The Therapeutic Effect of Transcranial Magnetic Stimulation on Post-stroke Aphasia and the Optimal Treatment Parameters: A Meta-analysis

Cuicui Wang; Peixin Nie; Peng Wang; Yunxia Wang; Yufeng Zang; Ye Zhang

doi:10.1016/j.apmr.2023.11.006

The Therapeutic Effect of Transcranial Magnetic Stimulation on Post-stroke Aphasia and the Optimal Treatment Parameters: A Meta-analysis

Arch Phys Med Rehabil. 2023 Nov 18:S0003-9993(23)00659-7. doi: 10.1016/j.apmr.2023.11.006. Online ahead of print.

Authors

Cuicui Wang¹, Peixin Nie², Peng Wang³, Yunxia Wang⁴, Yufeng Zang⁵, Ye Zhang⁶

Affiliations

¹ Zhejiang Philosophy and Social Science Laboratory for Research in Early Development and Childcare, Hangzhou Normal University, Hangzhou, China; College of Education, Hangzhou Normal University, Hangzhou, China; TMS Center, Deqing Hospital of Hangzhou Normal University, China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
² Cognitive Brain Research Unit, Faculty of Medicine, University of Helsinki, Finland; Centre of Excellence in Music, Mind, Body, and Brain, Faculty of Medicine, University of Helsinki, Finland.
³ Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; University of Greifswald, Institute of Psychology, Greifswald, Germany.
⁴ Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
⁵ TMS Center, Deqing Hospital of Hangzhou Normal University, China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou Normal University, Hangzhou, China.
⁶ Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Institute of Psychological Sciences, Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou Normal University, Hangzhou, China. Electronic address: zhye@hznu.edu.cn.

PMID: 37984539
DOI: 10.1016/j.apmr.2023.11.006

Abstract

Objective: This meta-analysis aimed to examine the overall effectiveness of TMS on post-stroke aphasia using a meta-analysis approach, as well as examine the effect of moderating variables (eg, study design, TMS protocol) on the effectiveness of TMS.

Data sources: A keyword search was conducted in 5 databases: ERIC, Google Scholar, PsycINFO, MEDLINE, and ProQuest (01/1985-12/2022). The search algorithm included all possible combinations of relevant keywords. Full-text articles were thoroughly examined using forward/backward search methods.

Study selection: Studies were thoroughly screened using the following inclusion criteria: patients were diagnosed with post-stroke aphasia; studies focused on the effect of TMS on post-stroke aphasia; language assessments were conducted at pretest and posttest for TMS treatment and data were reported; studies included both an experimental group (ie, a group with TMS treatment) and a control group (ie, a group without TMS treatment).

Data extraction: Information was extracted from each study including authors, publication year, first language of participants, study design, stroke duration, demographics of participants, TMS protocol, stimulation site, targeting, and statistical data of language performance pre- and post-TMS treatment.

Data synthesis: A total of 17 studies were included in the final review, involving 682 patients with post-stroke aphasia (348 in the experimental group, 334 in the control group). The results showed that TMS treatment has significant immediate (Hedges' g=0.37) and maintenance (Hedges' g=0.34) effects on post-stroke aphasia. Additionally, the moderating variables showed a moderation effect on the effectiveness of TMS.

Conclusion: TMS treatment can significantly improve language ability for post-stroke aphasia. Additionally, this study provides an important reference for selecting the optimal TMS treatment parameters in treating post-stroke aphasia. Specifically, administering 15 sessions of rTMS lasting 10 min over the mirror area within Broca's area may produce the best TMS treatment outcomes.

Keywords: Aphasia; Language; Rehabilitation; Stroke; Transcranial magnetic stimulation.

Publication types

Review