| Objective: To probe into the language rehabilitation function and related mechanism of repetitive transcranial magnetic stimulation acting on the language area of the cerebral hemisphere for acute cerebral infarction aphasia patients.Method: Chosed 36 cases, right hands, 48 ~ 82 years old patients with Broca's aphasia of the left hemisphere acute cerebral infarction. The control group had 12 patients, the treatment group had 24 patients. The treatment group randomly divided into a low-frequency magnetic stimulation group with 12 patients and a high-frequency magnetic stimulation group with 12 patients. Three groups'patients age was not statistically significant (P>0.05). The control group used conventional drugs and language rehabilitation therapy; the treatment group based on conventional drugs and language treatment with the addition of the rTMS rehabilitation. The low-frequency magnetic stimulation groups: 1Hz, 80% motor evoked potential (MEP), exciting place on Broca area of the right hemisphere; the high-frequency magnetic stimulation groups: 10Hz, 80%MEP, stimulate place on Broca area of left hemisphere. The two groups stimulation sequences were 50 pulses, every day with 10 sequences, sequence at 120 seconds, continuous 10 days. All patients monitored aphasia battery in chinese(ABC) that would assess its language function and recorded the scalp EEG parallel nonlinear analysis monitored brain function change before treatment,2 weeks after the treatment,2 months after treatment and 6 months after treatment. Selected eight patients of each group to detected MR spectroscopy (MRS) and single-photon emission computed tomography (SPECT) at before treatment and 2 weeks after treatment, testing brain metabolism and the cerebral blood flow change respectively.Result: ABC score result showed that before treatment, the pairwise comparison of each group'ABC rating value was not statistically significant (P>0.05). At 2 weeks after treatment, the ABC rating value only the low-frequency magnetic stimulation group was higher than the control group significantly (P<0.05); While at 2 and 6 months after treatment, the low-frequency magnetic stimulation group and the high-frequency magnetic stimulation group that were higher than in the control group (P<0.05), and the low-frequency magnetic stimulation group was higher than the high-frequency magnetic stimulation group (P<0.05). The low-frequency magnetic stimulation group's ABC rating value at 2 weeks after treatment,2 and 6 months after treatment were higher than before treatment (P<0.05). The control group and high-frequecy magnetic stimulation group at 2 months after treatment that higher than before treatment (P < 0.05). SPECT result showed that each group's left inferior frontal lobe ischemia area was bigger than mirror area significantly at before treatment and 2 weeks after the treatment; At 2 weeks after treatment, the low-frequency group and the high-frequecy magnetic stimulation groups'left frontal frontal lobe ischemia area were less than before treatment and the control group obviously, its perturbation values were higher than the control group (P<0.05). MRS result showed that at before treatment, all patients on broca area of the left inferior frontal area appeared the inversion double lactic acid peak obviously, N-acetylaspartate (NAA) and NAA/creatine (Cr) value were lower than the contralateral mirror area significantly (P<0.05), but choline (Cho) value increased (P<0.05). At 2 weeks after treatment, the NAA and NAA/Cr value of the low-frequecy magnetic stimulation group and the high-frequency magnetic stimulation group's broca area in left inferior frontal lobe were higher than that in control group significantly (P<0.05), but still below the contralateral mirror area's (P<0.05). While the Cho value was less than the control group, but still above the contralateral mirror area (P<0.05). Non-linear EEG analysis showed that as the change of time, the outside-rolling correlation dimension(D2),point wise correlation dimension(PD2),complexity(Cx),approximate entropy(ApEn)value of each group's forehead around was rising trend gradually. While Lyapunov exponent(L1) value at 2 weeks after treatment was higher than before treatment, at 2 months and 6 months after treatment was lower than before treatment (P<0.05). The PD2 and D2 value of the treatment group's left and right forehead mainly at 2 weeks after rTMS treatment were higher than before treatment in different degrees, while the ApEn,Cx value mainly 2 weeks after rTMS treatment was higher than before treatment; At 2 months and 6 months after treatment, the PD2,D2,Cx,ApEn value of the treatment group were higher than those in the control group in different degrees , and each value of the low-frequecy magnetic stimulation group was higher than the high-frequency magnetic stimulation group. the PD2,D2,Cx value of each group's right frontal areas was higher than the left frontal area's in different degrees (P<0.05).Conclusion: 1Hz,rTMS and 10Hz,rTMS intervention aphasia of acute cerebral infarction in right,left broca 's area of cerebral hemisphere respectively that could improve its language function, promote language function recovery.1Hz,rTMS treatment was safe; and 10Hz,rTMS treatment was relatively safe. Recently the language function improved, we assumed that with low-frequecy stimulation rehabilitation side language area increased the local language blood flow and brain metabolism through dancers effect, restrain the right hemisphere excitability. Thus through TCI enhancement inhibition rehabilitation hemisphere. High-frequecy stimulation suffering from hemisphere brain regions increased the blood flow and brain metabolism of local language area directly, promote neuron function recovery, narrow infarction area, so as to facilitate language functional recovery in the damaged brain area related. Long-dated language function improvement then speculated the rTMS to promote bilateral hemisphere cortex local language excitability tend toequilibrium and the brain cortex language neural network was the faster and more effective reorganization relevant .The D2,PD2,L1,Cx and ApEn of non-linear EEG analysis parameters was sensitive in rTMS treatment aphasia post cerebral infarction. Early in the aphasia post cerebral infarction recovery, the PD2,D2 and L1 were more sensitive than the ApEn and Cx.After 2 months after treatmeat the Cx and ApEn most sensitive, that Cx and ApEn may more suitable for high dimensional system.
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