Deep magnetic stimulation in a progressive supranuclear palsy patient with speech involvement
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LETTER TO THE EDITORS
Deep magnetic stimulation in a progressive supranuclear palsy patient with speech involvement Francesca Spagnolo • Elisabetta Coppi • Pasquale Anthony Della Rosa • Mario Fichera • Alessandra Barbieri • Giuseppe Magnani • Monica Falautano • Abraham Zangen • Giancarlo Comi • Daniela Perani • Maria Antonietta Volonte` Letizia Leocani
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Received: 12 September 2012 / Revised: 16 November 2012 / Accepted: 17 November 2012 / Published online: 2 December 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Dear Sir, In the last few years, several dementia conditions have been recognized as responsible for speech disorders [1]. The underlying pathology is variable and encompasses Alzheimer’s disease (AD) [2] and frontotemporal lobar degeneration, including its variants such as corticobasal degeneration and progressive supranuclear palsy (PSP) [3]. Particularly, beside the classical symmetric parkinsonism and gaze supranuclear palsy, PSP patients may present apraxia of speech (AOS) and progressive nonfluent aphasia (PNFA) [4]. AOS represents a motor speech disorder showing slow speech rate, prolonged intervals between Electronic supplementary material The online version of this article (doi:10.1007/s00415-012-6772-3) contains supplementary material, which is available to authorized users. F. Spagnolo (&) E. Coppi M. Fichera A. Barbieri G. Magnani M. Falautano G. Comi M. A. Volonte` L. Leocani Department of Neurological, Institute of Experimental Neurology–INSPE, San Raffaele Hospital, Milan, Italy e-mail: [email protected] L. Leocani e-mail: [email protected] F. Spagnolo E. Coppi M. Fichera G. Comi D. Perani Vita-Salute University, Milan, Italy P. A. Della Rosa D. Perani Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy A. Zangen Department of Life Science, Ben-Gurion University, Beer-Sheva, Israel L. Leocani Experimental Neurophysiology Unit Scientific Institute, San Raffaele Hospital, Via Olgettina 48, I-20132 Milan, Italy
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words, decreased articulatory accuracy and sound distortions [4]. PNFA is a language disorder with dysfluent, effortful and agrammatic speech, often accompanied by similar difficulty with writing and comprehension [1]. Regardless of aetiology, AOS and PNFA usually co-occur, eventually leading to a complete mutism. Cortical atrophy predominantly shows a perisylvian distribution [1]. Unfortunately despite the recent advantages in diagnostic accuracy, the therapeutic options for these patients are disappointing. Repetitive TMS (rTMS) is based on the application of transient electromagnetic fields to induce electric currents in the brain and consequently transynaptic depolarization of neurons located in superficial cortical layers. Increased cortical excitability has been reported after high-frequency rTMS (5 Hz or higher), while the opposite after low-frequency (\1 Hz) [5]. Evidence is accumulating about a possible beneficial role of high-frequency left prefrontal rTMS on cognitive performances in subjects with dementia [7]. For example
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