导航下重复经颅磁刺激治疗亚急性脑卒中后非流利性失语患者的有效性与安全性研究

周莹; 周明; 李世俊; 苏新玲; 耿雨涵; 周美齐; 黄丽萍

doi:10.12435/j.issn.2095-5227.2023.067

导航下重复经颅磁刺激治疗亚急性脑卒中后非流利性失语患者的有效性与安全性研究

Effectiveness and safety of neuronavigational repetitive transcranial magnetic stimulation in treatment of subacute stroke patients with non-fluent aphasia

摘要

摘要:
背景重复经颅磁刺激(repetitive transcranial magnetic stimulation，rTMS)是一项脑卒中后失语治疗的新技术，但存在定位不准确的问题。神经影像导航下重复经颅磁刺激已应用于临床，但对脑卒中后失语的临床疗效尚未见研究报道。
目的分析评价神经影像导航定位引导重复经颅磁刺激治疗亚急性脑卒中非流利性失语患者的安全性和有效性。
方法本研究为随机、双盲、前瞻性临床试验。选择2020年10月 - 2022年4月于解放军总医院第一医学中心康复医学科住院的脑卒中后非流利性失语患者，随机数字法分为导航rTMS组(neuronavigational rTMS，nTMS)和传统的国际10-20脑电系统定位组(conventional TMS，cTMS)，两组均行右半球额下回三角部(pars triangularis，PTr)低频rTMS治疗。在治疗前、治疗10 d后，通过不良事件评分量表评价治疗的安全性，以中文语失语症评分(aphasia battery of Chinese，ABC)评价和比较组内和组间的言语功能。
结果 nTMS组15例，rTMS组14例，两组性别、年龄、病程等一般资料差异无统计学意义(P＞0.05)。治疗过程中，无不良事件发生。治疗前，两组复述、命名、听理解、阅读等言语评分无统计学差异(P＞0.05)；治疗后，nTMS组自发言语、听理解、复述、命名、阅读、空间与结构、运用均较治疗前显著改善，差异有统计学意义(P＜0.05)，cTMS组听理解、命名、阅读均较治疗前显著改善，差异有统计学意义(P＜0.05)；组间比较，导航rTMS组复述、命名功能较传统定位组改善更显著，差异有统计学意义(P＜0.05)。
结论导航下右侧额下回三角部低频rTMS治疗相比传统定位组可更显著改善亚急性脑卒中后非流利性失语患者的命名、复述功能。

Abstract:
Background Repetitive transcranial magnetic stimulation (rTMS) is a novel technology for the treatment of post-stroke aphasia, but its inaccurate positioning affects the treatment effect. Recently, little research has been performed focusing on the clinical efficacy of neuronavigational rTMS in post-stroke aphasia.
Objective To analyze and evaluate the safety and efficacy of neuronavigational rTMS in the treatment of subacute post-stroke non-fluent aphasia.
Methods This study was a randomized, double-blind, prospective clinical trial. From October 2020 to April 2022, patients with post-stroke non-fluent aphasia who were hospitalized in the Rehabilitation Medicine Department of the First Medical Center of Chinese PLA General Hospital were selected and randomly divided into neuronavigationed rTMS group (nTMS, n=15) and conventional international 10-20 EEG system guided rTMS group (cTMS, n=14). The regimens of both groups were low-frequency rTMS targeting right hemisphere pars triangularis (PTr). Before treatment and after 10 days of treatment, the safety of treatment was assessed by the Adverse Event Scoring Scale, and the language function was evaluated by Aphasia Battery of Chinese (ABC) within and between the groups.
Results There were 15 cases in the nTMS group, and 14 cases in the cTMS group, and no significant differences existed between the two groups in general data such as gender, age, and onset (P＞0.05). No adverse events occurred during the treatment. Before treatment, there was no significant difference in speech scores between the two groups (P＞0.05). After treatment, the spontaneous speech, comprehension, repetition, naming, reading, space and structure, and application of the nTMS group were significantly improved compared with those before treatment (P＜0.05); the comprehension, naming, and reading of the cTMS group were significantly improved compared with those before treatment (P＜0.05). Compared with cTMS group, the nTMS group had more significant improvement in repetition and naming scores (P＜0.05).
Conclusion Compared with conventional rTMS treatment, the neuronavigational low-frequency rTMS of the right inferior frontal gyrus triangle can significantly improve the naming and repetition functions of patients with subacute post-stroke non-fluent aphasia.

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