascular, gastrointestinal, endocrinologic, neurologic, immunologic, or hematological disease, that could require admission to a hospital within 3 months, or that death is anticipated within 3 years, or that requires daily supervision by a health professional
• Administration of any investigational drug within 5 half-lives of the drug prior to testing