Non-invasive brain stimulation as add-on therapy for subacute post-stroke aphasia: A randomized trial (NORTHSTAR)
Authors/Creators
Anna Zumbansen
Sandra E. Black
Joyce L. Chen
Dylan J. Edwards, Edith Cowan UniversityFollow
Alexander Hartmann
Wolf-Dieter Heiss
Sylvain Lanthier
Paul Lesperance
George Mochizuki
Caroline Paquette
Elizabeth A. Rochon
Ilona Rubi-Fessen
Jennie Valles
Heike Kneifel
Susan Wortman-Jutt
Alexander Thiel
NORTHSTAR-study group
Abstract
© European Stroke Organisation 2020. Introduction: Non-invasive brain stimulation (NIBS) with speech therapy might improve recovery from post-stroke aphasia. This three-armed sham-controlled blinded prospective proof-of-concept study tested 1 Hz subthreshold repetitive transcranial magnetic stimulation (rTMS) and 2-mA cathodal transcranial direct current stimulation (ctDCS) on the right pars triangularis in subacute post-stroke aphasia. Patients and methods: Sixty-three patients with left middle cerebral artery infarcts were recruited in five hospitals (Canada/United States/Germany, 01–2014/03–2018) and randomized to receive rTMS (N = 20), ctDCS (N = 24) or sham stimulation (N = 19) with ST for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Secondary outcome variable was the percent change in the Unified Aphasia Score. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment with a pre-planned subgroup analysis for lesion location (affecting Broca’s area or not). Results: Naming was significantly improved by rTMS (median = 1.91/interquartile range = 0.77/p =.01) at 30 days versus ctDCS (median = 1.11/interquartile range = 1.51) and sham stimulation (median = 1.02/interquartile range = 1.71). All other primary results were non-significant. The rTMS effect was driven by the patient subgroup with intact Broca’s area where NIBS tended to improve UnAS (median = 33.2%/interquartile range = 46.7%/p =.062) versus sham stimulation (median = 12.5%/interquartile range = 7.9%) at day 30. Conversely, in patients with infarcted Broca’s area, UnAS tended to improve more with sham stimulation (median = 75.0%/interquartile range = 86.9%/p =.053) versus NIBS (median = 12.7%/interquartile range = 31.7). Conclusion: We found a delayed positive effect of low-frequency rTMS targeting the right pars triangularis on the recovery of naming performance in subacute post-stroke aphasia. This intervention may be beneficial only in patients with morphologically intact Broca’s area.
RAS ID
35197
Document Type
Journal Article
Date of Publication
2020
ISSN
23969873
Volume
9
Funding Information
Canadian Institutes for Health Research W.-D. Heiss Foundation Lady Davis Institute CIHR Postdoctoral fellowship
School
School of Medical and Health Sciences
Copyright
free_to_read
Publisher
SAGE
Recommended Citation
Zumbansen, A., Black, S. E., Chen, J. L., Edwards, D. J., Hartmann, A., Heiss, W., Lanthier, S., Lesperance, P., Mochizuki, G., Paquette, C., Rochon, E. A., Rubi-Fessen, I., Valles, J., Kneifel, H., Wortman-Jutt, S., Thiel, A., & (2020). Non-invasive brain stimulation as add-on therapy for subacute post-stroke aphasia: A randomized trial (NORTHSTAR). DOI: https://doi.org/10.1177/2396987320934935
Comments
Zumbansen, A., Black, S. E., Chen, J. L., Edwards, D. J., Hartmann, A., Heiss, W. D., ... Thiel, A. (2020). Non-invasive brain stimulation as add-on therapy for subacute post-stroke aphasia: A randomized trial (NORTHSTAR). European Stroke Journal, 5(4), 402-413. https://doi.org/10.1177/2396987320934935