Repetitive Deep Transcranial Magnetic Stimulation Improves Verbal Fluency and Written Language in a Patient with Primary Progressive Aphasia-Logopenic Variant (LPPA)

Abstract Background To date, no therapies are available for the logopenic variant of primary progressive aphasia (LPPA). Even though deep repetitive transcranial magnetic stimulation (rTMS) may improve cognitive functions in some neurodegenerative disorders, no previous studies investigated its effe...

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Bibliographic Details
Published in:Brain stimulation 2013-07, Vol.6 (4), p.545-553
Main Authors: Trebbastoni, Alessandro, Raccah, Ruggero, de Lena, Carlo, Zangen, Abraham, Inghilleri, Maurizio
Format: Article
Language:English
Subjects:
Aphasia, Primary Progressive - physiopathology
Aphasia, Primary Progressive - therapy
Dorsolateral prefrontal cortex (DLPFC)
H-coil
Humans
Language
Male
Middle Aged
Neurology
Prefrontal Cortex - physiopathology
Primary progressive aphasia logopenic variant (LPPA)
Repetitive transcranial magnetic stimulation (rTMS)
Speech - physiology
Transcranial Magnetic Stimulation - methods
Treatment Outcome
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Summary:Abstract Background To date, no therapies are available for the logopenic variant of primary progressive aphasia (LPPA). Even though deep repetitive transcranial magnetic stimulation (rTMS) may improve cognitive functions in some neurodegenerative disorders, no previous studies investigated its effects in patients with LPPA. Objective Our aim was to investigate the effects on cognitive function of high frequency rTMS (hf-rTMS) delivered over the left dorso-lateral prefrontal cortex (DLPFC) through a coil designed for deep rTMS, compared to a SHAM stimulation, in a right-handed patient with LPPA. Methods The patient presented a progressive language impairment (phonological errors in speech and naming, impaired single word retrieval and sentences repetition) and predominant left perisylvian atrophy and hypoperfusion. He received four stimulation cycles (two REAL and two SHAM) each of whom lasted 20 min for 5 consecutive days. Patient's performances in frontal, visuo-spatial and linguistic tasks were evaluated before and after each stimulation session. Test scores after REAL were compared with those obtained at baseline and after SHAM. Results We found a temporary and highly significant improvement in the linguistic skills (both oral and written tasks) but not in the other cognitive domains tested, after REAL, but not SHAM stimulations. Discussion Hf-rTMS delivered over the DLPFC could improve language in LPPA by enhancing long-term potentiation and synaptic plasticity within the stimulated and interconnected areas involved in language network. Our findings might prompt future researches into the feasibility and efficacy of deep hf-rTMS as a therapeutic tool in progressive aphasia syndromes and other neurodegenerative disorders.
ISSN:1935-861X
1876-4754
DOI:10.1016/j.brs.2012.09.014