应用定量脑电图探讨低频重复经颅磁刺激干预亚急性期运动性失语症机制的研究

关键词：重复经颅磁刺激  运动性失语  定量脑电图  西方失语成套测验

Keywords:repetitive transcranial magnetic stimulation  motor aphasia  quantitative electroencephalogram  Western Aphasia Battery

摘要：

      摘要 目的：通过观察定量脑电图(QEEG)在低频重复经颅磁刺激(rTMS)干预亚急性期运动性失语患者前后的变化，进一步探讨其机制。 方法：将30例脑卒中后亚急性期运动性失语患者随机分为rTMS组与假刺激组各15例。两组患者均给予常规药物治疗及言语训练，rTMS组在右侧大脑半球Broca镜像区给予低频rTMS治疗，连续治疗3周。最终两组各脱落2例。于治疗前和治疗3周后(治疗后)行定量脑电图检查，比较各个频段上(δ+θ)/(α+β)值的差异，并采用西方失语成套测验(WAB)评定治疗前后的言语功能。 结果：治疗后，两组患者在FP1、F3、F7、T3、C3频段(δ+θ)/(α+β)值下降，差异有显著性意义(P＜0.01)；rTMS组在F3频段(δ+θ)/(α+β)值下降较假刺激组明显，差异有显著性意义(P＜0.01)；rTMS组治疗前后自发言语、复述、命名以及失语商(AQ)分的差值较假刺激组大，差异有显著性意义(P＜0.05)；相关分析显示rTMS组在FP1、F3、F7、T3、C3频段上，治疗前后的(δ+θ)/(α+β)差值与AQ差值呈负相关，差异有显著性意义(P＜0.05)。 结论：低频rTMS刺激右侧大脑半球Broca镜像区能改善亚急性期运动性失语患者的言语功能，定量脑电图的变化提示了低频rTMS能促进左侧大脑皮质神经电活动变化。

Abstract:

      Abstract Objective:To observe the variety of quantitative electroencephalogram(QEEG) in the treatment of subacute motor aphasia with low frequency repetitive transcranial magnetic stimulation(rTMS),and explore its mechanism. Method:Sixty stroke patients displaying motor aphasia were randomly divided into two groups, an rTMS group and a sham stimulation group, with 30 cases in each group．Both groups were treated with conventional drug therapy and language therapy. In addition, patients of the rTMS group were additionally given low frequency rTMS over the Broca's homologues of the unaffected for 3 weeks．Two patients of each group finally fell off. Before and after 3 weeks of treatment, (δ+θ)/(α+β)scores were compared for both groups，and the Western Aphasia Battery(WAB) was conducted to evaluate their language function. Result:After treatment, all the (δ+θ)/(α+β)scores over FP1,F3,F7,T3,C3 regions decreased in both groups(P＜0.01). Moreover, the (δ+θ)/(α+β)scores over F3 region in the rTMS group were decreased much more than those in the sham stimulation group(P＜0.01)．In the rTMS group, the decreased scores of spontaneous speech, repetition, nomenclature and aphasia quotient(AQ) were more bigger(P＜0.05)，and the decreased scores of (δ+θ)/(α+β) over FP1,F3,F7,T3,C3 regions were negatively correlated with those of AQ(P＜0.05). Conclusion:It is improved that the speech function of subacute motor aphasia patients with low frequency rTMS stimulation in the right cerebral hemisphere Broca mirror area, and the changes of QEEG suggest that low frequency rTMS can promote the left cerebral cortex electrical activity changes.