Department of Speech and Language Sciences, University of Arizona, AZ, USA.
Department of Speech and Language Sciences, University of Arizona, AZ, USA.
Clin Neurophysiol. 2022 Aug;140:196-227. doi: 10.1016/j.clinph.2022.04.017. Epub 2022 May 5.
This meta-analysis examined the effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) in treating post-stroke aphasia with a goal to identify parameters that are associated with successful treatment outcomes.
Following PRISMA guidelines, ten electronic databases were searched from inception till June 4th 2020. A total of 24 studies (out of 1971 records) with 567 participants met selection criteria and were included in the meta-analysis.
The overall pooled meta-analysis revealed a significant medium effect size in favor of rTMS treatment: Standard mean difference (SMD) of 0.655 (95% CI = [0.481, 0.830], z = 7.369, p < 0.001). Moderator subgroup analyses indicated that participants' clinical characteristics and rTMS parameters moderated treatment effects. The strongest effects were observed for naming, followed by speech production, repetition and comprehension. The results indicate that with 10 to 15 sessions of 1-Hz rTMS administered 20-40 min per day over right BA45 (Brodmann's area 45), significant language improvements can be observed for up to 12 months.
Our findings suggest that the rTMS technique can enhance rehabilitation of language skills in post-stroke aphasia when administered according to the established safety parameters.
Our results have implications for treatment of post-stroke aphasia. In subacute aphasia, low frequency rTMS over right BA45 improved naming, repetition, speech fluency and writing but not comprehension, whereas in chronic aphasia naming and speech production improved, but repetition and comprehension showed smaller gains.
本荟萃分析旨在探讨重复经颅磁刺激（rTMS）治疗脑卒中后失语症的有效性，以确定与治疗效果相关的参数。
根据 PRISMA 指南，从建库至 2020 年 6 月 4 日，检索了 10 个电子数据库。共有 24 项研究（来自 1971 项记录）和 567 名参与者符合入选标准，并纳入荟萃分析。
总体荟萃分析显示 rTMS 治疗有显著的中等效应量：标准均数差（SMD）为 0.655（95%CI[0.481, 0.830]，z=7.369，p<0.001）。亚组分析表明，参与者的临床特征和 rTMS 参数调节了治疗效果。命名的效果最强，其次是言语产生、重复和理解。结果表明，每天进行 20-40 分钟、10-15 次、1Hz 的 rTMS 治疗右额下回（45 区），可在长达 12 个月的时间内观察到语言显著改善。
我们的研究结果表明，rTMS 技术可增强脑卒中后失语症的语言康复，当按照既定的安全参数进行治疗时。
我们的研究结果对脑卒中后失语症的治疗具有一定意义。在亚急性期失语症中，右额下回的低频 rTMS 可改善命名、重复、言语流畅性和书写，但对理解无影响；而在慢性期失语症中，命名和言语产生得到改善，但重复和理解的获益较小。
