Small trial found patients had faster recovery of lost language, speech skills
THURSDAY, June 27, 2013 (HealthDay News) -- Magnetic stimulation of the brain appears to help speed recovery of speech and language in stroke survivors, a small new study finds.
The study, published June 27 in the journal Stroke, points to a new tool patients might use to regain lost function, the researchers said.
"For decades, skilled speech and language therapy has been the only therapeutic option for stroke survivors" who have lost some ability to communicate, study lead author Dr. Alexander Thiel said in a journal news release.
"We are entering exciting times where we might be able in the near future to combine speech and language therapy with noninvasive brain stimulation earlier in the recovery," said Thiel, who is associate professor of neurology and neurosurgery at McGill University in Montreal. "This could result in earlier and more efficient aphasia recovery and also have an economic impact."
The researchers said between 20 percent and 30 percent of stroke survivors suffer from aphasia (difficulties with speaking, understanding language, reading or writing).
The Canadian study included 24 stroke survivors with several types of aphasia. Thirteen of them received transcranial magnetic stimulation (TMS) and 11 received a "sham" brain stimulation.
The TMS device is a handheld magnetic coil that delivers low-intensity stimulation and causes muscle contractions when placed over the brain's motor cortex. In the sham stimulation, coil's intensity was too low to produce any real stimulation.
Each day for 10 days, the patients received 20 minutes of TMS or sham stimulation followed by 45 minutes of speech and language therapy. On average, patients in the TMS group showed three times greater improvement than those in the sham stimulation group, Thiel's team found.
TMS had the greatest impact on improvement in patients' ability to name objects, which is one of the most debilitating aphasia symptoms.
"We believe brain stimulation should be most effective early, within about five weeks after stroke, because genes controlling the recovery process are active during this window," Thiel said.
Two stroke rehabilitation experts were cautiously optimistic about the results.
"This is a small study, but it yielded interesting results," said Dr. Kristjan Ragnarsson, chairman of rehabilitation medicine at the Icahn School of Medicine at Mount Sinai in New York City. "The findings indicate that transcranial magnetic stimulation is important to use early, but that's also when we see the greatest improvement in our patients both naturally and with the help of speech therapy. A larger, well-controlled study is needed to confirm any long-term benefits after the initial testing period."
Thiel's team said a larger study in TMS therapy is set to launch at four sites in Canada and one in Germany later this year.
Another expert agreed that the treatment shows promise, adding that TMS is just one of many new techniques that are helping stroke survivors.
"Stroke is the leading cause of permanent disability," said Dr. Bruce Volpe, an investigator at the Feinstein Institute for Medical Research in Manhasset, N.Y.
"[However], attempts to improve the recovery after stroke have quickened with the noninvasive technologies based on robots and magnetism and electricity," he said. In his experience, "patients with stroke and robot training sustain better outcomes than those with only standard treatment."
Volpe said many of these new methods are in use at his institution and "provide enhanced recovery for many patients with stroke, even for those who are weeks and months after the episode."
The U.S. National Institute of Neurological Disorders and Stroke outlines what you can do to prevent stroke (http://www.ninds.nih.gov/disorders/stroke/preventing_stroke.htm ).
SOURCES: Kristjan Ragnarsson, M.D., professor and chairman of rehabilitation medicine, Icahn School of Medicine at Mount Sinai, New York City; Bruce Volpe, M.D., investigator at the Feinstein Institute for Medical Research, Manhasset, N.Y.; Stroke, news release, June 27, 2013