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Cognitive & Behavioral Neurology:
doi: 10.1097/WNN.0b013e3181bf2d20
Case Reports

Improved Language in a Chronic Nonfluent Aphasia Patient After Treatment With CPAP and TMS

Naeser, Margaret A. PhD*; Martin, Paula I.*; Lundgren, Kristine Sc.D*; Klein, Reva MD*; Kaplan, Jerome MA*; Treglia, Ethan MS*; Ho, Michael PhD*; Nicholas, Marjorie PhD*; Alonso, Miguel MD; Pascual-Leone, Alvaro MD, PhD

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Objective: To present pretreatment and post-treatment language data for a nonfluent aphasia patient who received 2 treatment modalities: (1) continuous positive airway pressure (CPAP) for his sleep apnea, starting 1-year poststroke; and (2) repetitive transcranial magnetic brain stimulation (TMS), starting 2 years poststroke.

Background: Language data were acquired beyond the spontaneous recovery period of 3 to 6 months poststroke onset. CPAP restores adequate oxygen flow throughout all stages of sleep, and may improve cognition. A series of slow, 1 Hz repetitive TMS treatments to suppress a posterior portion of right pars triangularis has been shown to improve phrase length and naming in chronic nonfluent aphasia.

Method: The Boston Diagnostic Aphasia Examination and Boston Naming Test were administered pre-CPAP, and after 2 to 5 months of CPAP. These same tests were administered pre-TMS, and at 3 and 6 months post-TMS, and again 2.4 years later.

Results: Post-CPAP testing showed increased Phrase Length, Auditory Comprehension, and naming Animals and Tools/Implements (Boston Diagnostic Aphasia Examination). Testing at 3 and 6 months post-TMS showed significant increase in Phrase Length, Auditory Comprehension, and Boston Naming Test compared with pre-TMS. These gains were retained at 2.4 years post-TMS. CPAP use continued throughout.

Conclusions: Physiologic treatment interventions may promote language recovery in chronic aphasia.

© 2010 Lippincott Williams & Wilkins, Inc.


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