Hara Takatoshi, Abo Masahiro
Department of Rehabilitaion Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
Diagnostics (Basel). 2021 Oct 8;11(10):1853. doi: 10.3390/diagnostics11101853.
Repetitive transcranial magnetic stimulation (rTMS) for post-stroke aphasia (PSA) has been suggested to promote improvement of language function when used in combination with rehabilitation. However, many challenges remain. In some reports examined by category of language function, only naming has good evidence of improvement, and the improvement effect on other language modalities is low. Therefore, it is necessary to establish methods that contribute to the improvement of language functions other than naming. Therapeutic methods for PSA based on the mechanism of rTMS are mainly inhibitory stimulation methods for language homologous areas. However, the mechanisms of these methods are controversial when inferred from the process of recovery of language function. Low-frequency rTMS applied to the right hemisphere has been shown to be effective in the chronic phase of PSA, but recent studies of the recovery process of language function indicate that this method is unclear. Therefore, it has been suggested that evaluating brain activity using neuroimaging contributes to confirming the effect of rTMS on PSA and the elucidation of the mechanism of functional improvement. In addition, neuroimaging-based stimulation methods (imaging-based rTMS) may lead to further improvements in language function. Few studies have examined neuroimaging and imaging-based rTMS in PSA, and further research is required. In addition, the stimulation site and stimulation parameters of rTMS are likely to depend on the time from onset to intervention. However, there are no reports of studies in patients between 90 and 180 days after onset. Therefore, research during this period is required. New stimulation methods, such as multiple target methods and the latest neuroimaging methods, may contribute to the establishment of new knowledge and new treatment methods in this field.
重复经颅磁刺激（rTMS）用于治疗脑卒中后失语（PSA），已被建议与康复治疗联合使用以促进语言功能改善。然而，仍存在许多挑战。在一些按语言功能类别进行检查的报告中，只有命名功能有充分证据显示有所改善，而对其他语言模式的改善效果较低。因此，有必要建立有助于改善命名功能以外其他语言功能的方法。基于rTMS机制的PSA治疗方法主要是针对语言同源区域的抑制性刺激方法。然而，从语言功能恢复过程推断，这些方法的机制存在争议。应用于右半球的低频rTMS已被证明在PSA慢性期有效，但最近关于语言功能恢复过程的研究表明，这种方法的效果尚不清楚。因此，有人建议使用神经影像学评估脑活动有助于确认rTMS对PSA的疗效并阐明功能改善机制。此外，基于神经影像学的刺激方法（基于成像的rTMS）可能会进一步改善语言功能。很少有研究在PSA中考察神经影像学和基于成像的rTMS，需要进一步研究。此外，rTMS的刺激部位和刺激参数可能取决于发病至干预的时间。然而，尚无发病后90至180天患者的研究报告。因此，需要在此期间开展研究。新的刺激方法，如多靶点方法和最新的神经影像学方法，可能有助于在该领域建立新知识和新治疗方法。
