Heikkinen Paula H, Pulvermüller Friedemann, Mäkelä Jyrki P, Ilmoniemi Risto J, Lioumis Pantelis, Kujala Teija, Manninen Riitta-Leena, Ahvenainen Antti, Klippi Anu
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Brain Language Laboratory, Department of Philosophy and Humanities, WE4, Freie Universität Berlin, Berlin, Germany.
Front Neurosci. 2019 Feb 4;12:1036. doi: 10.3389/fnins.2018.01036. eCollection 2018.
Neuromodulation technologies, such as transcranial magnetic stimulation (TMS), are promising tools for neurorehabilitation, aphasia therapy included, but not yet in common clinical use. Combined with behavioral techniques, in particular treatment-efficient (ILAT, previously CIAT or CILT), TMS could substantially amplify the beneficial effect of such behavioral therapy alone (Thiel et al., 2013; Martin et al., 2014; Mendoza et al., 2016; Kapoor, 2017). In this randomized study of 17 subjects with post-stroke aphasia in the chronic stage, we studied the combined effect of ILAT and 1-Hz placebo-controlled navigated repetitive TMS (rTMS) to the right-hemispheric inferior frontal cortex-that is, to the anterior part of the non-dominant hemisphere's homolog Broca's area (pars triangularis). Patients were randomized to groups A and B. Patients in group A received a 2-week period of rTMS during naming training where they named pictures displayed on the screen once every 10 s, followed by 2 weeks of rTMS and naming combined with ILAT. Patients in group B received the same behavioral therapy but TMS was replaced by sham stimulation. The primary outcome measures for changes in language performance were the Western Aphasia Battery's aphasia quotient AQ; the secondary outcome measures were the Boston naming test (BNT) and the Action naming test (Action BNT, ANT). All subjects completed the study. At baseline, no statistically significant group differences were discovered for age, post-stroke time or diagnosis. ILAT was associated with significant improvement across groups, as documented by both primary and secondary outcome measures. No significant effect of rTMS could be documented. Our results agree with previous results proving ILAT's ability to improve language in patients with chronic aphasia. In contrast with earlier claims, however, a beneficial effect of rTMS in chronic post-stroke aphasia rehabilitation was not detected in this study. www.ClinicalTrials.gov, identifier: NCT03629665.
神经调节技术，如经颅磁刺激（TMS），是神经康复（包括失语症治疗）中很有前景的工具，但尚未在临床中普遍使用。与行为技术，特别是高效治疗（ILAT，以前称为CIAT或CILT）相结合，TMS可以显著增强单独使用这种行为疗法的有益效果（蒂尔等人，2013年；马丁等人，2014年；门多萨等人，2016年；卡普尔，2017年）。在这项针对17名慢性期中风后失语症患者的随机研究中，我们研究了ILAT与1赫兹安慰剂对照的导航重复经颅磁刺激（rTMS）对右半球额下回（即非优势半球同源布罗卡区（三角部）的前部）的联合作用。患者被随机分为A组和B组。A组患者在命名训练期间接受为期2周的rTMS，他们每10秒对屏幕上显示的图片命名一次，随后2周的rTMS和命名与ILAT相结合。B组患者接受相同的行为疗法，但TMS被假刺激取代。语言表现变化的主要结局指标是西方失语症量表的失语商数AQ；次要结局指标是波士顿命名测试（BNT）和动作命名测试（动作BNT，ANT）。所有受试者均完成了研究。在基线时，未发现两组在年龄、中风后时间或诊断方面存在统计学显著差异。如主要和次要结局指标所记录，ILAT与各组的显著改善相关。未发现rTMS有显著效果。我们的结果与先前证明ILAT改善慢性失语症患者语言能力的结果一致。然而，与早期的说法相反，本研究未检测到rTMS对慢性中风后失语症康复的有益效果。 临床试验.gov网站，标识符：NCT03629665。
