重复经颅磁刺激右侧半球对脑梗死失语康复的影响

目的 探讨低频重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)右侧半球对急性脑梗死失语患者语言功能恢复的影响.方法 40例急性左侧半球脑梗死伴失语的右利手患者,其中治疗组20例,对照组20例.两组患者年龄无显著差异,均接受常规药物治疗和适当的语言训练,治疗组在此基础上还在发病7 d后接受1个疗程低频rTMS对右侧大脑半球语言区的治疗,1次/d,为期10 d.两组患者分别在rTMS治疗前、治疗后和发病后90 d进行汉语失语检查表(Aphasia Battery in Chinese,ABC)评价其语言功能,应用美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)和Barthel指数(Barthel Index,BI)评价其整体神经功能和日常生活能力.结果 治疗组rTMS前和rTMS后ABC、NIHSS和BI评分均与对照组无显著差异;发病后90 d时治疗组ABC评分显著改善(P＜0.05),但NIHSS和BI与对照仍无显著差异.治疗组rTMS治疗前、后ABC评分有显著差异(P＜0.01),而NIHSS和BI评分均无显著差异,但发病后90 d时3项评分均较治疗前、后显著改善(P＜0.01).对照组治疗前、后3项评分均无显著差异,而发病后90 d时3项评分均较rTMS治疗前、后显著改善(P＜0.01).结论 早期低频rTMS右侧大脑半球有助于急性脑梗死失语患者的语言功能恢复.

Effect of repetitive transcranial magnetic stimulation of right hemisphere on the rehabilitation of aphasia after cerebral infarction

Objective To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) of right hemisphere on the rehabilitation of aphasia in patients with acute cerebral infarction. Methods Forty right-handed patients with acute cerebral infarction on the left hemisphere complicated with aphasia were randomly allocated into either a treatment group (n=20) or a control group (n=20). There was no significant difference in the ages between the patients in both groups. They all received routine drug treatment and appropriate language training. The patients in the treatment group also received a course of low frequency rTMS at language area of right hemisphere 7 days after the symptom onset, once a day for 10 days. Their language function was evaluated by the Aphasia Battery in Chinese (ABC) before and after the treatment, and at day 90 after the onset. The National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) were used to evaluate their overall neurological function and activities of daily living. Results There were no significant differences in the ABC, NIHSS and BI scores between the control group and the treatment group before and after rTMS; at day 90 after the onset, the ABC scores were improved significantly in the treatment group (P＜ 0.05), however, there was still no significant difference between the NIHSS and BI scores.There were significant differences between the ABC scores before and after the rTMS in the treatment group (P＜0.01), and there was no significant difference between the NIHSS and ABC scores, however, the 3 scores were improved more significantly than those before and after the treatment at day 90 after the onset (P ＜0.01). There were no significant difference in the 3 scores before and after the treatment in the control group, and at day 90 after the onset the 3 scores were improved more significantly than those before and after rTMS (P＜0.01).Conclusions The early low-frequency rTMS of the right hemisphere contributes to the rehabilitation of language function in patients with acute cerebral infarction complicated with aphasia.