title: Role of the contralateral inferior frontal gyrus in recovery of language function in poststroke aphasia: a combined repetitive transcranial magnetic stimulation and positron emission tomography study.
abstract: OBJECTIVE
  Functional neuroimaging studies have demonstrated right inferior frontal gyrus (IFG) activation in poststroke aphasia. It remains unclear whether this activation is essential for language performance. We tested this hypothesis in a positron emission tomography (PET) activation study during a semantic task with repetitive transcranial magnetic stimulation (rTMS) on right-handed patients experiencing poststroke aphasia and examined whether rTMS stimulation over the right and left IFG would interfere with language performance.
  
  
  METHODS
  Eleven patients with left-sided middle cerebral arterial infarction, 50 to 75 years of age, were tested with the Aachen Aphasia Test Battery and underwent (15)O-H2O PET activation during a semantic task within 2 weeks after stroke. PET activation images were coregistered to T1-weighted MRIs. Stimulation sites were determined on renderings of head and brain over the maximum activation within left and right IFG. rTMS was performed with 20% maximum output (2.1 T), 10-s train duration, at 4 Hz frequency. A positive rTMS effect was defined as an increased reaction time latency or error rate in the semantic task.
  
  
  RESULTS
  PET activations of the IFG were observed on the left (3 patients) and bilaterally (8 patients). Right IFG stimulation was positive in 5 patients with right IFG activation, indicating essential language function. In a verbal fluency task, these patients had a lower performance than patients without right-sided TMS effect.
  
  
  CONCLUSIONS
  In some poststroke aphasics, right IFG activation is essential for residual language function. However, its compensatory potential seems to be less effective than in patients who recover left IFG function. These results suggest a hierarchy in recovery from poststroke aphasia and a (limited) compensatory potential of the nondominant hemisphere.
authors: Department of Neurology, University of Cologne, Germany. L.Winhuisen@pet.mpin-koeln.mpg.de
authors: Lutz
authors: L
authors: Winhuisen
authors: Alexander
authors: A
authors: Thiel
authors: Birgit
authors: B
authors: Schumacher
authors: Josef
authors: J
authors: Kessler
authors: Jobst
authors: J
authors: Rudolf
authors: Walter F
authors: WF
authors: Haupt
authors: Wolf D
authors: WD
authors: Heiss
mesh_terms: D000368:Aged; D001037:Aphasia / Q000473:pathology* / Q000503:physiopathology; D001921:Brain / Q000473:pathology*; D005625:Frontal Lobe / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D020521:Stroke / Q000150:complications* / Q000473:pathology; D013997:Time Factors; D050781:Transcranial Magnetic Stimulation / Q000379:methods