Darkow Robert, Martin Andrew, Würtz Anna, Flöel Agnes, Meinzer Marcus
Department of Neurology, NeuroCure Clinical Research Center, and Center of Stroke Research Berlin, Berlin, Charité University Medicine, Berlin, 10117, Germany.
The University of Queensland, Centre for Clinical Research, Brisbane Queensland, 4029, Australia.
Hum Brain Mapp. 2017 Mar;38(3):1518-1531. doi: 10.1002/hbm.23469. Epub 2016 Nov 11.
Non-invasive transcranial direct current stimulation (tDCS) can enhance recovery after stroke. However, fundamental knowledge about how tDCS impacts neural processing in the lesioned human brain is currently lacking. In the present study, it was investigated how tDCS modulates brain function in patients with post-stroke language impairment (aphasia). In a cross-over, randomized trial, patients named pictures of common objects during functional magnetic resonance imaging (fMRI). Concurrently, excitatory (anodal-) or sham-tDCS (1 mA, 20 min, or 30 s, respectively) was administered to the left primary motor cortex, a montage with demonstrated potential to improve aphasic language. By choosing stimuli that could reliable be named by the patients, the authors aimed to derive a pure measure of stimulation effects that was independent of treatment or performance effects and to assess how tDCS interacts with the patients' residual language network. Univariate fMRI data analysis revealed reduced activity in domain-general regions mediating high-level cognitive control during anodal-tDCS. Independent component functional network analysis demonstrated selectively increased language network activity and an inter-correlated shift from higher to lower frequency bands, indicative of increased within-network communication. Compared with healthy controls, anodal-tDCS resulted in overall "normalization" of brain function in the patients. These results demonstrate for the first time how tDCS modulates neural processing in stroke patients. Such information is crucial to assure that behavioral treatments targeting specific neural circuits overlap with regions that are modulated by tDCS, thereby maximizing stimulation effects during therapy. Hum Brain Mapp 38:1518-1531, 2017. © 2016 Wiley Periodicals, Inc.
无创经颅直流电刺激(tDCS)可促进中风后的恢复。然而,目前尚缺乏关于tDCS如何影响受损人脑神经处理的基础知识。在本研究中,我们探究了tDCS如何调节中风后语言障碍(失语症)患者的脑功能。在一项交叉随机试验中,患者在功能磁共振成像(fMRI)期间对常见物体的图片进行命名。同时,分别对左侧初级运动皮层施加兴奋性(阳极)或假tDCS(分别为1 mA,20分钟或30秒),这是一种已证明有改善失语症语言潜力的电极贴片。通过选择患者能够可靠命名的刺激,作者旨在获得一种独立于治疗或表现效果的纯粹刺激效果测量方法,并评估tDCS如何与患者残留的语言网络相互作用。单变量fMRI数据分析显示,在阳极tDCS期间,介导高级认知控制的全脑区域活动减少。独立成分功能网络分析表明,语言网络活动选择性增加,并且从高频带向低频带出现相互关联的转变,这表明网络内通信增加。与健康对照相比,阳极tDCS使患者的脑功能总体上“正常化”。这些结果首次证明了tDCS如何调节中风患者的神经处理。这些信息对于确保针对特定神经回路的行为治疗与tDCS调节的区域重叠至关重要,从而在治疗期间最大化刺激效果。《人类大脑图谱》38:1518 - 1531,2017年。© 2016威利期刊公司