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高频重复经颅磁刺激对慢性脑卒中后失语症恢复的影响。

Effect of High Frequency Transcranial Magnetic Stimulation on Recovery of Chronic Post-Stroke Aphasia.

作者信息

Fahmy Ebtesam Mohamed, Elshebawy Haidy Mohamed

机构信息

Professor of neurology, Faculty of Medicine, Cairo University, Cairo, Egypt.

Lecturer of neurology, Faculty of Medicine, Cairo University, Cairo, Egypt.

出版信息

J Stroke Cerebrovasc Dis. 2021 Aug;30(8):105855. doi: 10.1016/j.jstrokecerebrovasdis.2021.105855. Epub 2021 May 25.

Abstract

BACKGROUND

Both hemispheres have role in post-stroke aphasia recovery but better recovery is expected with the restoration of function by the left hemisphere. Transcranial stimulation has been used to favor recruitment of left-hemispheric language networks and increase activity of the left hemisphere, thus helps aphasia recovery .

OBJECTIVE

The aim of this study is to evaluate the effect of excitatory repetitive transcranial magnetic stimulation (rTMS) on recovery of post stroke aphasic patients .

MATERIALS AND METHODS

Twenty patients with post stroke chronic aphasia were enrolled in the study. Aphasia severity was assessed using Aphasia Severity Rating Scale (ASRS). Linguistic deficits were assessed using Kasr Al-Aini Arabic Aphasia test (KAAT). Real rTMS was applied three for 10 sessions of 10-Hz stimulation, positioned over the left Broca's area of the affected hemisphere. All patients were evaluated before, after the end of treatment sessions and one month later .

RESULTS

There was a significant improvement in the mean total score and mean scores of components of KAAT scale before, immediately after and after one month of rTMS (P< 0.05). Moreover, there was a significant improvement in mean scores of ASRS before, immediately after and after one month of rTMS (P= 0.000). There was a significant difference in mean scores of ASRS and KAAT before, immediately after the last session and after one month between small, medium and large brain infarcts. (P< 0.05).

CONCLUSION

Excitatory rTMS is a beneficial adjuvant therapy that improves language skills in patients with chronic post-stroke non-fluent aphasia in short and long term. The protocol of this observational study was registered in clinical trial registration: www.ClinicalTrials.gov, identifier: NCT04708197.

摘要

背景

两个半球在中风后失语症恢复中都发挥作用,但左半球功能恢复有望带来更好的恢复。经颅刺激已被用于促进左半球语言网络的募集并增加左半球的活动,从而有助于失语症恢复。

目的

本研究旨在评估兴奋性重复经颅磁刺激(rTMS)对中风后失语症患者恢复的影响。

材料与方法

20例中风后慢性失语症患者纳入本研究。使用失语症严重程度评定量表(ASRS)评估失语症严重程度。使用卡斯尔·阿尼阿拉伯失语症测试(KAAT)评估语言缺陷。对受影响半球的左侧布洛卡区进行10次10赫兹刺激,共3次施加真正的rTMS。所有患者在治疗疗程结束前、结束后及1个月后进行评估。

结果

rTMS治疗前、治疗结束后即刻及治疗后1个月,KAAT量表的平均总分及各成分平均得分均有显著改善(P<0.05)。此外,rTMS治疗前、治疗结束后即刻及治疗后1个月,ASRS平均得分也有显著改善(P = 0.000)。小、中、大面积脑梗死患者在最后一次治疗前、治疗结束后即刻及治疗后1个月的ASRS和KAAT平均得分存在显著差异(P<0.05)。

结论

兴奋性rTMS是一种有益的辅助治疗方法,可在短期和长期内改善中风后慢性非流利性失语症患者的语言技能。本观察性研究方案已在临床试验注册中心:www.ClinicalTrials.gov注册,标识符:NCT04708197。

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