Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Med Sci Monit. 2021 Jun 29;27:e931468. doi: 10.12659/MSM.931468.
BACKGROUND Research indicates intermittent theta burst stimulation (iTBS) is a potential treatment of post-stroke aphasia. MATERIAL AND METHODS In this double-blind, sham-controlled trial (NCT01512264) participants were randomized to receive 3 weeks of sham (G₀), 1 week of iTBS/2 weeks of sham (G₁), 2 weeks of iTBS/1 week of sham (G₂), or 3 weeks of iTBS (G₃). FMRI localized residual language function in the left hemisphere; iTBS was applied to the maximum fMRI activation in the residual language cortex in the left frontal lobe. FMRI and aphasia testing were conducted pre-treatment, at ≤1 week after completing treatment, and at 3 months follow-up. RESULTS 27/36 participants completed the trial. We compared G0 to each of the individual treatment group and to all iTBS treatment groups combined (G₁₋₃). In individual groups, participants gained (of moderate or large effect sizes; some significant at P<0.05) on the Boston Naming Test (BNT), the Semantic Fluency Test (SFT), and the Aphasia Quotient of the Western Aphasia Battery-Revised (WAB-R AQ). In G₁₋₃, BNT, and SFT improved immediately after treatment, while the WAB-R AQ improved at 3 months. Compared to G₀, the other groups showed greater fMRI activation in both hemispheres and non-significant increases in language lateralization to the left hemisphere. Changes in IFG connectivity were noted with iTBS, showing differences between time-points, with some of them correlating with the behavioral measures. CONCLUSIONS The results of this pilot trial support the hypothesis that iTBS applied to the ipsilesional hemisphere can improve aphasia and result in cortical plasticity.
研究表明，间歇性 theta 爆发刺激（iTBS）是治疗中风后失语症的一种潜在方法。
在这项双盲、假对照试验（NCT01512264）中，参与者被随机分配接受 3 周的假刺激（G₀）、1 周的 iTBS/2 周的假刺激（G₁）、2 周的 iTBS/1 周的假刺激（G₂）或 3 周的 iTBS（G₃）。功能性磁共振成像（fMRI）定位左半球残留的语言功能；iTBS 应用于左额叶残留语言皮质的最大 fMRI 激活区。在治疗前、治疗结束后≤1 周和 3 个月随访时进行 fMRI 和失语症测试。
36 名参与者中有 27 名完成了试验。我们将 G0 与每个单独的治疗组和所有 iTBS 治疗组（G₁₋₃）进行了比较。在个别组中，参与者在波士顿命名测试（BNT）、语义流畅性测试（SFT）和西方失语症成套测验修订版（WAB-R AQ）的失语症商数上均有（中等或较大的效应量；一些在 P<0.05 时具有统计学意义）获益。在 G₁₋₃中，BNT 和 SFT 在治疗后立即改善，而 WAB-R AQ 在 3 个月时改善。与 G₀ 相比，其他组在两个半球的 fMRI 激活均增加，且左侧语言侧化无显著增加。iTBS 后观察到 IFG 连接的变化，表现为不同时间点之间的差异，其中一些与行为测量相关。
这项初步试验的结果支持 iTBS 应用于病灶对侧半球可以改善失语症并导致皮质可塑性的假设。
