TY - JOUR
T1 - Differential Effects of Speech and Language Therapy and rTMS in Chronic Versus Subacute Post-stroke Aphasia
T2 - Results of the NORTHSTAR-CA Trial
AU - on behalf of the NORTHSTAR-study group
AU - Zumbansen, Anna
AU - Kneifel, Heike
AU - Lazzouni, Latifa
AU - Ophey, Anja
AU - Black, Sandra E.
AU - Chen, Joyce L.
AU - Edwards, Dylan
AU - Funck, Thomas
AU - Hartmann, Alexander Erich
AU - Heiss, Wolf Dieter
AU - Hildesheim, Franziska
AU - Lanthier, Sylvain
AU - Lespérance, Paul
AU - Mochizuki, George
AU - Paquette, Caroline
AU - Rochon, Elizabet
AU - Rubi-Fessen, Ilona
AU - Valles, Jennie
AU - Wortman-Jutt, Susan
AU - Thiel, Alexander
N1 - Funding Information:
We thank Sharon Shapiro (research coordinator), Stephanie Houston, Mica Vincent, Dominique Gillis, Mélissa Bouchard, Sophie Audy, Susan Martin, Lauren Tittley, Michèle Masson-Trottier, and Édith Durand (speech-language pathologists) and all patients who volunteered to participate in this study. This trial was supported by research grants from the Canadian Institutes for Health Research (CIHR) [MOP#125954]; the W.-D. Heiss Foundation; and the Lady Davis Institute at the Jewish General Hospital [CLIPP#2014]. A.Z. was funded by a CIHR postdoctoral fellowship.
Funding Information:
This trial was supported by research grants from the Canadian Institutes for Health Research (CIHR) [MOP#125954]; the W.-D. Heiss Foundation; and the Lady Davis Institute at the Jewish General Hospital [CLIPP#2014]. A.Z. was funded by a CIHR postdoctoral fellowship.
Publisher Copyright:
© The Author(s) 2022.
PY - 2022/4
Y1 - 2022/4
N2 - Background & objective: Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5–45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (>6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. Methods: Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. Results: Adverse events were rare, mild, and did not differ between groups. Language outcomes improved significantly in all groups irrespective of treatment and recovery phase. At 30-day follow-up, there was a significant interaction of stimulation and recovery phase on naming recovery (P <.001). Naming recovery with rTMS was larger in subacute (Mdn = 1.91/IQR =.77) than chronic patients (Mdn =.15/IQR = 1.68/P =.015). There was no significant rTMS effect in the chronic aphasia group. Conclusions: The addition of rTMS to SLT led to significant supplemental gains in naming recovery in the subacute phase only. While this needs confirmation in larger studies, our results clarify neuromodulatory vs training-induced effects and indicate a possible window of opportunity for contralesional inhibitory stimulation interventions in post-stroke aphasia. NORTHSTAR trial registration: https://clinicaltrials.gov/ct2/show/NCT02020421.
AB - Background & objective: Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5–45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (>6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. Methods: Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Intention-to-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. Results: Adverse events were rare, mild, and did not differ between groups. Language outcomes improved significantly in all groups irrespective of treatment and recovery phase. At 30-day follow-up, there was a significant interaction of stimulation and recovery phase on naming recovery (P <.001). Naming recovery with rTMS was larger in subacute (Mdn = 1.91/IQR =.77) than chronic patients (Mdn =.15/IQR = 1.68/P =.015). There was no significant rTMS effect in the chronic aphasia group. Conclusions: The addition of rTMS to SLT led to significant supplemental gains in naming recovery in the subacute phase only. While this needs confirmation in larger studies, our results clarify neuromodulatory vs training-induced effects and indicate a possible window of opportunity for contralesional inhibitory stimulation interventions in post-stroke aphasia. NORTHSTAR trial registration: https://clinicaltrials.gov/ct2/show/NCT02020421.
KW - aphasia
KW - language therapy
KW - randomized controlled trial
KW - speech therapy
KW - stroke
KW - transcranial magnetic stimulation
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UR - http://www.scopus.com/inward/citedby.url?scp=85127446133&partnerID=8YFLogxK
U2 - 10.1177/15459683211065448
DO - 10.1177/15459683211065448
M3 - Article
C2 - 35337223
AN - SCOPUS:85127446133
SN - 1545-9683
VL - 36
SP - 306
EP - 316
JO - Neurorehabilitation and Neural Repair
JF - Neurorehabilitation and Neural Repair
IS - 4-5
ER -