Moreover a shift toward left hemisphere activation during language tasks was observed in a single young patient who they followed over the course of years, suggesting that language reorganization, at least as seen in younger individuals, is a dynamic process that may last for years after stroke onset (Elkana et al., 2011). Increased right hemisphere activity seen after stroke in patients with aphasia may not represent an entirely beneficial change. One alternative account is that right hemisphere involvement

after left hemisphere stroke and aphasia reflects inefficient or maladaptive plastic changes in neural activity that have emerged during language reorganization (Belin et al., 1996). According to this model, ineffective changes in language representation may interfere with the reacquisition Antiinfection Compound Library of more efficient language processing by recovering left-hemisphere cortical networks. Consistent with this argument, it has been shown that increased activation in the right hemisphere in aphasic patients is not always coupled with improved language performance

(Naeser et al., 2002, Rosen et al., 2000 and Saur et al., 2006). In at least one recent fMRI study, increased right hemisphere activity was associated with worse performance on an overt naming task (Postman-Caucheteux et al., 2010). Another hypothesis that further extends the notion of the maladaptive right hemisphere is that increased Depsipeptide order right hemisphere activation after left hemisphere stroke results in abnormally increased and deleterious transcallosal inhibition of the already damaged left

hemisphere. As has been observed with unilateral lesions leading to other deficits such as hemiparesis and neglect, increased contralesional activity after left hemisphere injury may reflect loss of interhemispheric inhibitory influence from damaged language areas in the BCKDHA left hemisphere to right-sided homologues (Martin et al., 2004, Rosen et al., 2000 and Shimizu et al., 2002). This release of inhibition and resulting upsurge in right hemisphere activity may thus result in increased interhemispheric inhibitory influences from the right hemisphere on left hemisphere perisylvian areas, which may exacerbate language symptoms and impede recovery from aphasia (Fig. 2). Transcranial magnetic stimulation (TMS) is a technology that can be used to manipulate cortical activity focally, creating either transient or enduring changes in patterns of brain activity (Bailey et al., 2001 and Walsh and Pascual-Leone, 2003). TMS employs the principle of electromagnetic induction and involves the generation of a rapid time-varying magnetic field in a coil of wire.