title: Repetitive deep transcranial magnetic stimulation improves verbal fluency and written language in a patient with primary progressive aphasia-logopenic variant (LPPA).
abstract: BACKGROUND
  To date, no therapies are available for the logopenic variant of primary progressive aphasia (LPPA). Even though deep repetitive transcranial magnetic stimulation (rTMS) may improve cognitive functions in some neurodegenerative disorders, no previous studies investigated its effects in patients with LPPA.
  
  
  OBJECTIVE
  Our aim was to investigate the effects on cognitive function of high frequency rTMS (hf-rTMS) delivered over the left dorso-lateral prefrontal cortex (DLPFC) through a coil designed for deep rTMS, compared to a SHAM stimulation, in a right-handed patient with LPPA.
  
  
  METHODS
  The patient presented a progressive language impairment (phonological errors in speech and naming, impaired single word retrieval and sentences repetition) and predominant left perisylvian atrophy and hypoperfusion. He received four stimulation cycles (two REAL and two SHAM) each of whom lasted 20 min for 5 consecutive days. Patient's performances in frontal, visuo-spatial and linguistic tasks were evaluated before and after each stimulation session. Test scores after REAL were compared with those obtained at baseline and after SHAM.
  
  
  RESULTS
  We found a temporary and highly significant improvement in the linguistic skills (both oral and written tasks) but not in the other cognitive domains tested, after REAL, but not SHAM stimulations.
  
  
  CONCLUSIONS
  Hf-rTMS delivered over the DLPFC could improve language in LPPA by enhancing long-term potentiation and synaptic plasticity within the stimulated and interconnected areas involved in language network. Our findings might prompt future researches into the feasibility and efficacy of deep hf-rTMS as a therapeutic tool in progressive aphasia syndromes and other neurodegenerative disorders.
authors.affiliation: Department of Neurology and Psychiatry, University of Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Trebbastoni
authors.forename: Ruggero
authors.initials: R
authors.lastname: Raccah
authors.forename: Carlo
authors.initials: C
authors.lastname: de Lena
authors.forename: Abraham
authors.initials: A
authors.lastname: Zangen
authors.forename: Maurizio
authors.initials: M
authors.lastname: Inghilleri
mesh_terms: D018888:Aphasia, Primary Progressive / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology*; D013060:Speech / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Dorsolateral prefrontal cortex (DLPFC); H-coil; Primary progressive aphasia logopenic variant (LPPA); Repetitive transcranial magnetic stimulation (rTMS)