title: Effect of low-frequency rTMS on aphasia in stroke patients: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Small clinical trials have reported that low-frequency repetitive transcranial magnetic stimulation (rTMS) might improve language recovery in patients with aphasia after stroke. However, no systematic reviews or meta-analyses studies have investigated the effect of rTMS on aphasia. The objective of this study was to perform a meta-analysis of studies that explored the effects of low-frequency rTMS on aphasia in stroke patients.
  
  
  METHODS
  We searched PubMed, CENTRAL, Embase, CINAHL, ScienceDirect, and Journals@Ovid for randomized controlled trials published between January 1965 and October 2013 using the keywords "aphasia OR language disorders OR anomia OR linguistic disorders AND repetitive transcranial magnetic stimulation OR rTMS". We used fixed- and random-effects models to estimate the standardized mean difference (SMD) and a 95% CI for the language outcomes.
  
  
  RESULTS
  Seven eligible studies involving 160 stroke patients were identified in this meta-analysis. A significant effect size of 1.26 was found for the language outcome severity of impairment (95% CI = 0.80 to 1.71) without heterogeneity (I2 = 0%, P = 0.44). Further analyses demonstrated prominent effects for the naming subtest (SMD = 0.52, 95% CI = 0.18 to 0.87), repetition (SMD = 0.54, 95% CI = 0.16 to 0.92), writing (SMD = 0.70, 95% CI = 0.19 to 1.22), and comprehension (the Token test: SMD = 0.58, 95% CI = 0.07 to 1.09) without heterogeneity (I2 = 0%). The SMD of AAT and BDAE comprehension subtests was 0.32 (95% CI = -0.08 to 0.72) with moderate heterogeneity (I2 = 32%,P = 0.22). The effect size did not change significantly even when any one trial was eliminated. None of the patients from the 7 included articles reported adverse effects from rTMS.
  
  
  CONCLUSIONS
  Low-frequency rTMS with a 90% resting motor threshold that targets the triangular part of the right inferior frontal gyrus (IFG) has a positive effect on language recovery in patients with aphasia following stroke. Further well-designed studies with larger populations are required to ascertain the long-term effects of rTMS in aphasia treatment.
authors.affiliation: Department of Rehabilitation Medicine, Wuxi Tongren International Rehabilitation Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China; Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Cai-Li
authors.initials: CL
authors.lastname: Ren
authors.affiliation: Wuxi Mental Health Center of Nanjing Medical University, Wuxi, Jiangsu Province, China.
authors.forename: Guo-Fu
authors.initials: GF
authors.lastname: Zhang
authors.affiliation: Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Xia
authors.affiliation: Wuxi Mental Health Center of Nanjing Medical University, Wuxi, Jiangsu Province, China.
authors.forename: Chun-Hui
authors.initials: CH
authors.lastname: Jin
authors.affiliation: Department of Rehabilitation Medicine, Wuxi Tongren International Rehabilitation Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China.
authors.forename: Xiu-Hua
authors.initials: XH
authors.lastname: Zhang
authors.affiliation: Department of Rehabilitation Medicine, Wuxi Tongren International Rehabilitation Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China.
authors.forename: Jian-Feng
authors.initials: JF
authors.lastname: Hao
authors.affiliation: Department of Rehabilitation Medicine, Wuxi Tongren International Rehabilitation Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China.
authors.forename: Hong-Bo
authors.initials: HB
authors.lastname: Guan
authors.affiliation: Department of Rehabilitation Medicine, Wuxi Tongren International Rehabilitation Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Tang
authors.affiliation: Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Jian-An
authors.initials: JA
authors.lastname: Li
authors.affiliation: Department of Rehabilitation Medicine, Wuxi Tongren International Rehabilitation Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China.
authors.forename: De-Liang
authors.initials: DL
authors.lastname: Cai
mesh_terms: D000368:Aged; D001037:Aphasia / Q000209:etiology / Q000628:therapy*; D001039:Aphasia, Broca / Q000628:therapy; D001041:Aphasia, Wernicke / Q000628:therapy; D032882:Comprehension; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications*; D007807:Language Tests; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D020127:Recovery of Function; D012720:Severity of Illness Index; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects