经颅直流电刺激对非流利型原发性进行性失语症语言功能的作用

Effects of transcranial direct current stimulation on language improvement in nonfluent primary progressive aphasia

目的:明确经颅直流电刺激(t DCS)对非流利型原发性进行性失语症(PPA)患者语言功能和皮质激活的作用。方法:采用A1-B1-A2-B2设计,对1例发病5年的非流利型原发性进行性失语症患者进行假刺激5d(A期),t DCS 5d治疗(B期),分别在假刺激、t DCS治疗前后对患者进行听觉词—图匹配、图命名、词朗读、三字词复述检查。阳极t DCS上午刺激左外侧裂后部周围区(PPR),下午刺激左Broca区,阴极位于阳极刺激部位对侧肩部,刺激强度1.1m A,每次20min。在A1前和B1、B2后进行脑电检查,计算非线性分析的近似熵。结果:阳极t DCS治疗前患者的词汇听理解、图命名、词朗读、词复述严重受损,B1期治疗后,患者的上述检查成绩显著提高(P<0.05),B2期治疗前后比较,未见明显变化,t DCS治疗后刺激区和非刺激区的近似熵指数显著增高。结论:应用阳极t DCS刺激左Broca区和PPR区可以在短期内(5d)较大幅度地提高该例非流利型原发性进行性失语症患者的词汇理解、图命名、词朗读、词复述功能。t DCS可能成为原发性进行性失语症的可选治疗手段。

Objective： To investigate the effect of transcranial direct current stimulation （tDCS） on language improvement and cortical activation in nonfluent primary progressive aphasia （PPA）. Method： An A1-B1-A2-B2 design was used in the study, Sham stimulation was administered in phase A for 5d, and anodal tDCS was implemented for 5d in phase B in a female patient with nonfluent PPA. Each day＇s tDCS included two sessions： anodal tDCS over left posterior perisylvian region （PPR） on the morning and left Broca area on the afternoon. The auditory word-picture identification, picture naming, word reading, and word repetition were measured with psycholinguistic assessment in Chinese aphasia （PACA） before and after each phase. The EEG nonlinear index of approximate entropy （ApEn） was calculated before phase A1, and after phases B1 and B2. Result： The patient exhibited severe impairments in auditory word-picture identification, picture naming, word reading, and word repetition before phase B treatment. The accuracy of four subtests improved significantly af- ter phase B1 （P〈0.05）. No significant difference was found in the comparison post-B2 vs. pre-B2. ApEn indi- ces increased in stimulated areas and non-stimulated areas.Conclusion： Significant improvement in word-auditory comprehension, word reading, ture naming can be achieved in short time （5d） with anodal tDCS over the left PPR fluent PPA. tDCS may provide an alternative therapeutic tool for PPA. word repetition and pic- and Broca＇s area in non-fluent PPA. tDCS may provide an alternative therapeutic tool for PPA.