Zhang Hui, Chen Ying, Hu Ruiping, Yang Liqing, Wang Mengxing, Zhang Jilei, Lu Haifeng, Wu Yi, Du Xiaoxia
Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Materials Science, East China Normal University Department of Rehabilitation Medicine, Huashan Hospital Department of Rehabilitation Medicine, Shanghai Third Rehabilitation Hospital Department of Radiology, Huashan Hospital Department of Sports Medicine and Rehabilitation, Huashan Hospital State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
Medicine (Baltimore). 2017 Aug;96(32):e7399. doi: 10.1097/MD.0000000000007399.
To date, little is known regarding the neural mechanisms of the functional recovery of language after repetitive transcranial magnetic stimulation (rTMS) in aphasia. Our aim was to investigate the mechanism that underlies rTMS and speech training in a case report.
We report the case of a 39-year-old woman who was initially diagnosed with conduction aphasia following a left hemisphere stroke.
The rTMS location comprised the left Broca area, and a frequency of 5 Hz for 20 min/d for 10 days during a 2-week period was used. She had received speech rehabilitation training 1 month after stroke. Functional magnetic resonance imaging (fMRI) and diffusion tensor imaging were used to investigate the functional and microstructural changes before and after rTMS treatment.
The results demonstrated that the Western Aphasia Battery scores significantly improved for language ability at 2 weeks post-treatment, and the gains were steadily increased at 2.5 months post-treatment. The fMRI results indicated a more focused activation pattern and showed significant activation in the left dominant hemisphere relative to the right hemisphere, especially in the perilesional areas, post-treatment during 2 language tasks compared with pretreatment. Moreover, the fractional anisotropy increased in the left superior temporal gyrus, which comprises an important area that is involved in language processing.
Our findings suggest that rTMS combined with speech training improved the speech-language ability of this chronic conduction aphasia patient and enhanced the cerebral functional and microstructural reorganization.
迄今为止，关于失语症患者经重复经颅磁刺激（rTMS）后语言功能恢复的神经机制知之甚少。我们的目的是在一份病例报告中研究rTMS与言语训练背后的机制。
我们报告了一名39岁女性的病例，她最初在左半球中风后被诊断为传导性失语症。
rTMS的刺激部位为左侧布洛卡区，在为期2周的时间内，以5赫兹的频率每天刺激20分钟，共进行10天。她在中风后1个月接受了言语康复训练。使用功能磁共振成像（fMRI）和弥散张量成像来研究rTMS治疗前后的功能和微观结构变化。
结果表明，治疗后2周时，西方失语症成套测验的语言能力得分显著提高，且在治疗后2.5个月时得分持续上升。fMRI结果显示激活模式更加集中，与治疗前相比，治疗后在两项语言任务中，左侧优势半球相对于右侧半球有显著激活，尤其是在病灶周围区域。此外，左侧颞上回的分数各向异性增加，该区域是参与语言处理的重要区域。
我们的研究结果表明，rTMS联合言语训练改善了这位慢性传导性失语症患者的言语能力，并促进了大脑功能和微观结构的重组。
