Effect of high-frequency repetitive transcranial magnetic stimulation to contralesional hemisphere on global aphasia patients after left massive cerebral infarction_West China Medical Journal

Authors：

GAO Fei ^1,2 , ZHANG Yuge ^1,2 , MA Lin ^1,2 , CHEN Yudong ^1,2 , LIU Lixu ^1,2 ,  HU Xueyan ^1,2

1. Department of Neurorehabilitation, China Rehabilitation Research Center, Beijing 100068, P. R. China;
2. School of Rehabilitation Medicine, Capital Medical University, Beijing 100068, P. R. China;

Corresponding author：

HU Xueyan, Email: crrcrehab@163.com

Keywords：

Rehabilitation; repetitive transcranial magnetic stimulation; global aphasia

DOI：

10.7507/1002-0179.202403117

Video：

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Objective To observe the efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) applied at contralesional hemisphere Broca’s homologue on patients with global aphasia after left massive cerebral infarction. Methods Patients with global aphasia after left massive cerebral infarction in the Department of Neurorehabilitation of China Rehabilitation Research Center between August 2021 and December 2023 were selected. According to the random number table method, patients were randomly divided into a low-frequency rTMS group and a high-frequency rTMS group. rTMS targeted the mirror area within the right hemispheric Broca’s area. Patients’ language ability was assessed pre- and post-treatment by the Chinese version of the western aphasia battery (WAB). Results A total of 27 patients were included, with 14 in the low-frequency rTMS group and 13 in the high-frequency rTMS group. Before treatment, there was no statistically significant difference in the WAB test indicators between the two groups of patients (P>0.05). After treatment, WAB scores (spontaneous speech, auditory comprehension, naming, repetition, aphasia quotients) in both groups were significantly improved (P<0.05); compared to the low-frequency rTMS group, the high-frequency rTMS group exhibited significant improvement in spontaneous speech, auditory comprehension, repetition, naming and aphasia quotients (P<0.05). Conclusion The effect of high-frequency rTMS excitation to contralesional hemisphere is better than that of conventional low-frequency rTMS inhibition to contralesional hemisphere in improving the speech function of patients with global aphasia after left massive cerebral infarction.

Citation： GAO Fei, ZHANG Yuge, MA Lin, CHEN Yudong, LIU Lixu, HU Xueyan. Effect of high-frequency repetitive transcranial magnetic stimulation to contralesional hemisphere on global aphasia patients after left massive cerebral infarction. West China Medical Journal, 2024, 39(10): 1625-1630. doi: 10.7507/1002-0179.202403117 Copy

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15.	周莹, 周明, 李世俊, 等. 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. 解放军医学院学报, 2023, 44(8): 839-844.
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19.	Wang Q, Zhang D, Zhao YY, et al. Effects of high-frequency repetitive transcranial magnetic stimulation over the contralesional motor cortex on motor recovery in severe hemiplegic stroke: a randomized clinical trial. Brain Stimul, 2020, 13(4): 979-986.
20.	Harrington RM, Chan E, Rounds AK, et al. Roles of lesioned and nonlesioned hemispheres in reaching performance poststroke. Neurorehabil Neural Repair, 2020, 34(1): 61-71.
21.	胡雪艳, 江晓峰, 山磊, 等. 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. 中国康复理论与实践, 2023, 29(3): 249-255.
22.	胡雪艳, 张通, 刘丽旭, 等. 不同频率重复经颅磁刺激对脑卒中后非流畅性失语的影响及其血氧水平依赖-功能性磁共振成像的表现. 中华物理医学与康复杂志, 2014, 36(8): 586-591.
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24.	胡雪艳, 张通, 刘丽旭, 等. 低频重复经颅磁刺激对卒中后非流畅性失语的影响. 中华神经科杂志, 2012, 45(10): 715-717.
25.	Anglade C, Thiel A, Ansaldo AI. The complementary role of the cerebral hemispheres in recovery from aphasia after stroke: a critical review of literature. Brain Inj, 2014, 28(2): 138-145.
26.	Cornelissen K, Laine M, Tarkiainen A, et al. Adult brain plasticity elicited by anomia treatment. J Cogn Neurosci, 2003, 15(3): 444-461.
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28.	Hartwigsen G, Saur D. Neuroimaging of stroke recovery from aphasia - insights into plasticity of the human language network. Neuroimage, 2019, 190(4): 14-31.
29.	Turkeltaub PE, Messing S, Norise C, et al. Are networks for residual language function and recovery consistent across aphasic patients. Neurology, 2011, 76(20): 1726-1734.

1. 王陇德, 吉训明, 康德智, 等. 《中国卒中中心报告 2020》概要. 中国脑血管病杂志, 2021, 18(11): 737-743.
2. Bernhardt J, Godecke E, Johnson L, et al. Early rehabilitation after stroke. Curr Opin Neurol, 2017, 30(1): 48-54.
3. Roth GA, Mensah GA, Johnson CO, et al. Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study. J Am Coll Cardiol, 2020, 76(25): 2982-3021.
4. Sekhon JK, Oates J, Kneebone I, et al. Counselling training for speech-language therapists working with people affected by post-stroke aphasia: a systematic review. Int J Lang Commun Disord, 2019, 54(3): 321-346.
5. Lefaucheur JP, Aleman A, Baeken C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014-2018). Clin Neurophysiol, 2020, 131(2): 474-528.
6. Williams EER, Sghirripa S, Rogasch NC, et al. Non-invasive brain stimulation in the treatment of post-stroke aphasia: a scoping review. Disabil Rehabil, 2024, 46(17): 3802-3826.
7. Santhanam P, Duncan ES, Small SL. Therapy-induced plasticity in chronic aphasia is associated with behavioral improvement and time since stroke. Brain Connect, 2018, 8(3): 179-188.
8. Wilson SM, Eriksson DK, Yen M, et al. Language mapping in aphasia. J Speech Lang Hear Res, 2019, 62(11): 3937-3946.
9. Arheix-Parras S, Barrios C, Python G, et al. A systematic review of repetitive transcranial magnetic stimulation in aphasia rehabilitation: leads for future studies. Neurosci Biobehav Rev, 2021, 127: 212-241.
10. Saxena S, Hillis AE. An update on medications and noninvasive brain stimulation to augment language rehabilitation in post-stroke aphasia. Expert Rev Neurother, 2017, 17(11): 1091-1107.
11. 中华医学会神经病学分会神经康复学组. 卒中后失语临床管理专家共识. 中国康复理论与实践, 2022, 28(1): 15-23.
12. Torbey MT, Bösel J, Rhoney DH, et al. Evidence-based guidelines for the management of large hemispheric infarction: a statement for health care professionals from the neurocritical care society and the German society for neuro-intensive care and emergency medicine. Neurocrit Care, 2015, 22(1): 146-164.
13. 中国医师协会神经调控专业委员会电休克与神经刺激学组. 重复经颅磁刺激治疗专家共识. 转化医学杂志, 2018, 7(1): 4-9.
14. O’Brien AT, Bertolucci F, Torrealba-Acosta G, et al. Non-invasive brain stimulation for fine motor improvement after stroke: a meta-analysis. Eur J Neurol, 2018, 25(8): 1017-1026.
15. 周莹, 周明, 李世俊, 等. 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. 解放军医学院学报, 2023, 44(8): 839-844.
16. Kesikburun S. Non-invasive brain stimulation in rehabilitation. Turk J Phys Med Rehabil, 2022, 68(1): 1-8.
17. Di Pino G, Pellegrino G, Assenza G, et al. Modulation of brain plasticity in stroke: a novel model for neurorehabilitation. Nat Rev Neurol, 2014, 10(10): 597-608.
18. 陈松美, 周芷晴, 徐曙天, 等. 非受累侧半球高频经颅磁刺激改善脑卒中后中重度上肢偏瘫的作用及运动皮质重组特征分析. 中国康复医学杂志, 2023, 38(2): 167-173.
19. Wang Q, Zhang D, Zhao YY, et al. Effects of high-frequency repetitive transcranial magnetic stimulation over the contralesional motor cortex on motor recovery in severe hemiplegic stroke: a randomized clinical trial. Brain Stimul, 2020, 13(4): 979-986.
20. Harrington RM, Chan E, Rounds AK, et al. Roles of lesioned and nonlesioned hemispheres in reaching performance poststroke. Neurorehabil Neural Repair, 2020, 34(1): 61-71.
21. 胡雪艳, 江晓峰, 山磊, 等. 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. 中国康复理论与实践, 2023, 29(3): 249-255.
22. 胡雪艳, 张通, 刘丽旭, 等. 不同频率重复经颅磁刺激对脑卒中后非流畅性失语的影响及其血氧水平依赖-功能性磁共振成像的表现. 中华物理医学与康复杂志, 2014, 36(8): 586-591.
23. Hu XY, Zhang T, Rajah GB, et al. Effects of different frequencies of repetitive transcranial magnetic stimulation in stroke patients with non-fluent aphasia: a randomized, sham-controlled study. Neurol Res, 2018, 40(6): 459-465.
24. 胡雪艳, 张通, 刘丽旭, 等. 低频重复经颅磁刺激对卒中后非流畅性失语的影响. 中华神经科杂志, 2012, 45(10): 715-717.
25. Anglade C, Thiel A, Ansaldo AI. The complementary role of the cerebral hemispheres in recovery from aphasia after stroke: a critical review of literature. Brain Inj, 2014, 28(2): 138-145.
26. Cornelissen K, Laine M, Tarkiainen A, et al. Adult brain plasticity elicited by anomia treatment. J Cogn Neurosci, 2003, 15(3): 444-461.
27. Tillema JM, Byars AW, Jacola LM, et al. Cortical reorganization of language functioning following perinatal left MCA stroke. Brain Lang, 2008, 105(2): 99-111.
28. Hartwigsen G, Saur D. Neuroimaging of stroke recovery from aphasia - insights into plasticity of the human language network. Neuroimage, 2019, 190(4): 14-31.
29. Turkeltaub PE, Messing S, Norise C, et al. Are networks for residual language function and recovery consistent across aphasic patients. Neurology, 2011, 76(20): 1726-1734.

West China Medical Journal

Effect of high-frequency repetitive transcranial magnetic stimulation to contralesional hemisphere on global aphasia patients after left massive cerebral infarction

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