Abstract
Background: The clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) protocols on patients with poststroke dysphagia is still unclear.Objective: This trial aimed to explore and analyze the effectiveness of 5 Hz rTMS on the unaffected hemisphere, affected hemisphere, and cerebellum in stroke patients with dysphagia.Methods: This observer-blind and randomized controlled trial included a total of 147 patients with stroke. Patients were divided into four treatment groups: the unaffected hemispheric group, the affected hemispheric group, the cerebellum group and the control group. Each group received traditional dysphagia treatment 5 days a week for 2 weeks. All recruited patients except for those in the control group underwent 10 consecutive rTMS sessions for 2 weeks. For the affected hemispheric group and unaffected hemispheric group, 5 Hz rTMS was applied to the affected mylohyoid cortical region or to the unaffected mylohyoid cortical region. For the cerebellum group, 5 Hz rTMS was applied to the mylohyoid cortical representation of the cerebellum (4.3 cm lateral and 2.4 cm below the inion). The Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), Penetration/Aspiration Scale (PAS), Gugging Swallowing Screen (GUSS), and Standardized Swallowing Assessment (SSA) were used to evaluate clinical swallowing function before the intervention (baseline), immediately after the intervention and 2 weeks after the intervention.Results: There were significant time and intervention interaction effects on the FEDSS, PAS, SSA, and GUSS scores (p < 0.05). In a direct comparison of the swallowing parameters of the four groups, the changes in FEDSS, PAS, SSA, and GUSS scores showed a significantly greater improvement in the unaffected hemispheric group, the affected hemispheric group and cerebellum group than in the control group (p < 0.05).Conclusions: Whether stimulating the unaffected hemisphere or the affected hemisphere, 5 Hz high-frequency rTMS on mylohyoid cortical tissue might have a positive effect on poststroke patients with dysphagia. In addition, cerebellar rTMS is a safe method that represents a potential treatment for poststroke dysphagia, and more clinical trials are needed to develop this technique further.Clinical Trial Registration: chictr.org.cn, identifier: ChiCTR2000032255.
Highlights
Dysphagia, affecting 27–64% of stroke patients, is one of the most common poststroke sequelae [1] and is often associated with malnutrition, pneumonia, and dehydration [2]
There were no significant differences between the groups at baseline in clinical and demographic characteristics, Basic Activities of Daily Living (BADL) score, Mini-Mental State Examination (MMSE) score, Eating Assessment Tool-10 (EAT-10) score, Nutrition Risk Screening-2002 (NRS2002) score, Water Swallow Test (WST) score, Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) score, Penetration/Aspiration Scale (PAS) score, Standardized Bedside Swallowing Assessment (SSA) score, or Gugging Swallowing Screen (GUSS) score (Table 1)
Vasant et al [20] found that active cerebellar repetitive transcranial magnetic stimulation (rTMS) can increase PMEP amplitude, and their results indicated that cerebellar rTMS is a safe method that represents a potential treatment for poststroke dysphagia
Summary
Dysphagia, affecting 27–64% of stroke patients, is one of the most common poststroke sequelae [1] and is often associated with malnutrition, pneumonia, and dehydration [2]. In patients with dysphagia after stroke, the application of 3 Hz [11] and 10 Hz [12] rTMS on the ipsilateral motor cortex represented by the esophageal or mylohyoid cortex showed significant improvement compared with sham stimulation. Both 1 Hz [13] and 5 Hz [9] rTMS on the contralateral motor cortex represented by the pharyngeal or mylohyoid cortex showed improved swallowing function. The clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) protocols on patients with poststroke dysphagia is still unclear
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