低频和高频重复经颅磁刺激对脑卒中后非流畅性失语的影响

Effect of low frequency or high frequency repetitive transcranial magnetic stimulation on stroke patients with nonfluent aphasia

目的观察低频和高频重复经颅磁刺激(rTMS)刺激右侧大脑半球Broca区镜像区对脑卒中后非流畅性失语患者语言功能恢复的效果。方法2019年1月至2022年8月,北京博爱医院住院治疗的脑卒中后非流畅性失语症患者80例,随机分为对照组(n=20)、假刺激组(n=20)、低频组(n=20)和高频组(n=20)。所有患者均接受常规语言训练,在此基础上,后两组分别采用1 Hz和10 Hz rTMS刺激右侧大脑半球Broca区镜像区,假手术组接受假刺激,每天1次,每周5 d,共2周。治疗前、治疗结束时和治疗结束2个月后,分别采用中文版西方失语症成套检验(WAB)进行语言评估。结果治疗前,4组WAB各项评分比较无显著性差异(P>0.05)。治疗结束时和治疗结束2个月,4组WAB测试各项评分均改善(P<0.05)。与治疗结束时比较,治疗结束2个月低频组自发言语、听理解、复述、命名和失语商(AQ)均改善(P<0.05),高频组复述、命名和AQ改善(P<0.05)。治疗结束时,低频组自发言语、听理解、AQ评分高于高频组(P<0.05)。治疗结束2个月,低频组自发言语评分高于高频组(P<0.05)。结论1 Hz和10 Hz rTMS均可以改善脑卒中后非流畅性失语患者语言功能,1 Hz rTMS疗效更好。

Objective To explore the effect of low frequency or high frequency repetitive transcranial magnetic stimulation(rTMS)on right Broca's homologue in stroke patients with nonfluent aphasia.Methods From January,2019 to August,2022,80 inpatients in Beijing Bo'ai Hospital were randomly divided into control group(n=20),sham stimulation group(n=20),low-frequency(1 Hz)rTMS(LF-rTMS)group(n=20)and high-frequency(10 Hz)rTMS(HF-rTMS)group(n=20).All the patients received routine language therapy.LFrTMS group and HF-rTMS group received ten days of rTMS(1 Hz or 10 Hz),and the sham group received ten days of sham rTMS.The Western Aphasia Battery(WAB)was used to evaluate the language function before,after treatment,and two months after treatment.Results Before treatment,there was no significant difference in the scores of WAB among four groups(P>0.05).All the scores improved in the four groups immediately after treatment and two months after treatment(P<0.05).Compared with immediately after treatment,all the scores of WAB improved in LF-rTMS group(P<0.05),and the scores of recall,name and aphasia quotient(AQ)improved in HF-rTMS group(P<0.05)two months after treatment.Immediately after treatment,the scores of content and fluency,auditory comprehension and AQ were higher in LF-rTMS group than in HF-rTMS group(P<0.05).Two months after treatment,the scores of content and fluency were higher in LF-rTMS group than in HF-rTMS group(P<0.05).Conclusion Both 1 Hz and 10 Hz rTMS could improve the language function of stroke patients with nonfluent aphasia,especially 1 Hz.