Differential Effects of Speech and Language Therapy and rTMS in Chronic Versus Subacute Post-stroke Aphasia: Results of the NORTHSTAR-CA Trial.

Aphasia / etiology Humans Language Therapy Speech Speech Therapy / methods Transcranial Magnetic Stimulation / methods Treatment Outcome
aphasia language therapy randomized controlled trial speech therapy stroke transcranial magnetic stimulation

Journal

Neurorehabilitation and neural repair
ISSN: 1552-6844
Titre abrégé: Neurorehabil Neural Repair
Pays: United States
ID NLM: 100892086

Informations de publication

Date de publication:
04 2022
Historique:
pubmed: 27 3 2022
medline: 13 4 2022
entrez: 26 3 2022
Statut: ppublish

Résumé

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. 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. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. 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 ( 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. https://clinicaltrials.gov/ct2/show/NCT02020421.

Sections du résumé

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. Intention-to-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 (
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.
NORTHSTAR TRIAL REGISTRATION
https://clinicaltrials.gov/ct2/show/NCT02020421.

Identifiants

DOI: 10.1177/15459683211065448 PMID: 35337223 PMC: PMC9003806
pubmed: 35337223
doi: 10.1177/15459683211065448
pmc: PMC9003806
doi:

Banques de données

ClinicalTrials.gov
['NCT02020421']

Types de publication

Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

306-316

Subventions

Organisme : CIHR
ID : MOP125954
Pays : Canada

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Auteurs

Anna Zumbansen (A)

Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.
School of Rehabilitation Sciences, 6363University of Ottawa, Ottawa, ON, Canada.
ORCID: 0000-0003-2332-8263

Heike Kneifel (H)

Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.
School of Rehabilitation Sciences, 6363University of Ottawa, Ottawa, ON, Canada.
ORCID: 0000-0003-0524-3143

Latifa Lazzouni (L)

Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.

Anja Ophey (A)

Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.
ORCID: 0000-0001-5858-7762

Sandra E Black (SE)

Department of Medicine-Neurology and Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, 71545University of Toronto, Toronto, ON, Canada.
KITE Research Institute, Toronto Rehabilitation Institute, 12366University Health Network, University of Toronto, Toronto, ON, Canada.
ORCID: 0000-0001-7093-8289

Joyce L Chen (JL)

Faculty of Kinesiology and Physical Education, and Rehabilitation Sciences Institute, 177420University of Toronto, Toronto, ON, Canada.

Dylan Edwards (D)

10997Burke Neurological Institute, White Plains, NY, USA.
Moss Rehabilitation Research Institute, Elkins Park, PA, USA.
Edith Cowan University, Joondalup, WA, Australia.
ORCID: 0000-0001-7346-3100

Thomas Funck (T)

Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.

Alexander Erich Hartmann (AE)

Hospital of the City of Cologne and Department of Neurosurgery, 163483University of Witten-Herdecke, Germany.

Wolf-Dieter Heiss (WD)

Max Planck Institute für Stoffwechsel Forschung - MPI for Metabolism Research, and 28302Universität zu Köln, Cologne, Germany.

Franziska Hildesheim (F)

Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.
Canadian Platform for Trials in Non-invasive Brain Stimulation (CanSTIM), Montreal, QC, Canada.

Sylvain Lanthier (S)

Hôpital du Sacré-Cœur de Montreal, 12368Université de Montréal, Montreal, QC, Canada.

Paul Lespérance (P)

CHUM, 12368Université de Montréal, Montreal, QC, Canada.

George Mochizuki (G)

School of Kinesiology and Health Science, 56014York University, Toronto, ON, Canada.

Caroline Paquette (C)

Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.
ORCID: 0000-0001-8109-5301

Elizabet Rochon (E)

KITE Research Institute, Toronto Rehabilitation Institute, 12366University Health Network, University of Toronto, Toronto, ON, Canada.

Ilona Rubi-Fessen (I)

RehaNova, Neurological Rehabilitation Clinic, Cologne, Germany.
Department of Special Education and Rehabilitation, Faculty of Human Sciences, 14309University of Cologne, Cologne, Germany.
ORCID: 0000-0002-9775-3812

Jennie Valles (J)

10997Burke Rehabilitation Hospital, White Plains, NY, USA.

Susan Wortman-Jutt (S)

10997Burke Neurological Institute, White Plains, NY, USA.
10997Burke Rehabilitation Hospital, White Plains, NY, USA.

Alexander Thiel (A)

Jewish General Hospital, 5620McGill University, Montreal, QC, Canada.
Canadian Platform for Trials in Non-invasive Brain Stimulation (CanSTIM), Montreal, QC, Canada.

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Classifications MeSH

questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Troubles du langage › Troubles de la parole › Aphasie › Differential Effects of Speech and Language...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Differential Effects of Speech and Language...
questionsmedicales.fr › Thérapeutique › Rééducation des troubles de la parole et du langage › Thérapie des troubles du langage › Differential Effects of Speech and Language...
questionsmedicales.fr › Sciences de l'information › Langage › Arts du langage › Parole › Differential Effects of Speech and Language...
questionsmedicales.fr › Thérapeutique › Rééducation des troubles de la parole et du langage › Orthophonie › Differential Effects of Speech and Language...
questionsmedicales.fr › Thérapeutique › Magnétothérapie › Stimulation magnétique transcrânienne › Differential Effects of Speech and Language...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Differential Effects of Speech and Language...