LOW-FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION FOR PATIENTS WITH APHASIA AFTER STROKE: A META-ANALYSIS

Objective: To perform a meta-analysis of studies investigating the effects of low-frequency repetitive transcranial magnetic stimulation on post-stroke aphasia. Data sources: Studies were identified by performing a search of electronic databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Knowledge) for articles published until June 2014. Study selection: Randomized controlled trials (RCTs) reporting treatments with low-frequency repetitive transcranial magnetic stimulation in patients with post-stroke aphasia were included. The outcomes included naming, repetition, comprehension, changes in brain excitability, and adverse events. Data extraction: Two independent reviewers extracted the data. Study quality was evaluated with the PEDro scale. Data analysis: Of the 879 articles identified, 4 RCTs were included in the final analysis. Data synthesis showed that low-frequency repetitive transcranial magnetic stimulation was beneficial for post-stroke patients in terms of naming (standard mean difference (SMD) 0.51; 95% confidence interval (95% CI) 0.16-0.86) and changes in brain excitability (7.6 +/- 33.55; 95% CI -10.7-26.20). However, the changes in repetition (SMD 0.31; 95% CI -0.04-0.65) and comprehension (SMD 0.31; 95% CI -0.14-0.75) after stimulation were not significant. No adverse effects were reported. The included studies were of high methodological quality. Conclusion: These findings indicate that low-frequency repetitive transcranial magnetic stimulation is an effective treatment for recovery of naming. In addition, this treatment favours reorganization of the left-hemispheric language networks.