| BackgroundIschemice stroke(IS) is manifested by the abrupt onset of focal neurologic deficits, which were caused by a suddent reduction or completely blockage of blood supply to local brain tissues. The incidence of stroke in the upward trend year by year.IS is the first cause of disability for adults. IS is a leading cause of death and adult long-term disability worldwide, and remains as an enormous burden for personality and society due to lack of illustrated etiology and effective treatments. Aphasia is a common symptom after cerebrovascular disease, such as the understanding of language, the ability to express. The loss was due to the cerebral cortex of the dominant hemisphere damage caused by the language center. Aphasia is a common complication after stroke, there is still no unified view about its pathogenesis. Neurologists and linguists with years of unremitting efforts, and found that cortex is located in the middle frontal gyrus, writing center is located in the rear of the middle frontal gyrus, the visual language center is located in the back corner on the inferior parietal lobule while auditory speech center is located on the rear of the superior temporal gyrus, which is the classic language center. There are two language centers:one called language sports center, located on the main side of the hemisphere Broca area. If the central trauma, patients will lose the ability to speak. But they still can understand the meaning of words, gestures or nod to answer common questions. Depending on the circumstances of aphasia function it can be divided into two types: sports aphasia patients are often poor in writing, verbal fluency, naming abilities, and the ability to understand the relative retention; and the second--sensory aphasia, there are flaws, but relatively good ability to repeat. No matter what type of aphasia, stroke patients are often very concerned about their recovery of language, writing ability and motor function. Aphasia will seriously affect the patient’s quality of daily life.Therefore, an effective method of treatment for patients with aphasia after stroke is necessary. Transcranial magnetic stimulation is an vitro application of pulsed magnetic fields to stimulate specific parts of the brain tissue technology. The repeated administration of stimulation is called repetitive transcranial magnetic stimulation (rTMS). At the beginning of 1985, rTMS was used for clinical. Cerebral cortex, spinal nerve root and peripheral nerve noninvasive electrical stimulation, nerve excitability changes in the cerebral cortex to regulate the function of each area. General stimulation frequency 1 Hz (1 time/s) or less called low frequencies, which can produce cortical inhibition, and 1 Hz or more called high frequency which can improve cortical excitability. In clinical terms, the present study has confirmed that rTMS was effective for depression and severe movement disorders and other neuropsychiatric disorders. Under normal physiological conditions, the brain’s language center located in the dominant hemisphere, which in the dominant hemisphere aphasia injury recovery depends on the reconstruction of the dominant hemisphere language areas and the non-dominant hemisphere language function mirror area network. Thus, the brain plasticity post-stroke in cortical functional areas and their corresponding functions of the network, which is the basis of aphasia recovery. After the stroke, inevitably lead to the destruction of the structural integrity, which lead to aphasia.Small clinical trials have reported that low-frequency repetitive transcranial magnetic stimulation (rTMS) might improve language recovery in patients with aphasia after stroke. However, no systematic reviews or meta-analyses studies have investigated the effect of rTMS combined with speech and language training(SLT) on aphasia.At present, there are a variety of treatment methods for aphasia after stroke, including speech therapy, neural active drugs (such as Laci Staw, levodopa, bromocriptine treatment) and so on. But the effect is not significant. In addition, noninvasive rTMS has become a kind of alternative treatment for aphasia. we speculated that rTMS may effective in the treatment of aphasia patients after stroke. Recently, transcranial magnetic stimulation as an non-invasive therapy, based on magnetic electric principle, rapid fluctuations caused by magnetic field, creating the current spread in the brain region wide, make changes of neural electrical activity of cerebral cortex, affecting the brain language function area, and affecting the language activities in human. Accordingly, rTMS may have certain positive effect to the patients with aphasia after stroke. The integrity of the damaged brain after stroke has been destroyed. Under normal physiological conditions, the human brain language center located in the dominant hemisphere, when damaged, may caused aphasia. The language function reconstruction mainly depends on the dominant hemisphere unaffected language functional areas on the dominant hemisphere and the language function network on the non dominant hemisphere mirror area. Through further research, rTMS has been demonstrated to achieve a cross-correlation function of the network connection.Systematic review is a rigorous evaluation method of the literature, using a variety of methods to retrieve comprehensive collection of the world’s published and unpublished research results, then analyzing the study datas. Systematic review can be divided into two types:a systematic review of quantitative and qualitative evaluation system, the former is what we call Meta-analysis. From a statistical perspective, meta analysis allows inconsistencies between the results of individual studies to be resolved and increased the sample size, thereby, increasing the effectiveness of the test, improving statistical inference to make the conclusions more accurate and reliable.However, no systematic review and meta-analysis about the effect of rTMS studies on the treatment of aphasia after ischemic stroke. The purpose of this study is to explored the effects of low-frequency rTMS combined with speech and language training on aphasia in ischemic stroke patients with the use of meta-analysis.ObjectiveThe objective of this study was to perform a meta-analysis of studies that explored the effects of low-frequency rTMS combined with speech and language training on aphasia in ischemic stroke patients.MethodsWe searched PubMed, CENTRAL, Embase, CINAHL, ScienceDirect, and Journals@Ovid for randomized controlled trials published between January 1965 and March 2015 using the keywords "aphasia OR language disorders OR anomia OR linguistic disorders AND repetitive transcranial magnetic stimulation OR rTMS". Using the Newcastle-Ottawa Scale (NOS) standards for quality assessment, then RevMan 5.2 software to meet the quality requirements of the Meta-analysis of the literature. We used fixed-and random-effects models to estimate the standardized mean difference (SMD) and a 95% CI for the language outcomes, including long-term (morer than 1 month) and short-term (less than one month) efficacy in the naming, repetition, comprehension terms. With a sensitivity analysis to assess the stability of the results.ResultsA total of five case-control studies including 60 patients and 63 control patients in this meta-analysis. Heterogeneity test results suggest that in addition to the existence of a long-term set of results in comprehension moderate heterogeneity (12= 45%), there was no significant heterogeneity among the rest of the individual studies. Five studies were merged for analysis of results showed that:a long-term group in naming:SMD= 0.69,95% CI (0.24,1.13); long-term group in terms of repetition SMD= 0.55,95% CI (0.03,1.08); long-term group comprehension SMD= 0.15,95% CI (-0.37,0.67) short-term group naming SMD= 0.47,95%CI (-0.17,1.12); Short-term group in terms of repetition SMD= 0.65,95% CI (0.19,1.11); Short-term group comprehension SMD= 0.28,95% CI (-0.17,0.73). Based on the length of time after treatment, subgroup analysis showed statistically significant correlation between the two. Each group analyzed the combined effect of the amount of income sensitivity and heterogeneity of the situation did not change significantly, the funnel plot test results strongly suggest that no significant publication bias, Meta-analysis shows that the results are stable and reliable.Conclusion1、Low-frequency rTMS combined with Speech and Language Training has a positive effect on language recovery in patients with aphasia following stroke.2、Further well designed studies with larger populations are required to ascertain the long-term effects of rTMS in aphasia treatment. |
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