Treatment of dysphasia with rTMS and language therapy after childhood stroke: Multimodal imaging of plastic change.
Expressive dysphasia accompanies left inferior frontal gyrus (IFG/Broca) injury. Recovery may relate to interhemispheric balance with homologous, contralesional IFG but is unexplored in children. We evaluated effects of inhibitory rTMS to contralesional IFG combined with intensive speech therapy (SLT). A 15year-old, right-handed male incurred a left middle cerebral artery stroke. After 30months, severe non-fluent dysphasia impacted quality of life. Language networks, neuronal metabolism and white matter pathways were explored using MRI. Language function was measured longitudinally. An intensive SLT program was combined with contralesional inhibitory rTMS of right pars triangularis. Procedures were well tolerated. Language function improved persisting to four months. Post-treatment fMRI demonstrated increased left perilesional IFG activations and connectivity at rest. Bilateral changes in inositol and glutamate metabolism were observed. Contralesional, inhibitory rTMS appears safe in childhood stroke-induced dysphasia. We observed clinically significant improvements after SLT coupled with rTMS. Advanced neuroimaging can evaluate intervention-induced plasticity.
Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada. Electronic address: Helen.carlson@albertahealthservices.ca.
Helen L
HL
Carlson
Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.
Zeanna
Z
Jadavji
Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
Aleksandra
A
Mineyko
Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada.
Omar
O
Damji
Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.
Jacquie
J
Hodge
Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.
Jenny
J
Saunders
Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada.
Mia
M
Hererro
Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada.
Michele
M
Nowak
Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada.
Rebecca
R
Patzelt
Department of Clinical Psychology, Chicago School of Professional Psychology, Chicago, IL, USA.
Anya
A
Mazur-Mosiewicz
Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, University of Calgary, AB, Canada; The Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, AB, Canada; Child and Adolescent Imaging Research (CAIR) Programs, Alberta Children's Hospital, Calgary, AB, Canada.
Frank P
FP
MacMaster
Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada; Alberta Children's Hospital Research Institute (ACHRI), Calgary, AB, Canada; Department of Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada; Department of Pediatrics, University of Calgary, Calgary, AB, Canada; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
Adam
A
Kirton
D000293:Adolescent; D001039:Aphasia, Broca / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D001931:Brain Mapping; D065711:Broca Area / Q000473:pathology / Q000503:physiopathology; D007839:Functional Laterality; D018698:Glutamic Acid / Q000378:metabolism; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000503:physiopathology / Q000628:therapy; D007294:Inositol / Q000378:metabolism; D007808:Language Therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D009473:Neuronal Plasticity; D009474:Neurons / Q000378:metabolism; D011788:Quality of Life; D012146:Rest; D013070:Speech Therapy; D020521:Stroke / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects; D066127:White Matter / Q000473:pathology / Q000503:physiopathology
D018698:Glutamic Acid; D007294:Inositol
Diffusion; Dysphasia; MRI; MRS; Neuroimaging; Pediatric; Resting state; Speech; Stroke