4.5 Article

Neuronavigated repetitive transcranial magnetic stimulation as novel mapping technique provides insights into language function in primary progressive aphasia

Journal

BRAIN IMAGING AND BEHAVIOR
Volume 16, Issue 3, Pages 1208-1216

Publisher

SPRINGER
DOI: 10.1007/s11682-021-00605-6

Keywords

Navigated repetitive transcranial magnetic stimulation; Primary progressive aphasia; Language mapping; Cortical plasticity

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Funding

  1. Projekt DEAL

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In this study using navigated repetitive transcranial magnetic stimulation (nrTMS) for language mapping in primary progressive aphasia (PPA) patients, a higher error rate was induced in the right hemisphere of patients with non-fluent variant of PPA. This suggests the presence of neuronal plasticity in nfvPPA and may indicate future therapeutic targets for neurodegenerative disorders.
Navigated repetitive transcranial magnetic stimulation (nrTMS) is an innovative technique that provides insight into language function with high accuracy in time and space. So far, nrTMS has mainly been applied in presurgical language mapping of patients with intracranial neoplasms. For the present study, nrTMS was used for language mapping in primary progressive aphasia (PPA). Seven patients (median age: 70 years, 4 males) with the non-fluent variant of PPA (nfvPPA) were included in this pilot study. Trains of nrTMS (5 Hz, 100% resting motor threshold) caused virtual lesions at 46 standardized cortical stimulation targets per hemisphere. Patients' errors in a naming task during stimulation were counted. The majority of errors induced occurred during frontal lobe stimulation (34.3%). Timing errors and non-responses were most frequent. More errors were induced in the right hemisphere (58%) than in the left hemisphere (42%). Mapping was tolerated by all patients, however, discomfort or pain was reported for stimulation of frontal areas. The elevated right-hemispheric error rate in our study could be due to a partial shift of language function to the right hemisphere in neurodegenerative aphasia during the course of disease and therefore points to the existence of neuronal plasticity in nfvPPA. While this is an interesting finding for neurodegenerative disorders per se, its promotion might also harbor future therapeutic targets.

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