Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, 21287, Maryland, USA.
Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, 21287, Maryland, USA.
Ann Clin Transl Neurol. 2023 Sep;10(9):1525-1532. doi: 10.1002/acn3.51842. Epub 2023 Jul 5.
OBJECTIVE: To examine changes to connectivity after aphasia treatment in the first 3 months after stroke. METHODS: Twenty people experiencing aphasia within the first 3 months of stroke completed MRI before and immediately following 15 hours of language treatment. They were classified based on their response to treatment on a naming test of nouns as either high responders (10% improvement or more), or low responders (<10% improvement). Groups were similar in age, gender distribution, education, days since stroke, stroke volume, and baseline severity. Resting-state functional connectivity analysis was limited to the connectivity of the left fusiform gyrus with the bilateral inferior frontal gyrus, supramarginal gyrus, angular gyrus, and superior, middle, and inferior temporal gyrus, based on previous studies showing the importance of left fusiform gyrus in naming performance. RESULTS: Baseline ipsilateral connectivity between the left fusiform gyrus and the language network was similar between high and low responders to therapy when controlling for stroke volume. Following therapy, change in connectivity was significantly greater among high responders between the left fusiform gyrus and the ipsilateral and contralateral pars triangularis, ipsilateral pars opercularis and superior temporal gyrus, and contralateral angular gyrus when compared with low responders. INTERPRETATION: An account of these findings incorporates primarily proximal connectivity restoration, but also potentially reflects select contralateral compensatory reorganization. The latter is often associated with chronic recovery, reflecting the transitional nature of the subacute period.
目的:研究中风后 3 个月内失语症治疗前后的连通性变化。
方法:20 名中风后 3 个月内出现失语症的患者在语言治疗前和治疗后立即进行 MRI 检查。他们根据名词命名测试的治疗反应分为高反应者(改善 10%或更多)或低反应者(改善<10%)。两组在年龄、性别分布、教育程度、中风后天数、中风量和基线严重程度方面相似。基于先前研究表明左侧梭状回在命名表现中的重要性,静息态功能连接分析仅限于左侧梭状回与双侧额下回、缘上回、角回和颞上、中、下回的连接。
结果:在控制中风量后,高反应者和低反应者的左侧梭状回与语言网络之间的基线同侧连通性相似。治疗后,高反应者左侧梭状回与同侧和对侧三角部、同侧三角部和额下回、对侧角回之间的连通性变化明显大于低反应者。
解释:这些发现的解释主要包括近端连通性的恢复,但也可能反映了选择性的对侧代偿性重组。后者通常与慢性恢复有关,反映了亚急性期的过渡性质。
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