Department of Neurology & Neurosurgery, McGill University, Montreal, QC, H3T 1E2, Canada.
Stroke. 2011 Feb;42(2):409-15. doi: 10.1161/STROKEAHA.110.597864. Epub 2010 Dec 16.
Although functional imaging studies suggest that recruitment of contralesional areas hinders optimal functional reorganization in patients with aphasic stroke, only limited evidence is available on the efficacy of noninvasive brain stimulation such as repetitive transcranial magnetic stimulation aimed at suppression of contralateral overactivation.
In this randomized, controlled, blinded pilot study, the effect of 1-Hz repetitive transcranial magnetic stimulation over right-hemispheric Broca homolog in subjects with poststroke aphasia in the subacute stage was examined. According to their group allocation, patients received, in addition to conventional speech and language therapy, multiple sessions of repetitive transcranial magnetic stimulation either over the right-hemispheric inferior frontal gyrus (intervention group) or over the vertex (control group). The primary outcome parameter was the change in laterality indices as quantified by activation positron emission tomography before and after the 2-week intervention period. The clinical efficacy was evaluated with the Aachen Aphasia Test.
At baseline, no group differences were discovered for age, laterality indices, or mean Aachen Aphasia Test scores. Four patients were lost to follow-up, but none due to side effects of the transcranial magnetic stimulation. Positron emission tomography revealed an activation shift toward the right hemisphere in the control group (P=0.0165), which was absent in the intervention group. Furthermore, the latter improved significantly clinically by a mean of 19.8 points in the Aachen Aphasia Test total score (P=0.002), whereas the control group did not. There was however no clear linear relationship between the extent of laterality shift and clinical improvement (r=0.193, P=nonsignificant).
Repetitive transcranial magnetic stimulation might be an effective, safe, and feasible complementary therapy for poststroke aphasia.
尽管功能影像学研究表明，对失语症卒中患者对侧区域的募集会阻碍其最佳功能重组，但关于旨在抑制对侧过度激活的非侵入性脑刺激（如重复经颅磁刺激）的疗效，仅有有限的证据。
在这项随机、对照、盲法的初步研究中，我们检查了在亚急性期卒中后失语症患者中，对右侧半球布罗卡区同源区进行 1Hz 重复经颅磁刺激的效果。根据分组，患者在接受常规言语和语言治疗的基础上，分别接受多次右侧额下回（干预组）或顶点（对照组）的重复经颅磁刺激。主要的结局参数是在 2 周干预期前后通过正电子发射断层扫描量化的偏侧性指数的变化。临床疗效用阿亨失语症测试进行评估。
在基线时，年龄、偏侧性指数或平均阿亨失语症测试评分均未发现组间差异。有 4 名患者失访，但均不是因为经颅磁刺激的副作用。正电子发射断层扫描显示对照组的激活向右侧半球转移（P=0.0165），而干预组则没有。此外，后者在阿亨失语症测试总分中平均提高了 19.8 分（P=0.002），而对照组则没有。然而，偏侧性转移的程度与临床改善之间没有明显的线性关系（r=0.193，P=非显著）。
重复经颅磁刺激可能是一种有效、安全且可行的卒中后失语症的补充治疗方法。
