Garcia Gabriella, Norise Catherine, Faseyitan Olufunsho, Naeser Margaret A, Hamilton Roy H
Department of Neurology, Perelman School of Medicine, University of Pennsylvania.
J Vis Exp. 2013 Jul 2(77):e50228. doi: 10.3791/50228.
Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia(1). In this experiment, we demonstrate the administration of low-frequency repetitive TMS (rTMS) to an optimal stimulation site in the right hemisphere in patients with chronic non-fluent aphasia. A battery of standardized language measures is administered in order to assess baseline performance. Patients are subsequently randomized to either receive real rTMS or initial sham stimulation. Patients in the real stimulation undergo a site-finding phase, comprised of a series of six rTMS sessions administered over five days; stimulation is delivered to a different site in the right frontal lobe during each of these sessions. Each site-finding session consists of 600 pulses of 1 Hz rTMS, preceded and followed by a picture-naming task. By comparing the degree of transient change in naming ability elicited by stimulation of candidate sites, we are able to locate the area of optimal response for each individual patient. We then administer rTMS to this site during the treatment phase. During treatment, patients undergo a total of ten days of stimulation over the span of two weeks; each session is comprised of 20 min of 1 Hz rTMS delivered at 90% resting motor threshold. Stimulation is paired with an fMRI-naming task on the first and last days of treatment. After the treatment phase is complete, the language battery obtained at baseline is repeated two and six months following stimulation in order to identify rTMS-induced changes in performance. The fMRI-naming task is also repeated two and six months following treatment. Patients who are randomized to the sham arm of the study undergo sham site-finding, sham treatment, fMRI-naming studies, and repeat language testing two months after completing sham treatment. Sham patients then cross over into the real stimulation arm, completing real site-finding, real treatment, fMRI, and two- and six-month post-stimulation language testing.
经颅磁刺激（TMS）已被证明能显著改善非流利性失语患者的语言功能(1)。在本实验中，我们对慢性非流利性失语患者右侧半球的最佳刺激部位进行低频重复经颅磁刺激（rTMS）。采用一系列标准化语言测试来评估基线表现。随后，患者被随机分为接受真正的rTMS组或初始假刺激组。接受真正刺激的患者要经历一个位点寻找阶段，包括在五天内进行一系列六次rTMS治疗；在这些治疗的每次过程中，刺激被施加到右侧额叶的不同部位。每次位点寻找治疗包括600个1赫兹的rTMS脉冲，在其前后各有一个图片命名任务。通过比较刺激候选位点引起的命名能力的瞬时变化程度，我们能够为每个患者确定最佳反应区域。然后在治疗阶段对该位点进行rTMS治疗。在治疗期间，患者在两周内共接受十天的刺激；每次治疗包括在90%静息运动阈值下进行20分钟的1赫兹rTMS。在治疗的第一天和最后一天，刺激与功能磁共振成像（fMRI）命名任务配对。治疗阶段完成后，在刺激后的两个月和六个月重复进行基线时的语言测试，以确定rTMS引起的表现变化。在治疗后的两个月和六个月也重复进行fMRI命名任务。被随机分配到研究假刺激组的患者在完成假刺激治疗两个月后接受假位点寻找、假治疗、fMRI命名研究和重复语言测试。然后假刺激组患者转入真正刺激组，完成真正的位点寻找、真正的治疗、fMRI以及刺激后两个月和六个月的语言测试。
