Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 895 Muwang-Ro, Iksan, Jeonlabuk-do 54538, Republic of Korea.
Brain Stimul. 2017 Jan-Feb;10(1):75-82. doi: 10.1016/j.brs.2016.08.005. Epub 2016 Aug 11.
BACKGROUND: Optimal protocol of repetitive transcranial magnetic stimulation (rTMS) on post-stroke dysphagia remains uncertain with regard to its clinical efficacy. OBJECTIVE: The aim of the present study is to investigate the effects of high-frequency rTMS at the bilateral motor cortices over the cortical representation of the mylohyoid muscles in the patients with post-stroke dysphagia. METHODS: This study was a single-blind, randomized controlled study with a blinded observer. Thirty-five stroke patients were randomly divided into three intervention groups: the bilateral stimulation group, the unilateral stimulation group, and the sham stimulation group. For the bilateral stimulation group, 500 pulses of 10 Hz rTMS over the ipsilesional and 500 pulses of 10 Hz rTMS over the contralesional motor cortices over the cortical areas that project to the mylohyoid muscles were administered daily for 2 consecutive weeks. For the unilateral stimulation group, 500 pulses of 10 Hz rTMS over the ipsilesional motor cortex over the cortical representation of the mylohyoid muscle and the same amount of sham rTMS over the contralesional hemisphere were applied. For the sham stimulation group, sham rTMS was applied at the bilateral motor cortices. Clinical swallowing function and videofluoroscopic swallowing studies were assessed before the intervention (T0), immediately after the intervention (T1) and 3 weeks after the intervention (T2) using Clinical Dysphagia Scale (CDS), Dysphagia Outcome and Severity Scale (DOSS), Penetration Aspiration Scale (PAS), and Videofluoroscopic Dysphagia Scale (VDS). RESULTS: There were significant time and intervention interaction effects in the CDS, DOSS, PAS, and VDS scores (p < 0.05). In the direct comparison of the changes in the swallowing parameters among the three groups, the change in CDS scores at T1 and T2 showed a significantly higher improvement in the bilateral simulation group than in two other groups (p < 0.05). There was a significantly larger change in the DOSS, PAS, and VDS scores at T1 in the bilateral stimulation group than in two other groups (p < 0.05). CONCLUSIONS: The results of the present study provide substantial evidence that 10 Hz rTMS at the bilateral motor cortices over the cortical areas projecting to the mylohyoid muscles is effective as an additional treatment strategy to traditional dysphagia therapies.
背景：高频重复经颅磁刺激（rTMS）治疗卒中后吞咽障碍的最佳方案在其临床疗效方面仍存在不确定性。
目的：本研究旨在探讨高频 rTMS 刺激双侧运动皮质区对卒中后吞咽障碍患者颏舌肌皮质代表区的影响。
方法：本研究为单盲、随机对照研究，观察者设盲。将 35 例卒中患者随机分为三组干预组：双侧刺激组、单侧刺激组和假刺激组。双侧刺激组每天给予同侧和对侧运动皮质区 500 个 10 Hz rTMS 脉冲，连续 2 周，同侧和对侧皮质区投射至颏舌肌。单侧刺激组给予同侧颏舌肌皮质区 500 个 10 Hz rTMS 脉冲和对侧半球相同量的假 rTMS。假刺激组给予双侧运动皮质区假 rTMS。在干预前（T0）、干预后即刻（T1）和干预后 3 周（T2）使用临床吞咽障碍量表（CDS）、吞咽障碍结局和严重程度量表（DOSS）、渗透-吸入量表（PAS）和吞咽视频透视量表（VDS）评估临床吞咽功能和视频透视吞咽研究。
结果：CDS、DOSS、PAS 和 VDS 评分均有显著的时间和干预交互作用（p<0.05）。在三组间吞咽参数变化的直接比较中，T1 和 T2 时 CDS 评分的变化显示双侧模拟组的改善明显高于其他两组（p<0.05）。T1 时双侧刺激组的 DOSS、PAS 和 VDS 评分变化明显大于其他两组（p<0.05）。
结论：本研究结果提供了充分的证据表明，高频 rTMS 刺激双侧颏舌肌皮质代表区运动皮质区是一种有效的辅助治疗策略，可作为传统吞咽障碍治疗方法的补充。
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