Ren Jianxun, Ren Weijing, Zhou Ying, Dahmani Louisa, Duan Xinyu, Fu Xiaoxuan, Wang Yezhe, Pan Ruiqi, Zhao Jingdu, Zhang Ping, Wang Bo, Yu Weiyong, Chen Zhenbo, Zhang Xin, Sun Jian, Ding Mengying, Huang Jianting, Xu Liu, Li Shiyi, Wang Weiwei, Xie Wuxiang, Zhang Hao, Liu Hesheng
Division of Brain Sciences, Changping Laboratory, Beijing, 102206, China.
Department of Neurorehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, 100069, China; University of Health and Rehabilitation Sciences, Qingdao, Shandong, 266000, China.
Brain Stimul. 2023 Sep-Oct;16(5):1313-1321. doi: 10.1016/j.brs.2023.08.023. Epub 2023 Aug 29.
Aphasia affects approximately one-third of stroke patients and yet its rehabilitation outcomes are often unsatisfactory. More effective strategies are needed to promote recovery.
We aimed to examine the efficacy and safety of the theta-burst stimulation (TBS) on the language area in the superior frontal gyrus (SFG) localized by personalized functional imaging, in facilitating post-stroke aphasia recovery.
This randomized sham-controlled trial uses a parallel design (intermittent TBS [iTBS] in ipsilesional hemisphere vs. continuous TBS [cTBS] in contralesional hemisphere vs. sham group). Participants had aphasia symptoms resulting from their first stroke in the left hemisphere at least one month prior. Participants received three-week speech-language therapy coupled with either active or sham stimulation applied to the left or right SFG. The primary outcome was the change in Western Aphasia Battery-Revised (WAB-R) aphasia quotient after the three-week treatment. The secondary outcome was WAB-R aphasia quotient improvement after one week of treatment.
Ninety-seven patients were screened between January 2021 and January 2022, 45 of whom were randomized and 44 received intervention (15 in each active group, 14 in sham). Both iTBS (estimated difference = 14.75, p < 0.001) and cTBS (estimated difference = 13.43, p < 0.001) groups showed significantly greater improvement than sham stimulation after the 3-week intervention and immediately after one week of treatment (p's < 0.001). The adverse events observed were similar across groups. A seizure was recorded three days after the termination of the treatment in the iTBS group.
The stimulation showed high efficacy and SFG is a promising stimulation target for post-stroke language recovery.
失语症影响约三分之一的中风患者，但其康复效果往往不尽人意。需要更有效的策略来促进恢复。
我们旨在研究经个性化功能成像定位的额上回（SFG）语言区的theta爆发刺激（TBS）在促进中风后失语症恢复方面的疗效和安全性。
这项随机假对照试验采用平行设计（患侧半球间歇性TBS [iTBS] 对比健侧半球连续性TBS [cTBS] 对比假刺激组）。参与者在至少一个月前因左侧半球首次中风出现失语症状。参与者接受为期三周的言语治疗，并在左侧或右侧SFG施加主动或假刺激。主要结局是三周治疗后西方失语症成套测验修订版（WAB-R）失语商数的变化。次要结局是治疗一周后WAB-R失语商数的改善情况。
2021年1月至2022年1月期间筛选了97名患者，其中45名被随机分组，44名接受干预（每个主动刺激组15名，假刺激组14名）。在为期3周的干预后以及治疗一周后立即进行评估，iTBS组（估计差异=14.75，p<0.001）和cTBS组（估计差异=13.43，p<0.001）均显示出比假刺激组有显著更大的改善（p值<0.001）。各小组观察到的不良事件相似。iTBS组在治疗结束后三天记录到一次癫痫发作。
该刺激显示出高效性，SFG是中风后语言恢复的一个有前景的刺激靶点。
