The possible role of repetitive transcranial magnetic stimulation in dysphagia following brain stem infarctions

Abstract

Background Dysphagia is a very common manifestation of brain stem infarctions, which is usually severe enough to need special feeding programs including nasogastric tube application. Repetitive transcranial magnetic stimulation (rTMS) can modulate the cortical excitability and enhance the recovery of swallowing dysfunctions. Aim To evaluate the possible therapeutic role of rTMS in accelerating recovery of dysphagia following brain stem infarctions. Patients and methods This study was conducted on 30 dysphagic patients following brain stem infarctions; 15 received real rTMS and 15 received sham rTMS on bilateral supratentorial cortical swallowing areas. Every patient underwent 10 rTMS sessions repeated five times per week for 2 successive weeks. Scheduled dysphagia severity was evaluated using The Dysphagia Outcome and Severity Scale at stroke onset, after the first rTMS session, and then at 7, 30, and 60 days after the last rTMS session (visits 0, 1, 2, 3, and 4, respectively). Results There was significant improvement of dysphagia in patients who received real rTMS compared with those who received sham rTMS during visits 1 and 2. The improvement was maintained through visits 3 and 4, but without significant difference. Conclusion Bilateral application of real rTMS on cortical swallowing areas for patients with dysphagia following brain stem infarctions has a potential rapid maintained improving effect of swallowing functions with decreased burden of aspiration in the early poststroke period until recovery takes place.