The effect of repetitive transcranial magnetic stimulation combined with traditional dysphagia therapy on poststroke dysphagia: a pilot double-blinded randomized-controlled trial

Abstract

Dysphagia following stroke is common and can lead to severe complications such as aspiration pneumonia, but there is inconclusive evidence on how poststroke dysphagia should be treated. This study aimed to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) combined with the traditional dysphagia therapy on the swallowing function in patients with poststroke dysphagia. In this pilot double-blind randomized clinical trial, 18 patients with poststroke dysphagia were allocated randomly to three groups: (i) traditional dysphagia therapy, (ii) rTMS, and (iii) combined intervention. Patients received traditional dysphagia therapy for 18 treatment sessions three times per week. The inhibitory rTMS was applied to the intact cerebral hemisphere at 1 Hz with a train of 1200 for 5 consecutive days. The patients in the combined intervention group received traditional dysphagia therapy and rTMS simultaneously. The Mann Assessment of Swallowing Ability (MASA) and Functional Oral Intake Scale were performed before treatment, after the end of the fifth session, after the end of the 10th session, after the end of the 15th session, and after the end of the 18th session. All groups had improved on MASA and Functional Oral Intake Scale scores over time (P<0.01). The improvements achieved in all outcomes were significantly greater in the combined intervention group than those of the traditional dysphagia therapy and rTMS groups. The large effect sizes were found for the MASA score in all groups: traditional dysphagia therapy group (d = 3.57), rTMS group (d = 2.67), and combined intervention group (d = 3.87). This pilot randomized-controlled trial showed that the combination of rTMS and traditional dysphagia therapy significantly improved swallowing function in patients with poststroke dysphagia.

The Effect of Repetitive Transcranial Magnetic Stimulation on Dysphagia After Stroke: A Systematic Review and Meta-Analysis

“…They investigated the efficacy of rTMS on patients with dysphagia after stroke from different perspectives. Tarameshlu et al ( 2019 ), Zhang et al ( 2019 ), Du et al ( 2016 ), and Verin and Leroi ( 2009 ) all supported that rTMS treatment over the tongue area of the motor cortex may facilitate the recovery of dysphagia after stroke. However, not all studies proved the efficacy of rTMS for the treatment of dysphagia.…”

“…After reading the full text, 30 articles without available full-text visions or outcomes data and 13 literature including complex experimental scheme were excluded. Finally, we included seven literature (Khedr et al, 2009 ; Khedr and Abo-Elfetoh, 2010 ; Kim et al, 2011 ; Park et al, 2013 , 2017 ; Lim et al, 2014 ; Ünlüer et al, 2019 ), with a total of 186 participants from 14 groups of patients in our meta-analysis, and a qualitative systematic review of six studies (Verin and Leroi, 2009 ; Cheng et al, 2015 , 2017 ; Du et al, 2016 ; Tarameshlu et al, 2019 ; Zhang et al, 2019 ). The literature screening process and detailed characteristics of included studies are shown in Figure 1 and Table 1 .…”

“…participants from 14 groups of patients in our meta-analysis, and a qualitative systematic review of six studies (Verin and Leroi, 2009;Cheng et al, 2015Cheng et al, , 2017Du et al, 2016;Tarameshlu et al, 2019;Zhang et al, 2019). The literature screening process and detailed characteristics of included studies are shown in Figure 1 and Table 1.…”

“…A total of six studies with a small sample size or non-randomized controlled trial studies (Verin and Leroi, 2009 ; Cheng et al, 2015 , 2017 ; Du et al, 2016 ; Tarameshlu et al, 2019 ; Zhang et al, 2019 ) were included in the systematic review. They investigated the efficacy of rTMS on patients with dysphagia after stroke from different perspectives.…”

Scoping review to identify and map non-pharmacological, non-surgical treatments for dysphagia following moderate-to-severe acquired brain injury

“…Of the 26 included studies and trials, 18 are randomised controlled trials (n=10 to n=306), [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] one is a nonrandomised controlled trial (n=24), 48 three are cohort studies (n=24 to n=208), 8 49 50 two are case series 51 52 and two are case reports. 53 54 The studies are published between 1998 and 2020.…”