不同模式抑制性经颅磁刺激治疗老年脑卒中后失语症的疗效研究

doi:10.3969/j.issn.1003-9198.2026.09.008

摘要/Abstract

摘要： 目的观察低频重复经颅磁刺激(LF-rTMS)与连续Theta爆发式经颅磁刺激(cTBS)治疗老年脑卒中后失语症的疗效及治疗安全性。方法选取老年脑卒中后失语症患者共50例,采用随机数表法分为LF-rTMS组及cTBS组,每组25例。2组均给予常规言语语言疗法,在此基础上,LF-rTMS组给予LF-rTMS治疗,cTBS组给予cTBS治疗。于治疗前、治疗4周结束后,采用中文版西方失语症成套检验(WAB)及日常生活交流能力评估量表(CADL)评估语言功能及交流能力;治疗期间记录头痛、头晕、耳鸣、癫痫发作等不良反应的发生情况。结果治疗4周后,LF-rTMS组及cTBS组中文版WAB量表中自发言语、听理解、复述、命名评分以及失语商(AQ)、CADL评分较治疗前明显提高,且治疗后cTBS组WAB量表中听理解、复述评分,AQ及CADL评分亦显著优于LF-rTMS组(P＜0.05)。治疗期间2组均未发生严重不良反应。结论 LF-rTMS与cTBS均可有效改善老年脑卒中后失语症患者语言功能,改善其失语严重程度,并有效提升患者的交流能力,且安全性均良好。cTBS在改善患者理解、复述、AQ及CADL方面更有优势。

关键词: 低频重复经颅磁刺激, 连续Theta爆发式经颅磁刺激, 老年人, 脑卒中后失语症

Abstract: Objective To compare the efficacy and safety of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and continuous theta burst stimulation (cTBS) in the treatment of elderly patients with post-stroke aphasia(PSA). Methods Fifty elderly patients with PSA were randomly assigned to the LF-rTMS group (n=25) and the cTBS group (n=25) using a random number table. Both groups received conventional speech and language therapy. In addition, the LF-rTMS group received LF-rTMS intervention, while the cTBS group received cTBS intervention. Language function and daily communication ability were assessed before treatment and after 4 weeks of treatment using the Chinese version of the Western Aphasia Battery (WAB) and the Communicative Activities of Daily Living (CADL) scale. During the treatment period, the occurrence of adverse reactions including headache, dizziness, tinnitus and epileptic seizures were recorded. Results After 4 weeks of treatment, both groups showed significant improvements in the scores of spontaneous speech, comprehension, repetition and naming in the Chinese version of WAB, as well as aphasia quotient (AQ) and CADL scores. Compared with the LF-rTMS group, the cTBS group showed significantly greater improvements in comprehension and repetition scores, AQ, and CADL scores after treatment (P<0.05). No serious adverse events were observed in either group. Conclusions Both LF-rTMS and cTBS may improve language function and daily communication ability in older patients with PSA. Compared with LF-rTMS, cTBS may provide additional benefits in comprehension, repetition, AQ, and CADL scores, with good short-term safety and tolerability.

Key words: low-frequency repetitive transcranial magnetic stimulation, continuous theta burst stimulation, aged, post-stroke aphasia

中图分类号:

R 743.3

郭华平, 陈立娜, 勾丽洁. 不同模式抑制性经颅磁刺激治疗老年脑卒中后失语症的疗效研究[J]. 实用老年医学, 2026, 40(9): 900-905.

GUO Huaping, CHEN Lina, GOU Lijie. Efficacy of different modalities of inhibitory repetitive transcranial magnetic stimulation for elderly patients with post-stroke aphasia[J]. Practical Geriatrics, 2026, 40(9): 900-905.

参考文献

[1] WANG W, JIANG B, SUN H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480687 adults[J]. Circulation, 2017, 135(8): 759-771.
[2] 喻文雅, 闫玉英, 姜彩肖. 石家庄市脑卒中流行病学特征及危险因素的Logistic分析[J]. 河北医药, 2010, 32(17): 2433-2434.
[3] BERNHARDT J, CORBETT D, DUKELOW S, et al. The international stroke recovery and rehabilitation alliance[J]. Lancet Neurol, 2023: 22(4):295-296.
[4] FLOWERS H L, SKORETZ S A, SILVER F L, et al. Poststroke aphasia frequency, recovery, and outcomes: a systematic review and meta-analysis[J]. Arch Phys Med Rehabil, 2016, 97(12): 2188-2201. e8.
[5] 张楠, 王振宇, 刘睿姝, 等. 不同方案非侵入性脑刺激治疗脑卒中后失语症疗效的网状Meta分析[J]. 海南医学, 2021, 32(13): 1755-1761.
[6] JIANG T, WEI X, WANG M, et al. Theta burst stimulation: what role does it play in stroke rehabilitation? A systematic review of the existing evidence[J]. BMC Neurol, 2024, 24(1): 52.
[7] 张芳, 谢博多, 郭华平, 等. 连续爆发式经颅磁刺激治疗脑卒中后失语症的疗效观察[J]. 中华物理医学与康复杂志, 2025, 47(9):804-808.
[8] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2014[J]. 中华神经科杂志, 2015, 48(4):246-257.
[9] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑出血诊治指南(2019)[J]. 中华神经科杂志, 2019, 52(12):994-1005.
[10] 张怡, 恽文伟, 张敏, 等. 低频重复经颅磁刺激联合高压氧治疗卒中后非流利性失语的疗效观察[J]. 中华物理医学与康复杂志, 2019, 41(7): 512-516.
[11] ZHANG J, ZHONG D, XIAO X, et al. Effects of repetitive transcranial magnetic stimulation (rTMS) on aphasia in stroke patients: a systematic review and meta-analysis[J]. Clin Rehabil, 2021, 35(8): 1103-1116.
[12] LEFAUCHEUR J P, ALEMAN A, BAEKEN C, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): an update (2014-2018)[J]. Clin Neurophysiol, 2020, 131(2): 474-528.
[13] REN J, REN W, ZHOU Y, et al. Personalized functional imaging-guided rTMS on the superior frontal gyrus for post-stroke aphasia: a randomized sham-controlled trial[J]. Brain Stimul, 2023, 16(5): 1313-1321.
[14] 汉语失语症康复治疗专家共识组. 汉语失语症康复治疗专家共识[J]. 中华物理医学与康复杂志, 2019, 41(3): 161-169.
[15] 高素荣. 失语症[M]. 2版. 北京: 北京大学医学出版社, 2006:516-518.
[16] 中国康复医学会脑功能检测与调控康复专业委员会, 中国康复医学会脑机接口与康复专业委员会. 经颅磁刺激多模式评估技术应用规范[J]. 康复学报, 2026, 36(5): 299-307, 311.
[17] CHENG J, JIANG Y, RAO T, et al. Repetitive transcranial magnetic stimulation for post-stroke non-fluent aphasia: a systematic review and meta-analysis of randomized controlled trials[J]. Front Neurol, 2024, 15: 1348695.
[18] MUSSO M, MORO A, GLAUCHE V, et al. Broca’s area and the language instinct[J]. Nat Neurosci, 2003, 6(7): 774-781.
[19] SAUR D, KREHER B W, SCHNELL S, et al. Ventral and dorsal pathways for language[J]. Proc Natl Acad Sci U S A, 2008, 105(46): 18035-18040.
[20] UENO T, SAITO S, ROGERS T T, et al. Lichtheim 2: synthesizing aphasia and the neural basis of language in a neurocomputational model of the dual dorsal-ventral language pathways[J]. Neuron, 2011, 72(2): 385-396.
[21] 王莉, 朱毅, 李晓丹, 等. 低频重复经颅磁刺激治疗脑卒中后亚急性期非流利性失语症的有效性及安全性评价[J]. 中华物理医学与康复杂志, 2019, 41(9): 662-667.
[22] REN C, ZHANG G, XU X, et al. The effect of rTMS over the different targets on language recovery in stroke patients with global aphasia: a randomized sham-controlled study[J]. Biomed Res Int, 2019, 2019: 4589056.
[23] LEFAUCHEUR J P, ANDRÉ-OBADIA N, ANTAL A, et al. Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS)[J]. Clin Neurophysiol, 2014, 125(11):2150-2206.
[24] HARTWIGSEN G, SAUR D. Neuroimaging of stroke recovery from aphasia-insights into plasticity of the human language network[J]. NeuroImage, 2019, 190: 14-31.
[25] HURTADO-PUERTO A M, NESTOR K, ELDAIEF M, et al. Safety considerations for cerebellar theta burst stimulation[J]. Clin Ther, 2020, 42(7): 1169-1190. e1.
[26] HUANG Y Z, EDWARDS M J, ROUNIS E, et al. Theta burst stimulation of the human motor cortex[J]. Neuron, 2005, 45(2): 201-206.
[27] ZHENG K, XU X, JI Y, et al. Continuous theta burst stimulation-induced suppression of the right Fronto-thalamic-cerebellar circuit accompanies improvement in language performance in poststroke aphasia: a resting-state fMRI study[J]. Front Aging Neurosci, 2023, 14: 1079023.
[28] GEORGIOU A M, KAMBANAROS M. The effectiveness of transcranial magnetic stimulation (TMS) paradigms as treatment options for recovery of language deficits in chronic poststroke aphasia[J]. Behav Neurol, 2022, 2022: 7274115.