Zheng Kai, Xu Xinlei, Ji Yingying, Fang Hui, Gao Fanglan, Huang Guilan, Su Bin, Bian Li, Zhang Guofu, Ren Caili
Department of Neurorehabilitation, Wuxi Central Rehabilitation Hospital, The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China.
The Affiliated Mental Health Center of Jiangnan University, Wuxi, Jiangsu, China.
Front Aging Neurosci. 2023 Jan 12;14:1079023. doi: 10.3389/fnagi.2022.1079023. eCollection 2022.
Continuous theta burst stimulation (cTBS) is a specific paradigm of repetitive transcranial magnetic stimulation (rTMS) with an inhibitory effect on cortical excitability for up to 60 min after less than 1 min of stimulation. The right posterior superior temporal gyrus (pSTG), homotopic to Wernicke's area in the left hemisphere, may be a potential stimulation target based on its critical role in semantic processing. The objective of this study was to explore whether cTBS over the right pSTG can promote language improvements in aphasic patients and the underlying mechanism.
A total of 34 subjects with aphasia were randomly assigned to undergo 15 sessions of either 40-s inhibitory cTBS over the right pSTG (the cTBS group) or sham stimulation (the sham group), followed by 30 min of speech and language therapy. Subjects underwent resting-state functional magnetic resonance imaging (rs-fMRI), and the aphasia quotient (AQ) of the Chinese version of the Western Aphasia Battery (WAB) was calculated before and after the intervention. This randomized controlled trial was registered in the Chinese Clinical Trial Registry (No. ChiCTR210052962).
After treatment, the language performance of the cTBS group was higher than that of the sham group in terms of the WAB-AQ score ( = 0.010) and the WAB scores for auditory comprehension ( = 0.022) and repetition ( = 0.035). The fractional amplitude of low-frequency fluctuations (fALFF) was significantly decreased in the pars triangularis of the inferior frontal gyrus (IFG), right middle frontal gyrus, right thalamus, and left cerebellar crus I. Clusters in the left orbitofrontal cortex exhibited increased fALFF. The change in WAB comprehension scores were significantly correlated with the change in the fALFF of the right IFG pars triangularis in both groups. Greatly increased functional connectivity was observed between the right pars triangularis and left paracingulate gyrus and between the right pSTG and right angular gyrus and the posterior cingulate gyrus with pre-and post-treatment between the two groups.
Our findings indicate that cTBS of the right pSTG may improve language production by suppressing intrinsic activity of the right fronto-thalamic-cerebellar circuit and enhancing the involvement of the right temporoparietal region.
连续theta爆发刺激（cTBS）是重复经颅磁刺激（rTMS）的一种特定模式，在刺激不到1分钟后对皮质兴奋性具有长达60分钟的抑制作用。右侧后颞上回（pSTG）与左侧半球的韦尼克区相对应，基于其在语义处理中的关键作用，可能是一个潜在的刺激靶点。本研究的目的是探讨右侧pSTG上的cTBS是否能促进失语症患者的语言改善及其潜在机制。
总共34名失语症患者被随机分配接受15次右侧pSTG上40秒的抑制性cTBS（cTBS组）或假刺激（假刺激组），随后进行30分钟的言语和语言治疗。受试者接受静息态功能磁共振成像（rs-fMRI），并在干预前后计算西方失语症成套测验（WAB）中文版的失语商（AQ）。这项随机对照试验已在中国临床试验注册中心注册（注册号：ChiCTR210052962）。
治疗后，cTBS组在WAB-AQ评分（P = 0.010）以及听觉理解（P = 0.022）和复述（P = 0.035）的WAB评分方面的语言表现高于假刺激组。低频波动分数（fALFF）在额下回三角部（IFG）、右侧额中回、右侧丘脑和左侧小脑脚I显著降低。左侧眶额皮质的簇显示fALFF增加。两组中WAB理解评分的变化与右侧IFG三角部的fALFF变化显著相关。两组治疗前后在右侧三角部与左侧扣带旁回之间以及右侧pSTG与右侧角回和后扣带回之间观察到功能连接显著增加。
我们的研究结果表明，右侧pSTG的cTBS可能通过抑制右侧额-丘脑-小脑回路的内在活动并增强右侧颞顶叶区域的参与来改善语言表达。
