摘要
卒中后失语症(PSA)的患病人群日益递增,此类患者临床表现为不同程度言语功能障碍,言语能力作为人类特有的核心认知与社交功能,其重要性贯穿于身心健康、文化延续等多个维度,但该病发生与恢复的脑机制不明,传统治疗效果欠佳,促使研究人员不断探索新的治疗方法。经颅磁刺激(TMS)是一种无创、安全的非侵入性大脑刺激技术,Theta爆发式经颅磁刺激(TBS)作为特殊TMS模式,具有耗时短、强度低、效应强、毒副作用少等优势,近年来临床应用渐多。本文介绍了TBS的特点、常用参数及安全性,值得注意的是不同参数治疗PSA患者存在效果差异,需要更多的研究来明确最佳参数。现有的研究提示其治疗PSA的机制包括调节大脑代谢、改善功能网络连接、促进半球间兴奋性平衡等,目前国内外研究结果表明TBS作用于大脑皮层,如额下回、初级运动皮层、Wernicke区和额叶背外侧等脑区,分别对自发言语、听理解、复述、命名等言语功能亚项的一项或几项功能有改善作用,表明TBS对PSA患者的言语功能恢复具有潜在的临床意义。此外,双侧或单侧多靶点TBS刺激结合言语训练的治疗方案,可实现功能互补,且TBS耗时短,多靶点刺激可行性较高。目前研究存在以短期效果为主、长期数据缺乏的局限,未来需探索小脑等更多潜在靶点,结合神经心理学量表与影像学技术,评估长期疗效并深入探讨脑机制,为PSA精准治疗提供依据。
Currently,the population affected by post-stroke aphasia(PSA)is increasing steadily and clinically these patients present with speech impairments of varying degrees.As a unique core cognitive and social function specific to humans,speech ability is crucial across multiple dimensions,including physical and mental health as well as cultural inheritance.However,the cerebral mechanisms underlying the onset and recovery of PSA remain unclear,and traditional treatments yield suboptimal results,prompting researchers to continuously explore new therapeutic approaches.Transcranial magnetic stimulation(TMS)is a non-invasive,safe brain stimulation technique.Theta burst transcranial magnetic stimulation(TBS),a specialized TMS mode,offers advantages such as short treatment duration,low intensity,strong efficacy,and minimal side effects,leading to its growing clinical application in recent years.This article reviews the characteristics,common parameters,and safety of TBS;notably,therapeutic effects on PSA patients vary with different TBS parameters,and more research is needed to identify the optimal parameters.Existing studies suggest that the therapeutic mechanisms for PSA include regulating cerebral metabolism,improving functional network connectivity,and promoting interhemispheric excitatory balance.Current domestic and international research results indicate that when TBS acts on cerebral cortical regions,such as the inferior frontal gyrus,primary motor cortex,Wernicke's area,and dorsolateral prefrontal cortex,it can improve one or more of the subdomains of speech function,including spontaneous speech,auditory comprehension,repetition,and naming,which suggests that TBS has potential clinical significance for the recovery of speech function in PSA patients.In addition,therapeutic regimens combining bilateral or unilateral multi-target TBS stimulation with speech training can achieve functional complementarity,and due to the short duration of TBS,multi-target stimulation is highly feasible.Currently,research has limitations such as focusing mainly on short-term effects and lacking of long-term data.In the future,it is necessary to explore more potential targets such as the cerebellum,combine neuropsychological scales with imaging techniques to evaluate long-term efficacy and further explore cerebral mechanisms,so as to provide a basis for precise treatment of PSA.
作者
方群
戴燕红
王红
陈卓铭
缑磊
FANG Qun;DAI Yanhong;WANG Hong;CHEN Zhuoming;GOU Lei(The First Affiliated Hospital of Jinan University,Guangzhou,Guangdong 510630,China;Guangzhou Tianhe Hospital of Traditional Chinese Medicine,Guangzhou,Guangdong 510655,China;The Fifth Affiliated Hospital of Jinan University,Heyuan,Guangdong 517000,China)
出处
《康复学报》
2025年第5期527-535,共9页
Rehabilitation Medicine
基金
国家重点研发计划项目(2020YFC2005700)
广东省中医药局科研项目(20221104)
广东省医学科学技术研究基金项目(B2023080)。
关键词
Theta爆发式经颅磁刺激
卒中后失语症
刺激靶点
疗效
言语功能
Theta burst transcranial magnetic stimulation
post-stroke aphasia
stimulation target
therapeutic efficacy
speech function
