左外侧裂后部经颅直流电刺激对失语症图命名及听理解作用的研究

摘要

目的:探查恢复期失语症患者左外侧裂后部(PPR)经颅直流电刺激(tDCS)对图命名及听理解的作用.方法:采用成组前后对照实验设计,治疗分为A、B期.A期为4周语言治疗,B期为4周tDCS治疗与语言治疗.tDCS刺激电极阳极位于左侧外侧裂后部周围区,阴极位于右肩.刺激强度1.1mA,每次20min.7例脑卒中后失语症患者在每个治疗期前后进行汉语失语症心理语言评价(PACA).结果:7例患者经4周A期语言治疗后,图命名和听觉词—图匹配成绩未见显著改变；经4周tDCS与语言治疗后,患者的图命名和听觉词—图匹配成绩显著提高(图命名成绩平均提高64％,听觉词—图匹配成绩平均提高15％).结论:tDCS阳极刺激左外侧裂后部周围区可以提高恢复期失语症患者的图命名和听觉词—图匹配任务的正确率,其治疗机制可能是南于阳极刺激提高了脑损伤周围区的神经元兴奋性,促进了语言功能的代偿.tDCS为失语症提供了一种新的有效的治疗技术.%Objective: To investigate the effects of transcranial direct current stimulation (tDCS) over left posterior perisylvian region (PPR) on aphasics' picture naming and auditory word comprehension.Method: Treatment procedure was divided into phase A and phase B. First routine four-week language training (30min Od and 5d a week) was applied in phase A, then routine language training combined with tDCS (1.1mA, 20min) were implemented in phase B. Anode electrode was placed over PPR, while cathode electrode over right shoulder in tDCS treatment. Seven aphasia subjects after stroke were measured with psycholinguistic assessment in Chinese aphasia (PACA) before and after each treatment phase.Result: There was no significant change in picture naming and auditory word-picture matching in 7 aphasics after phase A treatment. Picture naming and auditory word-picture matching improved significantly after phase B treatment for aphasics (picture naming score improved by 64% and auditory word-picture matching improved by 15%).Conclusion: Anodal tDCS over left PPR could improve picture naming and auditory word comprehension in aphasia patients. The possible mechanism of therapeutic effect of tDCS might be that anodal tDCS could increase cortical excitability of peri-lesional regions under the stimulation electrode. tDCS provides a new therapeutic tech-nique for aphasia.