中国 国产 失语症评估与治疗系统 PACA

摘要 · 中文整理：目的：探讨亚急性期卒中后言语失用（AoS）患者在左侧初级运动皮层（M1）唇区接受阳极经颅直流电刺激（A-tDCS）后皮质言语发音网络功能连接的变化及A-tDCS对AoS的疗效。方法：24例卒中后AoS患者随机分为两组，分别接受左侧M1唇区A-tDCS（tDCS组）或假刺激（对照组），并联合每日2次、共5天的言语语言治疗。治疗前后进行AoS评估与脑电图（EEG）检查，采用脑电非线性指标交叉近似熵（C-ApEn）测量皮质间连接。结果：脑电分析显示，治疗后tDCS组被激活的连接均位于左半球，不仅包括言语发音网络的区域，还包括领域一般性网络中的背外侧前额叶皮层（DLPFC）；而对照组的连接局限于右半球以及双侧DLPFC与双侧额下回（IFG）之间。在AoS评估中，tDCS组在5项分测验中的4项改善显著优于对照组。多因素线性回归分析显示仅分组与词复述改善显著相关（P=0.002）。结论：左侧M1唇区A-tDCS联合言语治疗可上调左半球言语特异性网络与领域一般性网络的连接，卒中后AoS患者发音能力的改善可能与tDCS诱导的左半球网络连接增强有关。

原文摘要：Objective: This study aimed to examine the changes in the functional connectivity of the cortical speech articulation network after anodal transcranial direct current stimulation (A-tDCS) over the left lip region of the primary motor cortex (M1) in subacute post-stroke patients with apraxia of speech (AoS), and the effect of A-tDCS on AoS. Methods: A total of 24 patients with post-stroke AoS were randomized into two groups and received A-tDCS over the left lip region of M1 (tDCS group)/ sham tDCS (control group) as well as speech and language therapy two times per day for 5 days. Before and after the treatment, the AoS assessments and electroencephalogram (EEG) were evaluated. The cortical interconnections were measured using the EEG non-linear index of cross approximate entropy (C-ApEn). Results: The analysis of EEG showed that, after the treatment, the activated connectivity was all in the left hemisphere, and not only regions in the speech articulation network but also in the dorsal lateral prefrontal cortex (DLPFC) in the domain-general network were activated in the tDCS group. In contrast, the connectivity was confined to the right hemisphere and between bilateral DLPFC and bilateral inferior frontal gyrus (IFG) in the control group. In AoS assessments, the tDCS group improved significantly more than the control group in four of the five subtests. The results of multivariate linear regression analyses showed that only the group was significantly associated with the improvement of word repetition (P = 0.002). Conclusion: A-tDCS over the left lip region of M1 coupled with speech therapy could upregulate the connectivity of both speech-specific and domain-general networks in the left hemisphere. The improved articulation performance in patients with post-stroke AoS might be related to the enhanced connectivity of networks in the left hemisphere induced by tDCS.

关键词：言语失用、脑电图、功能连接、网络、初级运动皮层、卒中、经颅直流电刺激

研究目标：卒中后言语失用的tDCS治疗机制尚不清楚，本文旨在明确左侧M1唇区阳极tDCS联合言语治疗能否改善亚急性期卒中后AoS患者的发音表现，并通过脑电交叉近似熵揭示皮质言语发音网络功能连接的变化。

主要结论：左侧M1唇区阳极tDCS联合言语治疗可增强左半球言语特异性网络（SPT-IFG-M1、SPT-IPL、IPL-IFG）及领域一般性网络（DLPFC-IFG）的连接，并显著改善卒中后AoS患者的发音表现；对照组仅右半球SPT-IFG-M1及双侧IFG、双侧DLPFC间连接增强；更好的AoS恢复可能与tDCS诱导的左半球网络连接增强有关。

创新点：首次在随机对照设计下以脑电交叉近似熵考察左侧M1唇区tDCS后言语发音网络的连接变化；将PACA听觉词图匹配作为标准化听理解筛查指标以保证受试者同质性；提出领域一般性网络（DLPFC）参与AoS恢复的证据。

后续建议：扩大样本量并延长干预周期（如超过5天）以验证疗效的稳定性；增加随访以评估发音改善与网络连接变化的长期维持；结合高密度脑电或fMRI提高功能连接的空间分辨率；探索M1唇区与IFG或SPT的多靶点刺激方案；将PACA复述与朗读分测验纳入结局评估以更全面反映言语加工变化

APA 引文：Zhao, J., Li, Y., Zhang, X., Yuan, Y., Cheng, Y., Hou, J., Duan, G., Liu, B., Wang, J., & Wu, D. (2022). Alteration of network connectivity in stroke patients with apraxia of speech after tDCS: A randomized controlled study. Frontiers in Neurology, 13, 969786. https://doi.org/10.3389/fneur.2022.969786

仪器引用：All enrolled participants had baseline speech assessments before inclusion, including the Boston Diagnostic Aphasia Examination-Chinese Version for aphasia type and severity and Psycholinguistic Assessment in Chinese Aphasia for the performance of auditory comprehension (participants with auditory word-picture identification <6/30 were excluded).