Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
Restor Neurol Neurosci. 2013;31(4):501-15. doi: 10.3233/RNN-130314.
Aphasia is a common result of stroke, affecting over one million Americans. Currently, intensive speech therapy is the mainstay of treatment, although its efficacy has been variable at best. Recent years have seen the emergence of non-invasive brain stimulation, specifically Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS), as potential treatments for post-stroke aphasia. A growing body of investigations has shown the efficacy of both modalities in facilitating recovery from chronic aphasia, while data regarding subacute aphasia are much more limited and evidence in the acute post-stroke phase are still lacking. Much remains unknown about how these techniques cause clinical improvement or about their long-term efficacy, side-effects, and safety. In this article, we examine the data demonstrating the safety and efficacy of TMS and tDCS, discuss the major differences between them, and consider how those differences may inform the use of each modality. We also consider the different models of neuroplasticity in the setting of post-stroke aphasia and how these models may influence when and in which patients each modality would impart the most benefit.
失语症是中风的常见后果，影响了超过 100 万美国人。目前，强化语言治疗是主要的治疗方法，尽管其疗效充其量也是可变的。近年来，非侵入性脑刺激技术，特别是经颅磁刺激（TMS）和经颅直流电刺激（tDCS），已成为治疗中风后失语症的潜在方法。越来越多的研究表明这两种方法在促进慢性失语症康复方面的有效性，而关于亚急性期失语症的数据则更为有限，在急性中风后阶段的证据仍然缺乏。关于这些技术如何引起临床改善，以及关于它们的长期疗效、副作用和安全性，仍有许多未知之处。在本文中，我们检查了证明 TMS 和 tDCS 安全性和有效性的数据，讨论了它们之间的主要差异，并考虑了这些差异如何为每种方法的使用提供信息。我们还考虑了中风后失语症背景下不同的神经可塑性模型，以及这些模型如何影响每种方法会在何时以及对哪些患者带来最大益处。
