Universität zu Köln

Zumbansen, Anna ORCID: 0000-0003-2332-8263, Kneifel, Heike, Lazzouni, Latifa, Ophey, Anja ORCID: 0000-0001-5858-7762, Black, Sandra E., Chen, Joyce L., Edwards, Dylan, Funck, Thomas, Hartmann, Alexander Erich, Heiss, Wolf-Dieter, Hildesheim, Franziska, Lanthier, Sylvain, Lesperance, Paul, Mochizuki, George, Paquette, Caroline, Rochon, Elizabet, Rubi-Fessen, Ilona, Valles, Jennie, Wortman-Jutt, Susan and Thiel, Alexander (2022). Differential Effects of Speech and Language Therapy and rTMS in Chronic Versus Subacute Post-stroke Aphasia: Results of the NORTHSTAR-CA Trial. Neurorehabil. Neural Repair, 36 (4-5). S. 306 - 317. THOUSAND OAKS: SAGE PUBLICATIONS INC. ISSN 1552-6844

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Abstract

Background & objective: Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5-45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (>6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. Methods: Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Intentionto-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. Results: Adverse events were rare, mild, and did not differ between groups. Language outcomes improved significantly in all groups irrespective of treatment and recovery phase. At 30-day follow-up, there was a significant interaction of stimulation and recovery phase on naming recovery (P <.001). Naming recovery with rTMS was larger in subacute (Mdn = 1.91/IQR = .77) than chronic patients (Mdn = .15/IQR = 1.68/P = .015). There was no significant rTMS effect in the chronic aphasia group. Conclusions: The addition of rTMS to SLT led to significant supplemental gains in naming recovery in the subacute phase only. While this needs confirmation in larger studies, our results clarify neuromodulatory vs training-induced effects and indicate a possible window of opportunity for contralesional inhibitory stimulation interventions in post-stroke aphasia.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Zumbansen, Anna UNSPECIFIED orcid.org/0000-0003-2332-8263 UNSPECIFIED Kneifel, Heike UNSPECIFIED UNSPECIFIED UNSPECIFIED Lazzouni, Latifa UNSPECIFIED UNSPECIFIED UNSPECIFIED Ophey, Anja UNSPECIFIED orcid.org/0000-0001-5858-7762 UNSPECIFIED Black, Sandra E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Chen, Joyce L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Edwards, Dylan UNSPECIFIED UNSPECIFIED UNSPECIFIED Funck, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Hartmann, Alexander Erich UNSPECIFIED UNSPECIFIED UNSPECIFIED Heiss, Wolf-Dieter UNSPECIFIED UNSPECIFIED UNSPECIFIED Hildesheim, Franziska UNSPECIFIED UNSPECIFIED UNSPECIFIED Lanthier, Sylvain UNSPECIFIED UNSPECIFIED UNSPECIFIED Lesperance, Paul UNSPECIFIED UNSPECIFIED UNSPECIFIED Mochizuki, George UNSPECIFIED UNSPECIFIED UNSPECIFIED Paquette, Caroline UNSPECIFIED UNSPECIFIED UNSPECIFIED Rochon, Elizabet UNSPECIFIED UNSPECIFIED UNSPECIFIED Rubi-Fessen, Ilona UNSPECIFIED UNSPECIFIED UNSPECIFIED Valles, Jennie UNSPECIFIED UNSPECIFIED UNSPECIFIED Wortman-Jutt, Susan UNSPECIFIED UNSPECIFIED UNSPECIFIED Thiel, Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-693951
DOI:	10.1177/15459683211065448
Journal or Publication Title:	Neurorehabil. Neural Repair
Volume:	36
Number:	4-5
Page Range:	S. 306 - 317
Date:	2022
Publisher:	SAGE PUBLICATIONS INC
Place of Publication:	THOUSAND OAKS
ISSN:	1552-6844
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TRANSCRANIAL MAGNETIC STIMULATION; ACUTE STROKE; BRAIN-STIMULATION; NORMATIVE DATA; RECOVERY; DYNAMICS; REORGANIZATION; METAANALYSIS; PERFORMANCE; SEVERITY Multiple languages Clinical Neurology; Rehabilitation Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69395