Differential Effects of Speech and Language Therapy and rTMS in Chronic Versus Subacute Post-stroke Aphasia: Results of the NORTHSTAR-CA Trial

被引：33

作者：

Zumbansen, Anna ^{[1
,2
]}

Kneifel, Heike ^{[1
,3
]}

Lazzouni, Latifa ^{[1
]}

Ophey, Anja ^{[1
]}

Black, Sandra E. ^{[4
,5
,6
]}

Chen, Joyce L. ^{[8
,9
]}

Edwards, Dylan ^{[10
,11
,12
]}

Funck, Thomas ^{[1
]}

Hartmann, Alexander Erich ^{[13
,14
]}

Heiss, Wolf-Dieter ^{[15
,16
]}

Hildesheim, Franziska ^{[1
,7
]}

Lanthier, Sylvain ^{[17
]}

Lesperance, Paul ^{[18
]}

Mochizuki, George ^{[19
]}

Paquette, Caroline ^{[1
]}

Rochon, Elizabet ^{[6
]}

Rubi-Fessen, Ilona ^{[3
,20
]}

Valles, Jennie ^{[21
]}

Wortman-Jutt, Susan ^{[10
,21
]}

Thiel, Alexander ^{[1
,7
]}

机构：

[1] McGill Univ, Jewish Gen Hosp, 3755 Cote St Catherine Rd, Montreal, PQ H3T 1E2, Canada

[2] Univ Ottawa, Sch Rehabil Sci, Ottawa, ON, Canada

[3] Neurol Rehabil Clin, RehaNova, Cologne, Germany

[4] Univ Toronto, Dept Med Neurol, Toronto, ON, Canada

[5] Univ Toronto, Heart & Stroke Fdn Canadian Partnership Stroke Re, Sunnybrook Res Inst, Toronto, ON, Canada

[6] Univ Toronto, Univ Hlth Network, KITE Res Inst, Toronto Rehabil Inst, Toronto, ON, Canada

[7] Canadian Platform Trials Noninvas Brain Stimulat, Montreal, PQ, Canada

[8] Univ Toronto, Fac Kinesiol & Phys Educ, Toronto, ON, Canada

[9] Univ Toronto, Rehabil Sci Inst, Toronto, ON, Canada

[10] Burke Neurol Inst, White Plains, NY USA

[11] Moss Rehabil Res Inst, Elkins Pk, PA USA

[12] Edith Cowan Univ, Joondalup, WA, Australia

[13] Hosp City Cologne, Cologne, Germany

[14] Univ Witten Herdecke, Dept Neurosurg, Witten, Germany

[15] Max Planck Inst Stoffwechsel Forsch MPI Metab Res, Cologne, Germany

[16] Univ Cologne, Cologne, Germany

[17] Univ Montreal, Hop Sacre Coeur Montreal, Montreal, PQ, Canada

[18] Univ Montreal, CHUM, Montreal, PQ, Canada

[19] York Univ, Sch Kinesiol & Hlth Sci, Toronto, ON, Canada

[20] Univ Cologne, Fac Human Sci, Dept Special Educ & Rehabil, Cologne, Germany

[21] Burke Rehabil Hosp, White Plains, NY USA

来源：

NEUROREHABILITATION AND NEURAL REPAIR | 2022年 / 36卷 / 4-5期

关键词：

aphasia; stroke; transcranial magnetic stimulation; speech therapy; language therapy; randomized controlled trial; TRANSCRANIAL MAGNETIC STIMULATION; ACUTE STROKE; BRAIN-STIMULATION; NORMATIVE DATA; RECOVERY; DYNAMICS; REORGANIZATION; METAANALYSIS; PERFORMANCE; SEVERITY;

D O I：

10.1177/15459683211065448

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

100204 [神经病学];

摘要：

Background & objective: Contralesional 1-Hz repetitive transcranial magnetic stimulation (rTMS) over the right pars triangularis combined with speech-language therapy (SLT) has shown positive results on the recovery of naming in subacute (5-45 days) post-stroke aphasia. NORTHSTAR-CA is an extension of the previously reported NORTHSTAR trial to chronic aphasia (>6 months post-stroke) designed to compare the effectiveness of the same rTMS protocol in both phases. Methods: Sixty-seven patients with left middle cerebral artery infarcts (28 chronic, 39 subacute) were recruited (01-2014 to 07-2019) and randomized to receive rTMS (N = 34) or sham stimulation (N = 33) with SLT for 10 days. Primary outcome variables were Z-score changes in naming, semantic fluency and comprehension tests and adverse event frequency. Intentionto-treat analyses tested between-group effects at days 1 and 30 post-treatment. Chronic and subacute results were compared. Results: Adverse events were rare, mild, and did not differ between groups. Language outcomes improved significantly in all groups irrespective of treatment and recovery phase. At 30-day follow-up, there was a significant interaction of stimulation and recovery phase on naming recovery (P <.001). Naming recovery with rTMS was larger in subacute (Mdn = 1.91/IQR = .77) than chronic patients (Mdn = .15/IQR = 1.68/P = .015). There was no significant rTMS effect in the chronic aphasia group. Conclusions: The addition of rTMS to SLT led to significant supplemental gains in naming recovery in the subacute phase only. While this needs confirmation in larger studies, our results clarify neuromodulatory vs training-induced effects and indicate a possible window of opportunity for contralesional inhibitory stimulation interventions in post-stroke aphasia.

引用

页码：306 / 316

页数：11

共 46 条

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