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(Stroke. 2005;36:1759.)
© 2005 American Heart Association, Inc.

Original Contributions

Role of the Contralateral Inferior Frontal Gyrus in Recovery of Language Function in Poststroke Aphasia

A Combined Repetitive Transcranial Magnetic Stimulation and Positron Emission Tomography Study

Lutz Winhuisen, MD; Alexander Thiel, MD; Birgit Schumacher; Josef Kessler, PhD; Jobst Rudolf, MD; Walter F. Haupt, MD Wolf D. Heiss, MD

From the Department of Neurology (L.W., A.T., B.S., W.F.H., W.D.H.), University of Cologne, Germany; and the Max-Planck-Institute for Neurological Research (L.W., A.T., B.S., J.K., J.R., W.D.H.), Köln Germany.

Correspondence to Lutz Winhuisen, MD, Max-Planck-Institute for Neurological Research, Gleueler Str. 50, D-50866 Köln, Germany. E-mail L.Winhuisen{at}pet.mpin-koeln.mpg.de

Background and Purpose— Functional neuroimaging studies have demonstrated right inferior frontal gyrus (IFG) activation in poststroke aphasia. It remains unclear whether this activation is essential for language performance. We tested this hypothesis in a positron emission tomography (PET) activation study during a semantic task with repetitive transcranial magnetic stimulation (rTMS) on right-handed patients experiencing poststroke aphasia and examined whether rTMS stimulation over the right and left IFG would interfere with language performance.

Methods— Eleven patients with left-sided middle cerebral arterial infarction, 50 to 75 years of age, were tested with the Aachen Aphasia Test Battery and underwent ¹⁵O-H₂O PET activation during a semantic task within 2 weeks after stroke. PET activation images were coregistered to T1-weighted MRIs. Stimulation sites were determined on renderings of head and brain over the maximum activation within left and right IFG. rTMS was performed with 20% maximum output (2.1 T), 10-s train duration, at 4Hz frequency. A positive rTMS effect was defined as an increased reaction time latency or error rate in the semantic task.

Results— PET activations of the IFG were observed on the left (3 patients) and bilaterally (8 patients). Right IFG stimulation was positive in 5 patients with right IFG activation, indicating essential language function. In a verbal fluency task, these patients had a lower performance than patients without right-sided TMS effect.

Conclusions— In some poststroke aphasics, right IFG activation is essential for residual language function. However, its compensatory potential seems to be less effective than in patients who recover left IFG function. These results suggest a hierarchy in recovery from poststroke aphasia and a (limited) compensatory potential of the nondominant hemisphere.

Key Words: aphasia • recovery of function • tomography, emission computed

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