不同频率重复经颅磁刺激对脑卒中后非流畅性失语的影响及其血氧水平依赖-功能性磁共振成像的表现  

The effects of transcranial magnetic stimulations on non-fluent aphasia following stroke

作　　者：胡雪艳[1,2] 张通[1,2] 刘丽旭[1,2] 毕晓辉[1,2] 裴倩[2] 

机构地区：[1]中国康复研究中心北京博爱医院神经康复一科,北京100068 [2]首都医科大学康复医学院

出　　处：《中华物理医学与康复杂志》2014年第8期587-591,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：国家自然科学基金（81171243）,财政部课题（2011CZ-3）

摘　　要：目的探讨不同频率（10Hz、1Hz）重复经颅磁刺激（rTMS）刺激右侧大脑半球Broca区镜像区对脑卒中后非流畅性失语患者语言功能恢复的影响及其作用机制。方法对2例脑卒中后非流畅性失语患者分别进行低频rTMS治疗（1Hz）和高频rTMS治疗（10Hz），2例患者均于治疗前和治疗2周后（治疗后）行西方失语症成套检查量表（WAB）测试及fMRI检查。结果治疗后，2例患者的语言功能均治疗前均明显改善，病例1的AQ评分由治疗前37．2分提升至66．6分，病例2的AQ评分由36．2分提升至60．8分。治疗前，病例1词汇朗读任务主要激活脑区有左侧中央前回，左侧额中回，此外左侧的枕叶下部也有少量激活；治疗后，词汇朗读任务主要激活脑区有左侧额叶内侧面，左侧额下回，左侧额前区，左侧岛叶前部，左侧顶下小叶，左侧颞叶中下回前中部。治疗前，病例2词汇朗读任务主要激活脑区有双侧颞叶内侧面，双侧中央前回；治疗后，词汇朗读任务主要激活脑区有双侧额中回和额叶内侧面，右侧额下回，左侧额前区，双侧顶上小叶，右侧颞上、中回。结论rTMS治疗可显著改善脑卒中后非流畅性失语患者的语言功能，左侧半球语言区病灶较小的患者可能发生同侧半球功能重组，左侧半球病灶语言区较大的患者则可能发生双侧半球功能重组。Objective To explore the effects and mechanism of repetitive transcranial magnetic stimulation （rTMS） applied to the right Broca＇s homologue of stroke patients with non-fluent aphasia. Methods One stroke patient with non-fluent aphasia received rTMS at 1 Hz and another received the same treatment at 10 Hz. The western aphasia battery （WAB） and functional magnetic resonance imaging （fMRI） were used to evaluate their language function before and after the intervention. Results After treatment, language function in both patients had improved significantly. The aphasia quotient （AQ） score of patient 1 had improved from 37.2 to 66.6, and the AQ score of patient 2 had improved from 36.2 to 60.8. Before treatment, patient 1 ＇s activated brain areas during a vo- cabulary reading task were the left anterior central gyrus and the left gyrus frontalis medius. After the 1 Hz rTMS treatment the activated brain areas were the left medial surface of the lobus frontalis, the left gyrus frontalis inferior, the left prefrontal area, the left preinsula, the left lobulus parietalis inferior, and the left middle/inferior temporal gyrus. Before the 10 Hz rTMS treatment, patient 2＇s activated brain areas with the same vocabulary reading task were the bilateral medial surface of the temporal lobe, and the bilateral anterior central gyrus. After treatment the bilateral medial surface gyrus, the frontalis medius and lobus frontalis, the right gyrus frontalis inferior, the left prefrontal area, the bilateral lobulus parietalis superior, and the right superior/middle temporal gyrus were activated. Conclusion rTMS can significantly improve language function in stroke patients with non-fluent aphasia. Patients with smaller lesions in the left hemisphere language area can achieve hemisphere function restructuring. Larger lesions in the left hemisphere language area will probably yield bilateral restructuring in both hemispheres .

关 键 词：脑卒中 重复经颅磁刺激 非流畅性失语 康复 功能磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]