Fields or flows? A comparative metaanalysis of transcranial magnetic and direct current stimulation to treat post-stroke aphasia.
Fields or flows? A comparative metaanalysis of transcranial magnetic and direct current stimulation to treat post-stroke aphasia.
复制标题
DOI：
10.3233/rnn-150616
复制
发表时间：
2016
影响因子：
2.8
通讯作者：
P. Shah-Basak;R. Wurzman;Juliann B. Purcell;Felix Gervits;R. Hamilton
中科院分区：
文献类型：
--
作者：
P. Shah-Basak;R. Wurzman;Juliann B. Purcell;Felix Gervits;R. Hamilton
失语症--获得性语言理解或表达能力的丧失--是中风的一种常见和使人衰弱的神经学后果。有证据表明，经颅磁刺激（TMS）或直流电刺激（tDCS）可以显着改善失语症（PWA）患者的语言结果。然而，TMS和tDCS之间的相对有效性尚未探索。机制和方法学差异、患者入选/排除标准和实验设计可能会影响观察到的治疗获益。方法：我们对TMS和tDCS治疗PWA的研究进行了系统回顾和荟萃分析。估计图片命名准确性变化的标准平均差（SMD）;使用随机效应模型比较汇总的SMD。结果8项TMS（N = 143）和8项tDCS（N = 140）研究符合纳入标准。合并SMD为0.448（p < 0.001），有利于TMS，有利于tDCS，0.395（p < 0.001）。受试者间设计在慢性患者的亚急性和内/交叉设计中更常见。TMS SMD在慢性（SMD = 0.348）和亚急性（SMD = 0.667）人群中均具有显著性，而tDCS SMD在慢性（SMD = 0.320）PWA中具有显著性，但在亚急性（SMD = 0.283）PWA中无显著性。结论：TMS和tDCS治疗PWA的疗效大小似乎一致。更大规模的临床试验将进一步证实我们的发现。
PURPOSE Aphasia-acquired loss of the ability to understand or express language-is a common and debilitating neurological consequence of stroke. Evidence suggests that transcranial magnetic (TMS) or direct current stimulation (tDCS) can significantly improve language outcomes in patients with aphasia (PWA). However, the relative efficacy between TMS and tDCS has not yet been explored. Mechanistic and methodological differences, patient inclusion/exclusion criteria and experimental designs may influence observed treatment benefits. METHODS We conducted a systematic review and meta-analyses of TMS and tDCS treatment studies in PWA. Standard mean difference (SMD) for changes in picture naming accuracy was estimated; pooled SMDs were compared using a random-effects model. RESULTS Eight TMS (N = 143) and 8 tDCS studies (N = 140) met our inclusion criteria. Pooled SMDs of 0.448 (p < 0.001) in favor of TMS, and 0.395 (p < 0.001) in favor of tDCS were found. Between-subject designs were more common in subacute and within/crossover designs in chronic patients. TMS SMDs were significant in both chronic (SMD = 0.348) and subacute (SMD = 0.667) populations while those for tDCS were significant in chronic (SMD = 0.320) but not in subacute (SMD = 0.283) PWA. CONCLUSIONS The magnitude of treatment effects appears to be consistent between TMS and tDCS in PWA. Larger-scale clinical trials should further substantiate our findings.