, 2005) These structures were spared in the subject who responde

, 2005). These structures were spared in the subject who responded well. The subject who responded to rTMS of the right pars triangularis also showed increased fMRI activity in left supplementary motor area (SMA) during a naming task 16 months after receiving rTMS compared to his earlier neuroimaging studies. This change in activation was not seen in the patient who responded poorly to stimulation. These data suggest that differences in lesion anatomy may strongly modulate the functional and behavioral consequences of

intervention with TGF-beta inhibitor rTMS. Not all investigations using TMS in chronic aphasia have solely targeted the right hemisphere.

Hypothesizing that inhibitory interhemispheric connections may have deleterious effects on recovering language networks in either hemisphere, Kakuda, Abo, Kaito, Watanabe, and Senoo (2010) recently applied 1 Hz rTMS (20 min; 10 sessions over 6 days) to sites that were contralateral to those found to be most ICG-001 supplier activated by fMRI during a repetition task. Stimulating the right frontal lobe in two patients and the left frontal lobe in two others, they observed modest benefits in measures of spontaneous speech, repetition, writing, and naming that lasted at least 4 weeks (Kakuda, Abo, Kaito, et al., 2010). In another recent study, Kakuda, Abo, Uruma, Kaito, and Watanabe (2010) found that 1 Hz TMS (20 min; 10 sessions over 6 days followed by weekly sessions for 3 months) administered to Wernicke’s area in the left hemisphere resulted in improvement on a Token Test and several subtests of the Standard Language Test of Aphasia (SLTA; a Japanese language instrument) in two patients with chronic Methocarbamol fluent aphasia (Kakuda, Abo, Uruma, et

al., 2010). Unfortunately, both studies reported by Kakuda and colleagues were limited in that neither demonstrated that the gains in performance made by subjects were statistically significant and neither employed a control condition to ensure that patients’ behavioral changes were specifically attributable to TMS. Data from tDCS studies are limited but encouraging (See Table 2). Monti and colleagues (2008) explored the immediate effects tDCS in patients with chronic aphasia by applying anodal, cathodal and sham stimulation (2 mA, 10 min) over the left frontotemporal cortex of eight aphasic patients who had suffered ischemic strokes. In their first experiment, four subjects underwent a single session of cathodal tDCS and a single sham tDCS session separated by at least one week; the four other subjects underwent anodal tDCS and sham sessions.

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