Department of Neurological Rehabilitation, Wuxi Tongren Rehabilitation Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China.
Department of Psychiatry, The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, Jiangsu Province, China.
Biomed Res Int. 2019 Jul 29;2019:4589056. doi: 10.1155/2019/4589056. eCollection 2019.
To evaluate and compare the effects of repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis of the posterior inferior frontal gyrus (pIFG) and the right posterior superior temporal gyrus (pSMG) in global aphasia following subacute stroke.
Fifty-four patients with subacute poststroke global aphasia were randomized to 15-day protocols of 20-minute inhibitory 1 Hz rTMS over either the right triangular part of the pIFG (the rTMS-b group) or the right pSTG (the rTMS-w group) or to sham stimulation, followed by 30 minutes of speech and language therapy. Language outcomes were assessed by aphasia quotient (AQ) scores obtained from the Chinese version of the Western Aphasia Battery (WAB) at baseline and immediately after 3 weeks (15 days) of experimental treatment.
Forty-five patients completed the entire study. The primary outcome measures include the changes in WAB-AQ score, spontaneous speech, auditory comprehension, and repetition. These measures indicated significant main effect between the baseline of the rTMS-w, rTMS-b, and sham groups and immediately after stimulation (<0.05). Compared with the sham group, the increases were significant for auditory comprehension, repetition, and AQ in the rTMS-w group (<0.05), whereas the changes in repetition, spontaneous speech, and AQ tended to be higher in the rTMS-b group (<0.05).
Inhibitory rTMS targeting the right pIFG and pSTG can be an effective treatment for subacute stroke patients with global aphasia. The effect of rTMS may depend on the stimulation site. Low-frequency rTMS inhibited the right pSTG and significantly improved language recovery in terms of auditory comprehension and repetition, whereas LF-rTMS inhibited the right pIFG, leading to apparent changes in spontaneous speech and repetition.
评估和比较经颅重复磁刺激（rTMS）对亚急性脑卒中后完全性失语症患者右侧后下额下回三角部（pIFG）和右侧后上颞回（pSMG）的治疗效果。
将 54 例亚急性脑卒中后完全性失语症患者随机分为 15 天的治疗方案，即 20 分钟 1Hz 抑制性 rTMS 治疗右侧 pIFG 三角区（rTMS-b 组）或右侧 pSMG（rTMS-w 组）或假刺激，随后进行 30 分钟的言语和语言治疗。采用汉语版西方失语症成套测验（WAB）的失语商（AQ）评分评估语言结局，在基线和实验治疗 3 周（15 天）后即刻进行评估。
45 例患者完成了整个研究。主要结局指标包括 WAB-AQ 评分、自发言语、听觉理解和复述的变化。这些指标表明 rTMS-w、rTMS-b 和假刺激组的基线与刺激后即刻之间存在显著的主要效应（<0.05）。与假刺激组相比，rTMS-w 组的听觉理解、复述和 AQ 增加显著（<0.05），而 rTMS-b 组的复述、自发言语和 AQ 变化趋势较高（<0.05）。
针对右侧 pIFG 和 pSMG 的抑制性 rTMS 是治疗亚急性脑卒中后完全性失语症患者的有效方法。rTMS 的效果可能取决于刺激部位。低频 rTMS 抑制右侧 pSMG 可显著改善听觉理解和复述方面的语言恢复，而 LF-rTMS 抑制右侧 pIFG 则导致自发言语和复述明显变化。
