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Transcranial direct current stimulation in primary progressive aphasia: Whom does it help? (Kyrana Tsapkini, PhD)

Kyrana Tsapkini1*
  • 1 Johns Hopkins Medicine, United States

Transcranial direct current stimulation (tDCS)—a non-invasive and easy-to-implement-by-trained-clinicians technique—has been increasingly shown to be a valuable adjunct to speech and language therapy in stroke rehabilitation1 and recently in primary progressive aphasia (PPA)2, a neurodegenerative syndrome where language deficits are the first and foremost symptoms3-4. Most studies, however, in the field report tDCS effects on small sample sizes (1-8 participants) in underpowered designs and analyses that usually include only one of the three PPA variants. I will present on the state-of-the science in neuromodulation approaches (tDCS and TMS) in PPA. I will also present the results of the largest cohort of PPA participants ever treated under the same stimulation protocol: 28 participants from all 3 variants of PPA. We tested the additive effects of 15 sessions of anodal tDCS over the left IFG (a main language production area) coupled with written language production/spelling therapy, in a sham-controlled, double-blind, within-subjects crossover design. We compared the effects of tDCS vs. sham in trained and untrained words before, immediately after, two weeks after, and two months post-intervention. Overall, tDCS was more effective than language therapy alone (sham): therapy gains lasted longer (up to 2 months) generalized to untrained items. There were, however, differential effects of tDCS in each variant. Finally, we evaluated which brain areas may predict therapy outcomes. From all areas tested, only the volumes of the left hippocampus and the left fusiform predicted performance on trained and untrained items in writing/spelling. The present study shows for the first time in an experimentally constrained design that tDCS can be an effective adjuvant to speech and language therapy even in neurodegenerative diseases, but the effects may vary according to variant and atrophy patterns.

Acknowledgements

We are grateful to the participants in this project and for the support from the Science of Learning Institute of Johns Hopkins University and NIH/NIDCD R01 DC014475 to KT.

References

1. J. Fridriksson, J. D. Richardson, J. M. Baker, C. Rorden. (2011). Transcranial direct current stimulation improves naming reaction time in fluent aphasia: a double-blind, sham-controlled study, Stroke J. Cereb. Circ. 42, 819–821.

2. K. Tsapkini, C. Frangakis, Y. Gomez, C. Davis, A. E. Hillis, (2014). Augmentation of spelling therapy with transcranial direct current stimulation in primary progressive aphasia: Preliminary results and challenges, Aphasiology 28, 1112–1130.

3. M. M. Mesulam, (1982). Slowly progressive aphasia without generalized dementia, Ann. Neurol. 11, 592–598.

4. M. L. Gorno-Tempini, A. E. Hillis, S. Weintraub, A. Kertesz, M. Mendez, S. F. Cappa, J. M. Ogar, J. D. Rohrer, S. Black, B. F. Boeve, F. Manes, N. F. Dronkers, R. Vandenberghe, K. Rascovsky, K. Patterson, B. L. Miller, D. S. Knopman, J. R. Hodges, M. M. Mesulam, M. Grossman, (2011). Classification of primary progressive aphasia and its variants, Neurology 76, 1006–1014.

Keywords: transcranial direct current stimulation (tDCS), primary progressive aphasia, language rehabilitation, variants, Left inferior frontal cortex

Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017.

Presentation Type: symposium

Topic: General Submission

Citation: Tsapkini K (2019). Transcranial direct current stimulation in primary progressive aphasia: Whom does it help? (Kyrana Tsapkini, PhD). Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00025

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Received: 03 May 2017; Published Online: 25 Jan 2019.

* Correspondence: Dr. Kyrana Tsapkini, Johns Hopkins Medicine, Baltimore, United States, tsapkini@jhu.edu