title: Dual-hemisphere repetitive transcranial magnetic stimulation for rehabilitation of poststroke aphasia: a randomized, double-blind clinical trial.
abstract: BACKGROUND
  Recent neuroimaging studies on poststroke aphasia revealed maladaptive cortical changes in both hemispheres, yet their functional contribution in language recovery remains elusive. The aim of this study was to evaluate the long-term efficacy of dual-hemisphere repetitive transcranial magnetic stimulation (rTMS) on poststroke aphasia.
  
  
  METHODS
  Thirty patients with subacute poststroke nonfluent aphasia were randomly allocated to receive real or sham rTMS. Each patient received 1000 rTMS pulses (1 Hz at 110% of resting motor threshold [rMT] over the right unaffected Broca's area and 1000 pulses (20 Hz at 80% rMT) over the left affected Broca's area for 10 consecutive days followed by speech/language training. The language section of the Hemispheric Stroke Scale (HSS), the Stroke Aphasic Depression Questionnaire-Hospital Version (SADQ-H), and the National Institutes of Health Stroke Scale (NIHSS) were measured before, immediately after the 10 sessions, and 1 and 2 months after the last session.
  
  
  RESULTS
  At baseline, there were no significant differences between groups in demographic and clinical rating scales. However, there was a significantly greater improvement in the HSS language score as well as in the SADQ-H after real rTMS compared with sham rTMS, which remained significant 2 months after the end of the treatment sessions.
  
  
  CONCLUSIONS
  This is the first clinical study of dual-hemisphere rTMS in poststroke aphasia. Combining dual-hemisphere rTMS with language training might be a feasible treatment for nonfluent aphasia; further multicenter studies are needed to confirm this result.
authors: Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt emankhedr99@yahoo.com.
authors: Eman M
authors: EM
authors: Khedr
authors: Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt.
authors: Noha
authors: N
authors: Abo El-Fetoh
authors: Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt.
authors: Anwer M
authors: AM
authors: Ali
authors: Department of Rheumatology and Rehabilitation, Assiut University Hospital, Assiut, Egypt.
authors: Dina H
authors: DH
authors: El-Hammady
authors: Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt.
authors: Hosam
authors: H
authors: Khalifa
authors: Department of Radiology, Assiut University Hospital, Assiut, Egypt.
authors: Haisam
authors: H
authors: Atta
authors: Department of Prevention and Health Psychology, Riedlingen University, Riedlingen, Germany Department of Psychiatry and Psychotherapy, University Clinic Tübingen, Tübingen, Germany.
authors: Ahmed A
authors: AA
authors: Karim
mesh_terms: D000368:Aged; D001037:Aphasia / Q000534:rehabilitation*; D001921:Brain / Q000503:physiopathology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D020521:Stroke / Q000150:complications*; D065908:Transcranial Direct Current Stimulation; D016896:Treatment Outcome
keywords: Broca’s area; aphasia; cortical plasticity; hemispheric role; neurorehabilitation; stroke; transcranial magnetic stimulation (TMS)