非侵入性脑刺激技术对复述功能正常的卒中后非流利性失语症患者视图命名能力的疗效对比分析

Efficacy comparison of noninvasive brain stimulation techniques on picture naming ability of non-fluent aphasia patients after stroke with normal expression capacity

目的对比分析经颅磁刺激(TMS)和经颅直流电刺激(tDCS)对左半球额叶损伤的失语症患者视图命名能力的疗效。方法回顾性连续纳入2018年6月至2020年8月在首都医科大学宣武医院康复医学科进行康复治疗的左半球额叶损伤卒中后(1~6个月)非流利性失语症患者30例,复述功能正常。根据康复治疗方案的不同,将30例患者分为对照组、tDCS组和TMS组,每组各10例。对照组患者仅接受言语语言治疗(视图命名训练),训练内容包括评价图片中的治疗项图片,不训练非治疗项图片;训练30 min/次,2次/d,共训练2周。TMS组和tDCS组在言语语言治疗的基础上,分别给予间歇性θ节律刺激(iTBS)和阳极tDCS治疗。分别于治疗前及治疗2周后进行视图命名能力评估,评估内容包括治疗项视图命名和非治疗项视图命名。结果(1)3组接受不同言语康复治疗患者的性别、年龄、病程、受教育年限、听理解能力、卒中类型的差异均无统计学意义(均P>0.05)。(2)3组患者治疗前后治疗项命名得分的差异具有统计学意义(F=316.981,P<0.01),其中治疗前3组患者治疗项命名得分的差异无统计学意义[对照组:(8.6±3.3)分,tDCS组:(7.8±2.4)分,TMS组:(8.2±3.1)分;P>0.05];治疗2周后,TMS组[(14.2±2.3)分]和tDCS组[(17.5±2.8)分]得分高于对照组[(11.2±2.9)分],tDCS组得分高于TMS组(均P<0.05)。对照组、tDCS组和TMS组患者治疗后命名得分均较本组治疗前增加,差异均有统计学意义(对照组:t=6.614,tDCS组:t=4.651,TMS组:t=3.279,均P<0.05)。(3)3组患者治疗前后非治疗项命名得分的差异有统计学意义(F=64.512,P<0.05),其中3组患者治疗前非治疗项命名得分的差异无统计学意义[对照组:(7.6±3.2)分,tDCS组:(6.9±2.6)分,TMS组:(7.9±3.1)分;P>0.05];治疗后tDCS组得分[(11.6±2.4)分]高于对照组[(8.5±2.3)分]和TMS组[(8.5±2.8)分],差异均有统计学意义(均P<0.05)。治疗2周后,tDCS组较治疗前的差异具有统计学意义(t=9.029,P<0.01),对照组和TMS组与本组治疗前得分的差异均无统计学意义(均P>0.05)。结论对TMS和tDCS应用于左半球额叶损伤的失语症患者视图命名疗效的初步分析结果显示,tDCS治疗左侧额叶损伤的失语症患者视图命名效果可能优于TMS,更适合卒中后失语症康复治疗的临床应用。

Objective To compare the effect of transcranial magnetic stimulation(TMS)and transcranial direct current stimulation(tDCS)on picture naming in patients with left frontal lobe injury related aphasia.Methods From June 2018 to August 2020,30 stroke patients with non-fluent aphasia due to left frontal lobe injury(1-6 months)and received rehabilitation treatment in the Department of Rehabilitation Medicine of Xuanwu Hospital,Capital Medical University were recruited.Patients had normal expression capacity and were divided into control group,tDCS group and TMS group according to rehabilitation therapy,with 10 patients in each group.Patients in control group only received language therapy(picture naming training).The training contents included evaluating treatment items in the pictures,but not non-treatment items.Frequency of training was 30 min/time and 2 times/d for 2 weeks.On the basis of language therapy,patients in TMS group and tDCS group were given intermittentθrhythm stimulation(iTBS)and anodic tDCS respectively.Picture naming assessment was conducted before treatment and 2 weeks after treatment regarding both treatment and non-treatment items.Results(1)There was no significant difference in gender,age,course of disease,years of education,listening and understanding capacity,and stroke type among the three groups(all P>0.05).(2)Naming scores of treatment items before and after treatment among three groups were statistically significant(F=316.981,P<0.01).Before treatment,there was no statistical significance in the naming scores of treatment items among the three groups(control group:[8.6±3.3 points],tDCS group:[7.8±2.4 points],TMS group:[8.2±3.1 points];P>0.05).After 2 weeks of treatment,the scores of TMS group(14.2±2.3 points)and tDCS group(17.5±2.8 points)were higher than those of control group(11.2±2.9 points),and the scores of tDCS group were higher than those of TMS group(all P<0.05).Naming scores in the three groups all increased after treatment compared those before treatment,with statistical significance(control group:t=6.614,tDCS group:t=4.651,TMS group:t=3.279;all P<0.05).(3)There were statistically significant differences in naming scores of non-treatment items before and after treatment in the three groups(F=64.512,P<0.05).There was no statistically significant difference in naming scores of non-treatment items among the three groups before treatment(control group:[7.6±3.2 points],tDCS group:[6.9±2.6 points],TMS group:[7.9±3.1 points];P>0.05).After treatment,scores of tDCS group(11.6±2.4 points)were higher than those of control group(8.5±2.3 points)and TMS group(8.5±2.8 points),with statistically significant difference(both P<0.05).After 2 weeks of treatment,there was a statistically significant difference in naming scores between before treatment and after treatment in tDCS group(t=9.029,P<0.01);while there was no statistically significant difference in control group and TMS group(both P>0.05).Conclusion Preliminary analysis of the efficacy of TMS and tDCS in improving picture naming capacity of aphasia patients with left frontal lobe injury showed that tDCS may have better therapeutic effect than TMS and is more suitable for clinical application in aphasia rehabilitation after stroke.