背景:经颅直流电刺激(tDCS)是一种非侵入性神经调节工具,用于改善卒中后失语症患者的语言表现。然而,目前尚不清楚它是否具有长期影响。在查阅了大量相关研究后,研究发现,目前尚无关于tDCS对卒中后失语症患者的长期影响的明确结论.
目的:确定tDCS是否对卒中后失语患者(PAP)具有长期影响,以及哪种类型的tDCS对语言表现(尤其是命名能力)具有最有益的治疗效果。
方法:通过搜索直到2023年4月在以下数据库中发表的随机对照试验(RCT)进行了网络荟萃分析:WebofScience,Embase,Medline(来自OVID和PubMed),PsycInfo和Psycarticles(来自OVID)。我们只包括英文出版的RCT。选择tDCS联合言语语言治疗的PAP。假tDCS为对照组。必须在后续状态下评估命名能力或其他语言表现。两名评审员独立使用检查表评估主要结果(对命名能力的长期影响)和次要结果(其他语言表现,如通信)。Cochrane协作指南用于评估偏倚风险。
结果:纳入了249例患者的7项研究进行数据综合。对于主要结果(命名为nous),没有明显的证据表明干预措施之间存在差异(C-tDCS与S-tDCSSMD=0.06,95%CI=-1.01,1.12;A-tDCS与S-tDCSSMD=0.00,95%CI=-0.66,0.65;D-tDCS与S-tDCSSMD=0.77,95%CI=-0.71,2.24;A-tDCS与C-tDCSSMD=-0.06,95%CI=-1.31,1.19;D-tDCSvs.C-tDCSSMD=0.71,95%CI=-1.11,2.53;D-tDCS与A-tDCSSMD=0.77,95%CI=-0.84,2.39)。此外,没有证据表明沟通能力存在差异(C-tDCS与S-tDCSSMD=0.0895%CI=-1.77,1.92;A-tDCS与S-tDCSSMD=1.2395%CI=-1.89,4.34;D-tDCS与S-tDCSSMD=0.70;95%CI=-1.93,3.34;A-tDCS与C-tDCSSMD=1.1595%CI=-2.48,4.77;D-tDCS与C-tDCSSMD=0.6295%CI=-2.59,3.84;D-tDCS与A-tDCSSMD=-0.5295%CI=-4.60,3.56)。
结论:就我们的网络荟萃分析结果而言,tDCS在名词命名和交流方面似乎对卒中后失语症患者没有长期影响。然而,结果应谨慎解释.在未来,本研究应纳入更多随访时间较长的随机对照试验,以进行亚组或荟萃回归分析,以获得足够的效应大小.
BACKGROUND: Transcranial direct current stimulation (tDCS) is a noninvasive neuromodulation tool for improving language performance in patients with aphasia after stroke. However, it remains unclear whether it has long-term effects. After consulting a large number of relevant studies, it was found that there are no definitive conclusions about the long-term effects of tDCS on post-stroke aphasia patients.
OBJECTIVE: To determine whether tDCS has long-term effects on post-stroke aphasia patients (PAPs) and which type of tDCS has the most beneficial treatment effects on language performance (especially naming ability).
METHODS: A network meta-analysis was conducted by searching for randomized controlled trials (RCTs) published until April 2023 in the following databases: Web of Science, Embase, Medline (from OVID and PubMed), PsycInfo and PsycARTICLES (from OVID). We only included RCTs published in English. PAPs treated by tDCS combined with speech-language therapy were selected. Sham tDCS was the control group. Naming ability or other language performance must be assessed at follow-up states. Two reviewers independently used checklists to assess the primary outcome (the long-term effects on naming ability) and the secondary outcome (other language performance, such as communication). Cochrane Collaboration guidelines were used to assess the risk of bias.
RESULTS: Seven studies with 249 patients were included for data synthesis. For primary outcomes (naming nous), there was no obvious evidence to show a difference between interventions (C-tDCS vs. S-tDCS SMD = 0.06, 95% CI = -1.01, 1.12; A-tDCS vs. S-tDCS SMD = 0.00, 95% CI = -0.66, 0.65; D-tDCS vs. S-tDCS SMD = 0.77, 95% CI = -0.71, 2.24; A-tDCS vs. C-tDCS SMD = -0.06, 95% CI = -1.31,1.19; D-tDCS vs. C-tDCS SMD = 0.71, 95% CI = -1.11,2.53; D-tDCS vs. A-tDCS SMD = 0.77, 95% CI = -0.84, 2.39). In addition, no evidence showed differences in communication ability (C-tDCS vs. S-tDCS SMD = 0.08 95% CI = -1.77, 1.92; A-tDCS vs. S-tDCS SMD = 1.23 95% CI = -1.89, 4.34; D-tDCS vs. S-tDCS SMD = 0.70; 95% CI = -1.93, 3.34; A-tDCS vs. C-tDCS SMD = 1.15 95% CI = -2.48, 4.77; D-tDCS vs. C-tDCS SMD = 0.62 95% CI = -2.59, 3.84; D-tDCS vs. A-tDCS SMD = -0.52 95% CI = -4.60, 3.56).
CONCLUSIONS: It seems that tDCS has no long-term effects on post-stroke aphasia patients in naming nouns and communication in terms of the results of our network meta-analysis. However, the results should be interpreted with caution. In the future, more RCTs with long follow-up times should be included in the research to conduct subgroup or meta-regression analyses to obtain a sufficient effect size.