经颅直流电刺激在失语症康复中的应用研究进展

Advance in Transcranial Direct Current Stimulation for Aphasic Rehabilitation(review)

经颅直流电刺激(tDCS)可以有效促进脑卒中后失语症的康复。基于失语症康复三种主要假说,将tDCS应用于失语症临床治疗时,需综合考虑失语症患者大脑左半球的损伤阶段、损伤部位和损伤程度。大脑左半球核心语言功能区未受严重损伤时,宜采用tDCS兴奋大脑左半球以增强病灶周围区兴奋性,使病灶周围区发挥代偿作用;或采用tDCS抑制大脑右半球,以削弱健侧半球对患侧半球的非正常化抑制。大脑左半球核心语言功能区严重损伤时,则宜采用tDCS兴奋大脑右半球,使得大脑右半球发挥代偿作用。此外,还需考虑脑区之间白质纤维束连接是否完整,若白质纤维束受损,tDCS的治疗效果会降低。通过兴奋或抑制大脑皮层的功能,tDCS可增强大脑皮层活动的功能连接,调节脑的神经加工,进而改善失语症患者的词汇检索障碍、发音障碍,提高他们的日常口头交际能力。tDCS的治疗效果具有长期性与普遍化,但仍需进一步探究。

Transcranial direct current stimulation(tDCS) was applied in rehabilitation of aphasia effectively. Based on the three hypotheses on aphasic rehabilitation, it is needed to consider the stage, location and the extent of brain damage in the left hemisphere of aphasia patients. If the core language functional areas are not damaged, tDCS can be used to either activate the left hemisphere to enhance the activity of perilesional areas, or to inhibit the right hemisphere to weaken the inhibitory effect from the right one. In contrast, if the core language functional areas are damaged, tDCS should be used to activate the right hemisphere to compensate the left core language functional areas impaired. The integrity of white matter fiber tracts also affects the efficacy of tDCS. By exciting or inhibiting the cortex, tDCS can enhance the cerebral connectivity, and mediate its neural processing, to improve word-retrieval deficit, articulatory disturbance and discourse skill in daily living. The benefit from tDCS may be long-term and generalizated, which needs more researches.