Soliman Radwa K, Tax Chantal M W, Abo-Elfetoh Noha, Karim Ahmed A, Youssef Ayda, Kamal Doaa, Khedr Eman M
Department of Diagnostic and Interventional Radiology, Assiut University Hospitals, Assiut 71515, Egypt.
Cardiff University Brain Research Imaging Center (CUBRIC), School of Physics and Astronomy, Cardiff University, Cardiff CF24 4HQ, UK.
Brain Sci. 2021 Sep 26;11(10):1277. doi: 10.3390/brainsci11101277.
In this pilot study we investigated the effects of transcranial direct current stimulation (tDCS) on language recovery in the subacute stage of post-stroke aphasia using clinical parameters and diffusion imaging with constrained spherical deconvolution-based tractography. The study included 21 patients with subacute post-stroke aphasia. Patients were randomly classified into two groups with a ratio of 2:1 to receive real tDCS or sham tDCS as placebo control. Patients received 10 sessions (5/week) bi-hemispheric tDCS treatments over the left affected Broca's area (anodal electrode) and over the right unaffected Broca's area (cathodal stimulation). Aphasia score was assessed clinically using the language section of the Hemispheric Stroke Scale (HSS) before and after treatment sessions. Diffusion imaging and tractography were performed for seven patients of the real group, both before and after the 10th session. Dissection of language-related white matter tracts was achieved, and diffusion measures were extracted. A paired Student's -test was used to compare the clinical recovery and diffusion measures of the dissected tracts both pre- and post- treatment. The partial correlation between changes in diffusion measures and the language improvements was calculated. At baseline assessment, there were no significant differences between groups in demographic and clinical HSS language score. No significant clinical recovery in HSS was evident in the sham group. However, significant improvements in the different components of HSS were only observed in patients receiving real tDCS. Associated significant increase in the fractional anisotropy of the right uncinate fasciculus and a significant reduction in the mean diffusivity of the right frontal aslant tract were reported. A significant positive correlation was found between the changes in the right uncinate fasciculus and fluency improvement. Aphasia recovery after bi-hemispheric transcranial direct current stimulation was associated with contralesional right-sided white matter changes at the subacute stage. These changes probably reflect neuroplasticity that could contribute to the recovery. Both the right uncinate fasciculus and right frontal aslant tract seem to be involved in aphasia recovery.
在这项初步研究中，我们使用临床参数以及基于约束球面反卷积的纤维束成像扩散成像技术，研究了经颅直流电刺激（tDCS）对中风后失语亚急性期语言恢复的影响。该研究纳入了21例中风后失语亚急性期患者。患者按2:1的比例随机分为两组，分别接受真正的tDCS或作为安慰剂对照的假tDCS。患者接受10次（每周5次）双半球tDCS治疗，阳极电极置于左侧受影响的布洛卡区，阴极刺激置于右侧未受影响的布洛卡区。在治疗前后，使用半球卒中量表（HSS）的语言部分对失语症评分进行临床评估。对真实组的7例患者在第10次治疗前后均进行了扩散成像和纤维束成像。实现了与语言相关的白质纤维束的剖析，并提取了扩散测量值。使用配对学生t检验比较治疗前后剖析纤维束的临床恢复情况和扩散测量值。计算了扩散测量值变化与语言改善之间的偏相关性。在基线评估时，两组在人口统计学和临床HSS语言评分方面无显著差异。假刺激组在HSS方面未观察到明显的临床恢复。然而，仅在接受真正tDCS的患者中观察到HSS不同组成部分有显著改善。报告称右侧钩束的分数各向异性有相关显著增加，右侧额斜束的平均扩散率有显著降低。右侧钩束的变化与流畅性改善之间存在显著正相关。双半球经颅直流电刺激后的失语症恢复与亚急性期对侧右侧白质变化有关。这些变化可能反映了有助于恢复的神经可塑性。右侧钩束和右侧额斜束似乎都参与了失语症的恢复。
