ATLANTA – After undergoing 10 days of noninvasive magnetic brain stimulation with a novel device, eight of nine persons who stutter experienced improvements in speech fluency.
“This is the first step in what we believe is a major breakthrough in treatment,” lead study author David B. Rosenfield, MD, said in an interview at the annual meeting of the American Neurological Association.
In previously published work, Dr. Rosenfield, Director of the Speech and Language Center at Houston Methodist Neurological Institute, and his colleagues showed significant reduction in functional connectivity between Broca’s and Wernicke’s areas in persons who stutter, compared with normal speakers, by performing resting-state functional MRI of the brain. In the current open-label pilot trial, they tested the hypothesis that using direct noninvasive synchronous bifocal stimulation to potentiate the strength of connectivity between Broca’s and Wernicke’s areas in persons who stutter should improve their fluency.
Courtesy David B. Rosenfield, MD
The TRPMS cap placed on a dummy head showing the attachment of microstimulators to scalp locations overlying Broca's and Wernicke's areas. At right is the stimulator console device controller box.
Researchers enrolled nine persons who stutter who ranged in age from 18 to 80 years. For 40 minutes each consecutive weekday over the course of 2 weeks, the participants wore a compact, portable device known as a Transcranial Rotating Permanent Magnetic Stimulator (TRPMS) to deliver highly focal stimuli to Broca’s and Wernicke’s area locations specified by 10-20 international electroencephalographic electrode sites on the left side. Magnetic stimuli were 100 milliseconds in duration and delivered at 0.2 Hz. Next, a certified speech-language pathologist viewed video recordings of the study subjects both speaking spontaneously and reading a passage aloud on day 1 (before stimulation), day 5 (after stimulation), and day 10 (after stimulation), to assess fluency using the Stuttering Speech Severity Instrument version 4 (SSI-4).
The researchers found that all study participants significantly improved in fluency on either day 5 (P = 0.01) or day 10 (P = 0.02). Only one subject failed to show improvement on day 10 compared with day 1 after showing it on day 5. “This wasn’t meant to be a 10-day treatment that would last forever; this was meant to be a 10-day treatment to see whether the magnetic stimulation would work,” Dr. Rosenfield said. “It might well be that patients need treatment every day, once a week, or once a month. All we can say is that we have an input and an output. We gave them the treatment and they improved. One patient was so happy with it that he begged us to come back for additional treatment. It seems as though it’s a robust therapy.”
Doug Brunk/MDedge News
Dr. David B. Rosenfield
Going forward, the researchers plan to study fMRI brain imaging before and following external magnetic treatments to speech and language areas to confirm the efficacy of this therapy in a randomized, double-blind, sham treatment-controlled trial.
The TRPMS device was coinvented by Santosh A. Helekar, MD, PhD, and Henning Voss, PhD, both at Weill Cornell Medical College. The study received funding support from The Houston Methodist Hospital System Physicians Organization. Dr. Rosenfield reported having no financial disclosures. He noted that commercialization of the patented technology underlying the TRPMS device used in this study and in other diseases is currently being advanced by Seraya Medical Systems LLC.
dbrunk@mdedge.com
Source: Ann Neurol. 2018;84[S22]:S45-6. Abstract S115.