Excitatory repetitive transcranial magnetic stimulation induces improvements in chronic post-stroke aphasia.
Excitatory repetitive transcranial magnetic stimulation induces improvements in chronic post-stroke aphasia.
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DOI：
10.12659/msm.881446
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发表时间：
2011-02-25
期刊：
影响因子：
--
通讯作者：
Gilbert DL
中科院分区：
文献类型：
--
作者：
Szaflarski JP;Vannest J;Wu SW;DiFrancesco MW;Banks C;Gilbert DL
失语症影响1/3的中风患者，仅在其中一些患者中观察到改善。本探索性研究的目的是提供关于fMRI引导的兴奋性重复经颅磁刺激（rTMS）应用于残留左半球布罗卡区治疗慢性失语症的安全性和有效性的初步证据。我们招募了8例LMCA卒中后1年以上中度或重度失语症患者。语言电池管理前/后rTMS的语义决策/音调决策（SDTD）功能磁共振成像任务被用来定位左半球布罗卡区。RTMS方案包括10次每日治疗，每次200秒，使用称为间歇性θ爆发刺激（iTBS）的兴奋性刺激方案。弹簧圈放置分别针对左侧Broca’s。6/8例患者在rTMS前/后语义流畅性方面表现出显著改善（p=0.028）;当提示语义类别时，他们能够生成更合适的单词。前/后rTMS功能磁共振成像图显示左额颞顶叶语言网络的增加，左额叶（p=0.025），左颞顶叶（p=0.038）区域和全球语言LI（p=0.018）的左半球移位。患者倾向于报告沟通活动日志的主观改善（mini-CAL; p=0.075）。没有受试者报告rTMS的不良反应。FMRI引导的，兴奋性rTMS应用于受影响的布罗卡区改善慢性中风后失语症患者的语言技能，这些改善与增加语言偏侧到左半球。这种rTMS方案似乎是安全的，应该在盲法研究中进一步测试，评估其对卒中后失语症康复的短期和长期安全性/有效性。
Aphasia affects 1/3 of stroke patients with improvements noted only in some of them. The goal of this exploratory study was to provide preliminary evidence regarding safety and efficacy of fMRI-guided excitatory repetitive transcranial magnetic stimulation (rTMS) applied to the residual left-hemispheric Broca’s area for chronic aphasia treatment. We enrolled 8 patients with moderate or severe aphasia >1 year after LMCA stroke. Linguistic battery was administered pre-/post-rTMS; a semantic decision/tone decision (SDTD) fMRI task was used to localize left-hemispheric Broca’s area. RTMS protocol consisted of 10 daily treatments of 200 seconds each using an excitatory stimulation protocol called intermittent theta burst stimulation (iTBS). Coil placement was targeted individually to the left Broca’s. 6/8 patients showed significant pre-/post-rTMS improvements in semantic fluency (p=0.028); they were able to generate more appropriate words when prompted with a semantic category. Pre-/post-rTMS fMRI maps showed increases in left fronto-temporo-parietal language networks with a significant left-hemispheric shift in the left frontal (p=0.025), left temporo-parietal (p=0.038) regions and global language LI (p=0.018). Patients tended to report subjective improvement on Communicative Activities Log (mini-CAL; p=0.075). None of the subjects reported ill effects of rTMS. FMRI-guided, excitatory rTMS applied to the affected Broca’s area improved language skills in patients with chronic post-stroke aphasia; these improvements correlated with increased language lateralization to the left hemisphere. This rTMS protocol appears to be safe and should be further tested in blinded studies assessing its short- and long-term safety/efficacy for post-stroke aphasia rehabilitation.
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DOI：
10.1016/j.clinph.2009.08.016
发表时间：
2009-12
期刊：
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology
影响因子：
--
作者：
Rossi S;Hallett M;Rossini PM;Pascual-Leone A;Safety of TMS Consensus Group
通讯作者：
Safety of TMS Consensus Group
影响因子：
--
作者：
Cotelli, Maria;Manenti, Rosa;Miniussi, Carlo
通讯作者：
Miniussi, Carlo
影响因子：
14.5
作者：
Raja Beharelle, Anjali;Dick, Anthony Steven;Small, Steven L.
通讯作者：
Small, Steven L.
影响因子：
0.8
作者：
Finocchiaro, Chiara;Maimone, Mario;Fierro, Brigida
通讯作者：
Fierro, Brigida
影响因子：
4.2
作者：
Page SJ;Szaflarski JP;Eliassen JC;Pan H;Cramer SC
通讯作者：
Cramer SC