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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

Cognitive and Behavioral Neurology: March 2010 - Volume 23 - Issue 1 - p 29-38
doi: 10.1097/WNN.0b013e3181bf2d20
Case Reports

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.

*Department of Neurology, Harold Goodglass Boston University Aphasia Research Center, Boston University School of Medicine and the Veterans Affairs Boston Healthcare System

Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Supported by NIH grant RO1 DC05672 from the National Institute on Deafness and Other Communication Disorders, Bethesda, MD and a grant from the Medical Research Service, Department of Veterans Affairs, Washington, DC (to M.A.N.); a K24 NIH award (RRO18875, to A.P.-L) and the Harvard-Thorndike General Clinical Research Center (NCRR MO1 RR01032); and a P30 DC05207 grant to the Harold Goodglass BU Aphasia Research Center from the National Institute on Deafness and Other Communication Disorders.

Reprints: Margaret A. Naeser, PhD, Aphasia Research Center (12–A) V.A. Boston Healthcare System, JP, 150 So. Huntington Avenue, Boston, MA 02130 (e-mail:

Received for publication March 13, 2009

accepted August 30, 2009

Paper was presented at the American Speech-Language Hearing Association Meeting, November 2007, Boston, MA.

© 2010 Lippincott Williams & Wilkins, Inc.