不同频率重复经颅磁刺激治疗Wernicke失语患者的个案报告

A Case Report of Repeated Transcranial Magnetic Stimulation at Different Frequencies in the Treatment of Wernicke’s Aphasia

目的探讨不同频率重复经颅磁刺激对脑卒中后早期Wernicke失语患者的影响。比较低频及高频rTMS对Wernicke失语症患者早期自发言语、命名、复述及听理解能力的影响。方法对2例脑卒中后颞上回损伤1月余的感觉性失语(Wernicke失语)患者进行常规针对性语言训练结合经颅磁刺激治疗。经颅磁刺激治疗采用"A-B-A-B"实验设计,A方案:刺激部位L-Wernicke区,10Hz,1200个;B方案:刺激部位R-Wernicke区,1Hz,1200个。A-B方案之间有2天洗脱期。每周治疗后通过自然交谈、西方失语成套测验(western aphasia battery,WAB)进行随访,记录患者AQ值及评估过程中的语音资料。治疗前后通过蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)评估患者认知功能。结果2例患者WAB中自发言语、听理解、复述、命名能力均有显著改善,AQ值提升明显。第1周治疗后,各项分值提高最多。治疗4周后,2例患者MOCA值显著提高。通过语音记录前后对比,2例患者答非所问、无目标词滔滔不绝表达的现象均明显减少,实质词表达增加,家属反应听理解和自主表达改善明显。结论对早期重度感觉性失语患者进行有针对性的常规语言训练结合rTMS治疗可显著改善患者的自发言语、命名、听理解、复述以及认知功能。

Objective To investigate the effect of repetitive transcranial magnetic stimulation(TMS)with different frequencies on early Wernicke’s aphasia after stroke,and to compare the effects of low frequency and high frequency rTMS on spontaneous speech,naming,paraphasia and listening comprehension in patients with Wernicke’s aphasia.Method Two patients with Wernicke’s aphasia after stroke received routine targeted language training combined with transcranial magnetic stimulation(TMS)about 1 month after stroke.Transcranial magnetic stimulation(TMS)was performed with A-B-A-B experimental design(Protocol A:stimulation site at L-Wernicke area,10 Hz,1200;B protocol:stimulation site at R-Wernicke area,1 Hz,1200).After weekly treatment,the patients were followed up by natural conversation and Western Aphasia Battery(WAB),and voice data were recorded.Cognitive function was assessed with the Montreal Cognitive Assessment Scale(MOCA)at 0 and 4 weeks.Results After weekly treatment,the spontaneous speech,listening comprehension,repetition and naming ability of WAB in 2 patients were significantly improved,and the AQ was significantly increased.After the first week of treatment,the scores increased most.After 4 weeks of treatment,the MOCA of 2 patients were also significantly increased.The expression of parenchymatous words increased,and the improvement of listening comprehension and autonomous expression was obvious.Conclusion Targeted language training combined with rTMS can significantly improve the spontaneous speech,naming,listening comprehension,retelling and cognitive function of early Wernicke’s aphasia patients.