Abstract
Background Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia. Objective To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS. Methods Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Results Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference (SMD) = 1.44, 95% CI 0.80 to 2.08, P < 0.05) and the water swallow test score (SMD = 6.23, 95% CI 5.44 to 7.03, P < 0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD = −1.04, 95% CI -1.50 to -0.58, P < 0.05), the penetration-aspiration scale (PAS) score (SMD = −0.85, 95% CI -1.33 to -0.36, P < 0.05), and the functional dysphagia scale score (SMD = −1.05, 95% CI -1.48 to -0.62, P < 0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS (P = 0.52) > tDCS (P = 0.48), the best probabilistic ranking of the SSA score is rTMS (P = 0.72) > tDCS (P = 0.28), and the best probabilistic ranking of the PAS score is rTMS (P = 0.68) > tDCS (P = 0.32). Conclusion Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.
Highlights
Swallowing seems to be a simple action, but it involves the coordination of multiple muscle groups, the regulation of the cranial nerves, and the central nervous system [1]
Dysphagia refers to the damage to the structure or function of the lower jaw, lips, tongue, soft palate, throat, and esophagus, resulting in food or water that cannot be safely and effectively delivered from the mouth to the stomach [2], which are a common sequelae of stroke with incidence of 37%-78% [3]
Meta-analysis showed that Noninvasive brain stimulation (NIBS) could improve the dysphagia outcome and severity scale (DOSS) score and reduce the standardized swallowing assessment (SSA) score, with statistically significant results compared with the control groups (P < 0:05)
Summary
Swallowing seems to be a simple action, but it involves the coordination of multiple muscle groups, the regulation of the cranial nerves, and the central nervous system [1]. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference ðSMDÞ = 1:44, 95% CI 0.80 to 2.08, P < 0:05) and the water swallow test score (SMD = 6:23, 95% CI 5.44 to 7.03, P < 0:05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD = −1:04, 95% CI -1.50 to -0.58, P < 0:05), the penetration-aspiration scale (PAS) score (SMD = −0:85, 95% CI -1.33 to -0.36, P < 0:05), and the functional dysphagia scale score (SMD = −1:05, 95% CI -1.48 to -0.62, P < 0:05). Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, doubleblind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research
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