الفهرس | Only 14 pages are availabe for public view |
Abstract Aphasia, defined as an impaired ability to communicate, is one of the most feared symptoms of stroke, being a devastating neurological condition affecting a person’s ability and thus, reintegrate into the society (Berthier, 2005). Despite availability of pharmacological treatments and professionally administered speech language therapy (SLT), new strategies are required to boost recovery, either in the chronic stage of stroke as well as in acute or sub acute stages augmenting the natural spontaneous neuroplasticity (Brady & Enderby, 2010). from such new strategies to mange post stroke aphasia inducing neuroplasticity and functional recovery in language areas in the brain are the non invasive brain stimulation (NBS) devices including transcranial magnetic stimulation (TMS) (Priyanka et al., 2013). In the current pilot randomized clinical trail 60 patients diagnosed as first ever post cerebrovascular ischemic stroke sufferers of aphasic who were admitted in Ain Shams university or Ain Shams university specialized hospitals were divided into 3 equal groups. Each was subjected to careful history taking, neurological examination, MRI brain imaging, routine laboratory investigations for risk factors of stroke, Echo cardiography and carotid duplex. Besides properly identifying type of aphasia based on bedside language examination using the western aphasia battery (WAB). After identifying aphasia subclass the 60 patients were divided into 3 equal groups as regards number as well as aphasia subclass. The three groups were considered the three arms of the study; repetitive transcranial magnetic stimulation was applied to each patient as follows: Patients in group A were administered stimulatory rTMS (5 Hz – 90% of motor threshold) over the dominant language areas based on 10-20 international EEG system for four successive days followed by another 4 successive days. Patients in group B were administered inhibitory rTMS (1 Hz – 90% of motor threshold) over the non dominant language homologue areas based on 10-20 international EEG system for four successive days followed by another 4 successive days. Patients in group C were considered the control/sham arm of the study and were administered sham rTMS for the same time interval as the two active groups. Patients were assessed by the stroke aphasia quality of life 39 scale as well as stroke aphasia depression questionnaire at baseline, after ending first 4 sessions of rTMS (first week), after ending second 4 sessions of rTMS (second week) and after another 2 weeks (1 month from enrollment in the study). The communication domain of SAQOL-39 scale was separated and statistically analyzed as a separate entity as well as the above mentioned assessment modalities. Results were in favor that rTMS effect began to be pronounced after 8 sessions whether in the stimulated or inhibited group, yet total groups results whatever the aphasia subclasses were in favor of the stimulated group On further analysis and on calculating percent of change as well as rate of change whenever needed of the aphasia subclasses in different groups, active rTMS was superior to sham rTMS with inhibitory technique being more effective than stimulatory technique in global, receptive and transcortical, while stimulatory technique being more effective in anomic subclass and neither was superior in expressive subclass. Conclusion from the current study that targeting aphasic patients post stroke in their sub acute stage is effective and may be more superior than waiting till the chronic phase of the disability as if bombarding the brain while spontaneous neuroplasticity is going on by an external safe modality that will augment neuroplasticity and rehabilitation. |