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Personalized Repetitive Transcranial Magnetic Stimulation for Primary Progressive Aphasia
Journal of Alzheimer’s Disease ( IF 4 ) Pub Date : 2021-09-01 , DOI: 10.3233/jad-210566
Vanesa Pytel 1 , María Nieves Cabrera-Martín 2 , Alfonso Delgado-Álvarez 1 , José Luis Ayala 3 , Paloma Balugo 4 , Cristina Delgado-Alonso 1 , Miguel Yus 5 , María Teresa Carreras 6 , José Luis Carreras 2 , Jorge Matías-Guiu 1 , Jordi A Matías-Guiu 1
Affiliation  

Background:Primary progressive aphasia (PPA) is a neurodegenerative syndrome for which no effective treatment is available. Objective:We aimed to assess the effect of repetitive transcranial magnetic stimulation (rTMS), using personalized targeting. Methods:We conducted a randomized, double-blind,pilot study of patients with PPA receiving rTMS, with a subgroup of patients receiving active- versus control-site rTMS in a cross-over design. Target for active TMS varied among the cases and was determined during a pre-treatment phase from a list of potential regions. The primary outcome was changes in spontaneous speech (word count). Secondary outcomes included changes in other language tasks, global cognition, global impression of change, neuropsychiatric symptoms, and brain metabolism using FDG-PET. Results:Twenty patients with PPA were enrolled (14 with nonfluent and 6 with semantic variant PPA). For statistical analyses, data for the two variants were combined. Compared to the control group (n = 7), the group receiving active-site rTMS (n = 20) showed improvements in spontaneous speech, other language tasks, patient and caregiver global impression of change, apathy, and depression. This group also showed improvement or stabilization of results obtained in the baseline examination. Increased metabolism was observed in several brain regions after the therapy, particularly in the left frontal and parieto-temporal lobes and in the precuneus and posterior cingulate bilaterally. Conclusion:We found an improvement in language, patient and caregiver perception of change, apathy, and depression using high frequency rTMS. The increase of regional brain metabolism suggests enhancement of synaptic activity with the treatment.Trial registration: NCT03580954 (https://clinicaltrials.gov/ct2/show/NCT03580954)

中文翻译:

原发性进行性失语症的个性化重复经颅磁刺激

背景:原发性进行性失语症 (PPA) 是一种神经退行性疾病,尚无有效治疗方法。目的:我们旨在使用个性化靶向评估重复经颅磁刺激 (rTMS) 的效果。方法:我们对接受 rTMS 的 PPA 患者进行了一项随机、双盲、试点研究,其中一组患者在交叉设计中接受了主动与对照部位 rTMS。主动 TMS 的目标因病例而异,是在治疗前阶段从潜在区域列表中确定的。主要结果是自发说话(字数)的变化。次要结果包括其他语言任务的变化、整体认知、整体变化印象、神经精神症状和使用 FDG-PET 的脑代谢。结果:招募了 20 名 PPA 患者(14 名不流利的 PPA 和 6 名语义变异的 PPA)。为了进行统计分析,合并了两种变体的数据。与对照组 (n = 7) 相比,接受活性部位 rTMS 的组 (n = 20) 在自发言语、其他语言任务、患者和护理人员的整体变化印象、冷漠和抑郁方面都有所改善。该组还显示了基线检查中获得的结果的改善或稳定。治疗后在几个大脑区域观察到代谢增加,特别是在左侧额叶和顶颞叶以及双侧楔前叶和后扣带回。结论:我们发现使用高频 rTMS 可以改善语言、患者和护理人员对变化、冷漠和抑郁的感知。
更新日期:2021-09-03
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