The right inferior frontal gyrus and poststroke aphasia - A follow-up investigation
The right inferior frontal gyrus and poststroke aphasia - A follow-up investigation
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DOI：
10.1161/01.str.0000259632.04324.6c
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发表时间：
2007-04-01
期刊：
影响因子：
8.3
通讯作者：
Heiss, Wolf D.
中科院分区：
文献类型：
--
作者：
Winhuisen, Lutz;Thiel, Alexander;Heiss, Wolf D.
背景和目的——最近，重复经颅磁刺激（rTMS）和激活正电子发射断层扫描（PET）联合研究显示，一些右手急性中风后失语症患者的右额下回（IFG）具有重要的语言功能。我们在慢性期重新检查了这些患者，以测试右侧 IFG 是否仍然对语言表现至关重要。方法 - 我们重新检查了 9 名男性右利手患者，年龄 41 至 75 岁，左半球中风后 8 周出现失语症。 rTMS 在左右 IFG 内的最大激活范围内进行（如 (15)[O] 水 PET 所定义）以干扰语言功能。积极的 rTMS 效应被定义为相对于无刺激，语义任务中的反应时间延迟或错误率增加。结果 - PET 在左侧（2 名患者）和双侧（7 名患者）观察到 IFG 激活。在 rTMS 干扰左侧 IFG 期间，所有患者都有积极的 TMS 效果，表明左侧 IFG 仍然至关重要。对右侧 IFG 的刺激对 2 名右侧 IFG 持续激活的患者产生了积极的 rTMS 效果。在最初的研究中，两名右侧 rTMS 效果良好的患者在随访中并未显示出这些效果。所有患者的语言表现均有所改善。结论——中风后失语症的成功再生似乎更多地取决于可用的语言相关大脑区域的整合，而不是在康复过程中招募新的大脑区域。左半球网络的恢复似乎更有效，尽管在某些情况下，右半球区域被成功整合。
Background and Purpose-Recently, a combined repetitive transcranial magnetic stimulation (rTMS) and activation positron emission tomography ( PET) study showed essential language function of the right inferior frontal gyrus (IFG) in some right-handed acute poststroke aphasics. We reexamined these patients in the chronic phase to test whether the right IFG remained essential for language performance.Methods-We reexamined 9 male right-handed patients, age 41 to 75 years, with aphasia 8 weeks after left hemispheric stroke. rTMS was performed over the maximum activation within the left and right IFG as defined by (15)[O] water PET to interfere with language function. A positive rTMS effect was defined as increased reaction time latency or error rate in the semantic task relative to no stimulation.Results-PET activations of the IFG were observed on the left (2 patients) and bilaterally (7). During rTMS interference over the left IFG, all patients had positive TMS effects, indicating that the left IFG remained essential. Stimulation over the right IFG yielded positive rTMS effects in 2 patients with persisting right IFG activation. Two patients with positive rTMS effects over the right side in the initial study did not show these effects at follow-up. Language performance improved in all patients.Conclusions-Successful regeneration from poststroke aphasia seems to depend more on the integration of available language-related brain regions than on recruiting new brain regions during the rehabilitation process. Restoration of the left hemisphere network seems to be more effective, although in some cases, right hemisphere areas are integrated successfully.