title: Overt naming fMRI pre- and post-TMS: Two nonfluent aphasia patients, with and without improved naming post-TMS.
abstract: Two chronic, nonfluent aphasia patients participated in overt naming fMRI scans, pre- and post-a series of repetitive transcranial magnetic stimulation (rTMS) treatments as part of a TMS study to improve naming. Each patient received 10, 1-Hz rTMS treatments to suppress a part of R pars triangularis. P1 was a 'good responder' with improved naming and phrase length; P2 was a 'poor responder' without improved naming. Pre-TMS (10 years poststroke), P1 had significant activation in R and L sensorimotor cortex, R IFG, and in both L and R SMA during overt naming fMRI (28% pictures named). At 3 mo. post-TMS (42% named), P1 showed continued activation in R and L sensorimotor cortex, R IFG, and in R and L SMA. At 16 mo. post-TMS (58% named), he also showed significant activation in R and L sensorimotor cortex mouth and R IFG. He now showed a significant increase in activation in the L SMA compared to pre-TMS and at 3 mo. post-TMS (p < .02; p < .05, respectively). At 16 mo. there was also greater activation in L than R SMA (p < .08). At 46 mo. post-TMS (42% named), this new LH pattern of activation continued. He improved on the Boston Naming Test from 11 pictures named pre-TMS, to scores ranging from 14 to 18 pictures, post-TMS (2-43 mo. post-TMS). His longest phrase length (Cookie Theft picture) improved from three words pre-TMS, to 5-6 words post-TMS. Pre-TMS (1.5 years poststroke), P2 had significant activation in R IFG (3% pictures named). At 3 and 6 mo. post-TMS, there was no longer significant activation in R IFG, but significant activation was present in R sensorimotor cortex. On all three fMRI scans, P2 had significant activation in both the L and R SMA. There was no new, lasting perilesional LH activation across sessions for this patient. Over time, there was little or no change in his activation. His naming remained only at 1-2 pictures during all three fMRI scans. His BNT score and longest phrase length remained at one word, post-TMS. Lesion site may play a role in each patient's fMRI activation pattern and response to TMS treatment. P2, the poor responder, had an atypical frontal lesion in the L motor and premotor cortex that extended high, near brain vertex, with deep white matter lesion near L SMA. P2 also had frontal lesion in the posterior middle frontal gyrus, an area important for naming (Duffau et al., 2003); P1 did not. Additionally, P2 had lesion inferior and posterior to Wernicke's area, in parts of BA 21 and 37, whereas P1 did not. The fMRI data of our patient who had good response following TMS support the notion that restoration of the LH language network is linked in part, to better recovery of naming and phrase length in nonfluent aphasia.
authors.affiliation: Harold Goodglass Boston University Aphasia Research Center, Department of Neurology, Boston University School of Medicine and the Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA. paulak@bu.edu
authors.forename: Paula I
authors.initials: PI
authors.lastname: Martin
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Naeser
authors.forename: Michael
authors.initials: M
authors.lastname: Ho
authors.forename: Karl W
authors.initials: KW
authors.lastname: Doron
authors.forename: Jacquie
authors.initials: J
authors.lastname: Kurland
authors.forename: Jerome
authors.initials: J
authors.lastname: Kaplan
authors.forename: Yunyan
authors.initials: Y
authors.lastname: Wang
authors.forename: Marjorie
authors.initials: M
authors.lastname: Nicholas
authors.forename: Errol H
authors.initials: EH
authors.lastname: Baker
authors.forename: Miguel
authors.initials: M
authors.lastname: Alonso
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual-Leone
mesh_terms: D001039:Aphasia, Broca / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D004558:Electric Stimulation; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010364:Pattern Recognition, Visual / Q000502:physiology; D010775:Photic Stimulation; D013068:Speech Production Measurement; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D014705:Verbal Behavior / Q000502:physiology*
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