rTMS treatments combined with speech training for a conduction aphasia patient A case report with MRI study

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rTMS treatments combined with speech training for a conduction aphasia patient 
A case report with MRI study

rTMS treatments combined with speech training for a conduction aphasia patient 
A case report with MRI study
Hui Zhang, MSa, Ying Chen, MSb, Ruiping Hu, MSb,c, Liqing Yang, PhDdJilei Zhang,PhDa, Haifeng Lu, MSa, Yi Wu, MDb,e,f,∗
Medicine 2017
Abstract
Rationale: To date, little is known regarding the neural mechanisms of the functional recovery of language after repetitivetranscranial magnetic stimulation (rTMS) in aphasia. Our aim was to investigate the mechanism that underlies rTMS and speechtraining in a case report.
Patient concerns and diagnoses: We report the case of a 39-year-old woman who was initially diagnosed with conductionaphasia following a left hemisphere stroke.
Interventions: The rTMS location comprised the left Broca area, and a frequency of 5Hz for 20min/d for 10 days during a 2-weekperiod was used. She had received speech rehabilitation training 1 month after stroke. Functional magnetic resonance imaging (fMRI)and diffusion tensor imaging were used to investigate the functional and microstructural changes before and after rTMS treatment.Outcomes: The results demonstrated that the Western Aphasia Battery scores significantly improved for language ability at 2weeks post-treatment, and the gains were steadily increased at 2.5 months post-treatment. The fMRI results indicated a morefocused activation pattern and showed significant activation in the left dominant hemisphere relative to the right hemisphere,especially in the perilesional areas, post-treatment during 2 language tasks compared with pretreatment. Moreover, the fractionalanisotropy increased in the left superior temporal gyrus, which comprises an important area that is involved in language processing.Lessons: Our findings suggest that rTMS combined with speech training improved the speech-language ability of this chronicconduction aphasia patient and enhanced the cerebral functional and microstructural reorganization.

Abbreviations: AD = axial diffusivity, AQ = Aphasia Quotient, DTI = diffusion tensor imaging, FA = fractional anisotropy, FDR=false discovery rate, fMRI = functional magnetic resonance imaging, FOV = field of view, LH = left hemisphere, MNI = MontrealNeurological Institute, MRI = magnetic resonance imaging, RCI = Reliable Change Index, RD = radial diffusivity, RH = righthemisphere, ROIs = regions of interest, rTMS = repetitive transcranial magnetic stimulation, SLT = speech and language therapy, TE= echo time, TR = repetition time, WAB = Western Aphasia Battery.

Keywords: aphasia, DTI, fMRI, rehabilitation, rTMS




伝導性失語症患者のための言語訓練と組み合わせたrTMS治療
MRI研究による症例報告

理論的根拠：現在までに、失語症における反復経頭蓋磁気刺激（rTMS）後の言語機能回復の神経機構に関してはほとんど知られていない。私たちの目的は、rTMSと発話訓練の基礎となるメカニズムを事例報告で調べることだった。
患者情報と診断：左半球脳卒中後に伝導失語と最初に診断された39歳の女性の症例を報告する。
介入：rTMSの位置は左のBroca領域を含み、2週間の期間中10日間、20分/日の5Hzの頻度を使用した。対象者は脳卒中1ヵ月後に音声リハビリ訓練を受けた。機能的磁気共鳴イメージング（fMRI）および拡散テンソルイメージングを用いて、rTMS治療前後の機能的および微細構造の変化を調べた。
結果：治療後2週間でWestern Aphasia Batteryスコアの言語能力が有意に改善し、治療後2.5ヶ月で着実に増加していることが示された。 fMRIの結果は、より焦点を当てた活性化パターンを示し、右半球と比較して左側の支配的な半球において有意な活性化を示した。さらに、FAは、言語処理に関与する重要な領域を構成する左上側頭側回で増加した。
結語：rTMSと言語訓練を組み合わせることで、慢性伝導失語症患者の音声言語能力が向上し、脳機能および微細構造の再構成が強化されたことが示唆された。

コメント:脳の機能的変化をfMRIにて確認し、DTIにて微細構造の変化をDTIにて確認している。一症例に対するfMRIとDTIを用いた研究を論文化したものを探していたので参考になった。現所属での環境を活かしたいところ。ある特異的な介入によって機能改善が見られれば、その回復の神経機構を事例報告によって報告するという点で我々も実践できる手段となるか。

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