经颅直流电刺激对失写症书写功能的影响

Effect of transcranial direct current stimulation on writing function of dysgraphia

目的:观察经颅直流电刺激(tDCS)对失写症书写功能的影响,为tDCS治疗失写症提供依据。方法:对1例左顶叶梗死后(7个月)Gerstmann(综合征)失写症患者进行10次书写训练和10次书写训练加tDCS治疗。tDCS阳极刺激部位为左侧顶叶(国际脑电图10—20系统电极放置法,P3导联位置),阴极放置于对侧肩部;每日一次,每次20min。治疗前后应用汉语失语证心理语言评价对患者进行语言功能检查。结果:书写训练前语言评价显示患者的字形输出词典和字形输出缓冲模块受损。单纯书写训练前后,患者的听写、看图书写、自发书写的正确率无明显改变。书写训练加tDCS治疗后,患者的听写、看图书写、自发书写的正确率显著改善(P<0.05);书写错误,如部件替代、遗漏,笔画遗漏和无反应明显减少(P<0.05),延迟抄写接近正常。结论:tDCS阳极刺激左侧顶叶可以提高Gerstmann综合征失写患者的书写能力,即改善患者的字形输出词典和字形输出缓冲的功能。tDCS为失写症的康复提供了一种新的治疗技术。

Objective：To investigate the effect of transcranial direct current stimulation（tDCS）on writing function of dysgraphia,in order to provide evidence for treatment of dysgraphia.Method：A stroke patient with Gerstmann syndrome presenting dysgraphia 7 months after parietal infarction was treated with writing training for 10 sessions and writing training combined with tDCS for another 10 sessions.The anodal tDCS was placed over left P3（International EEG 10—20 system）,the cathodal tDCS placed over right shoulder;once per day,20 min each session.Language evaluations were implemented before and after each treatment session using Psycholinguistic Assessment in Chinese Aphasia.Result：The language assessment before writing training showed impairment in orthographic output lexicon and orthographic output buffer.There was no significant change in dictation,writing names of pictures and spontaneous writing after writing training.The accuracy of dictation,writing names of pictures and spontaneous writing improved significantly after writing training with tDCS（P0.05）.Writing errors such as substitution and omission of Chinese character components and stroke omission reduced significantly（P0.05）,Chinese character delayed-copy almost recovered to normal.Conclusion：Anodal tDCS over left parietal lobe can improve writing ability in dysgraphic patient with Gerstmann syndrome,and repair the orthographic output lexicon and the orthographic output buffer.tDCS may provide a new technique for dysgraphia rehabilitation.