Neuropsychiatric Rehabilitation Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Hong SAR, China.
Rev Neurosci. 2013;24(1):105-14. doi: 10.1515/revneuro-2012-0072.
This evidence-based review reports an updated evaluation and critical appraisal of available studies that investigated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) on post-stroke aphasia rehabilitation.
A literature search was performed to identify studies that investigated the therapeutic effects of rTMS on post-stroke aphasia in various electronic databases, from their inception to 2011. The selected studies were classified according to the types of participants, types of interventions, outcome measures, and results. The methodological qualities of the selected studies were evaluated using the Physiotherapy Evidence Database scale.
The current review was based on 12 studies, including open-label designs and controlled trials, that showed a positive effect of rTMS, with or without conventional rehabilitation, on post-stroke aphasia compared with sham or conventional rehabilitation alone. About 41% of the selected studies reported the long-term effect of rTMS on aphasia recovery. No adverse effect was reported.
The current review reveals that rTMS with or without conventional rehabilitation has positive effects on post-stroke aphasia. The studies also contributed to the plausible mechanisms of stroke recovery. However, with the concerns over the methodology of the selected studies in this review, a larger-scale, multicenter, well-designed randomized controlled trial involving different phases and types of aphasia needs to be carried out before recommending rTMS as a complementary treatment for post-stroke aphasia.
本循证综述报告了对现有研究的最新评估和批判性评价，这些研究调查了重复经颅磁刺激（rTMS）在脑卒中后失语症康复中的有效性。
从建库到 2011 年，我们在各种电子数据库中进行了文献检索，以确定研究 rTMS 对各种类型的脑卒中后失语症治疗效果的研究。根据参与者类型、干预类型、结果测量和结果对所选研究进行分类。使用物理治疗证据数据库量表评估所选研究的方法学质量。
本综述基于 12 项研究，包括开放性设计和对照试验，这些研究表明 rTMS 联合或不联合常规康复治疗与假刺激或单纯常规康复治疗相比，对脑卒中后失语症有积极的影响。约 41%的入选研究报告了 rTMS 对失语症恢复的长期影响。未报告不良反应。
本综述揭示 rTMS 联合或不联合常规康复治疗对脑卒中后失语症有积极的影响。这些研究也为中风恢复的可能机制提供了证据。然而，考虑到本综述中入选研究的方法学问题，需要开展更大规模、多中心、设计良好的随机对照试验，涉及不同阶段和类型的失语症，然后才能推荐 rTMS 作为脑卒中后失语症的补充治疗方法。
