Neural correlates of high frequency repetitive transcranial magnetic stimulation improvement in post-stroke non-fluent aphasia: a case study.

Damage to the left inferior frontal gyrus (lIFG) affects language and can cause aphasia in stroke. Following left hemisphere damage it has been suggested that the homologue area in the right hemisphere compensates for lost functions. An increasing number of studies have demonstrated that inhibitory 1-Hz repetitive transcranial magnetic stimulation (rTMS) targeting the right IFG can be useful for enhancing recovery in aphasic patients. In the present study we applied activating high frequency (10-Hz) rTMS, which increases cortical excitability, to the damaged lIFG daily for 3 weeks. Pre- and post-TMS EEG are performed, as well as language function assessments with the Aachener Aphasia Test Battery. Results demonstrate a decrease in rIFG activity post rTMS and normalization for the lIFG for beta3 frequency band. Also increased activity was in the right supplementary motor area for beta3 frequency band. In comparison to pre-TMS the aphasic patient improved on repetition tests, for naming and comprehension. After rTMS increased functional connectivity was shown in comparison to before between the lIFG and the rIFG for theta and beta3 frequency band. This case report suggests that 10 Hz rTMS of the lIFG can normalize activity in the lIFG and right IFG possibly mediated via altered functional connectivity.