The use of non-invasive brain stimulation techniques to facilitate recovery from post-stroke aphasia.
The use of non-invasive brain stimulation techniques to facilitate recovery from post-stroke aphasia.
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DOI：
10.1007/s11065-011-9181-y
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发表时间：
2011-09
影响因子：
5.8
通讯作者：
Wan, Catherine Y.
中科院分区：
文献类型：
--
作者：
Schlaug, Gottfried;Marchina, Sarah;Wan, Catherine Y.
关键词：
失语症是左半球中风后的常见症状。过去10-15年的神经影像学技术描述了两个总的趋势：左半球小卒中患者倾向于招募病灶周围区域，而左半球大病变患者主要招募右半球的同源区域。非侵入性脑刺激技术，如经颅磁刺激（TMS）和经颅直流电刺激（tDCS），已被用来促进通过刺激病变和对侧病变区域的恢复。这些脑刺激研究中的大多数都试图阻断右后额下回（IFG）中的同伦区域，以影响假定的去抑制右IFG（三角形部分）。其他研究使用阳极或兴奋性tDCS刺激对侧病灶（右侧）额颞区或完整的左侧IFG和病灶周围区域的部分，以改善语言运动输出。目前还不清楚作为运动皮层刺激研究基础的大脑半球间去抑制模型是否也适用于语言系统。未来的研究可以解决一些问题，包括：病变位置对电流密度分布的影响，干预中风发作的时间，脑刺激是否应该与行为治疗相结合，以及是否应该刺激多个大脑部位。更好地了解自然结局研究中恢复的预测因素也将有助于为研究设计提供信息，并在未来的研究中选择有临床意义的结局指标。
Aphasia is a common symptom after left hemispheric stroke. Neuroimaging techniques over the last 10–15 years have described two general trends: Patients with small left hemisphere strokes tend to recruit perilesional areas, while patients with large left hemisphere lesions recruit mainly homotopic regions in the right hemisphere. Non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) have been employed to facilitate recovery by stimulating lesional and contralesional regions. The majority of these brain stimulation studies have attempted to block homotopic regions in the right posterior inferior frontal gyrus (IFG) to affect a presumed disinhibited right IFG (triangular portion). Other studies have used anodal or excitatory tDCS to stimulate the contralesional (right) fronto-temporal region or parts of the intact left IFG and perilesional regions to improve speech-motor output. It remains unclear whether the interhemispheric disinhibition model, which is the basis for motor cortex stimulation studies, also applies to the language system. Future studies could address a number of issues, including: the effect of lesion location on current density distribution, timing of the intervention with regard to stroke onset, whether brain stimulation should be combined with behavioral therapy, and whether multiple brain sites should be stimulated. A better understanding of the predictors of recovery from natural outcome studies would also help to inform study design, and the selection of clinically meaningful outcome measures in future studies.
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