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神经导航高频重复经颅磁刺激治疗慢性脑卒中后吞咽困难:一项随机对照研究。

Neuronavigated high-frequency repetitive transcranial magnetic stimulation for chronic post-stroke dysphagia: A randomized controlled study.

作者信息

Cheng Ivy K Y, Chan Karen M K, Wong Chun-Sing, Li Leonard S W, Chiu Karen M Y, Cheung Raymond T F, Yiu Edwin M L

机构信息

Division of Speech and Hearing Sciences, The University of Hong Kong, , Hong Kong.

出版信息

J Rehabil Med. 2017 Jun 28;49(6):475-481. doi: 10.2340/16501977-2235.

Abstract

OBJECTIVE

There are potential benefits of repetitive transcranial magnetic stimulation (rTMS) in improving swallowing functions after stroke; however, few studies have been performed in the chronic stroke population. This study aims to distil the key effects of rTMS on swallowing functions and swallowing-related quality of life.

METHODS

Twenty-two participants with chronic post-stroke dysphagia were randomly assigned into active or sham rTMS groups. Seven participants withdrew from the study, thus data from 15 participants (mean age 64.6 years) were analysed. Participants received 3,000 pulses of 5 Hz rTMS (active: n = 11; sham: n = 4) on the tongue area of the motor cortex for 10 days over a period of 2 weeks. All participants were assessed 1 week before, and 2 months, 6 months and 12 months after stimulation. Outcomes were measured by a videofluoroscopic swallowing study, swallowing-related quality-of-life questionnaire and Iowa Oral Performance Instrument.

RESULTS

No statistically significant effects were identified for any outcome measures.

CONCLUSION

This study indicates that 5 Hz rTMS applied over the tongue area of the motor cortex is not effective for improving swallowing function in individuals with chronic post-stroke dysphagia. Possible explanations for these non-significant results are dis cussed. Future studies should explore the potential of the current protocol in conjunction with conventional dysphagia therapy.

摘要

目的

重复经颅磁刺激(rTMS)在改善卒中后吞咽功能方面可能具有益处;然而,针对慢性卒中患者群体开展的研究较少。本研究旨在提炼rTMS对吞咽功能及吞咽相关生活质量的关键影响。

方法

22例慢性卒中后吞咽困难患者被随机分为rTMS治疗组或假刺激组。7例患者退出研究,因此对15例患者(平均年龄64.6岁)的数据进行了分析。患者在2周内,于运动皮质舌区接受10天、频率为5Hz的3000次rTMS脉冲刺激(治疗组:n = 11;假刺激组:n = 4)。所有患者在刺激前1周、刺激后2个月、6个月和12个月进行评估。通过电视荧光吞咽造影检查、吞咽相关生活质量问卷及爱荷华口腔功能评估量表进行结果测量。

结果

未发现任何结果测量指标有统计学意义上的显著效果。

结论

本研究表明,对运动皮质舌区施加5Hz的rTMS对改善慢性卒中后吞咽困难患者的吞咽功能无效。对这些无显著结果的可能解释进行了讨论。未来的研究应探索当前方案与传统吞咽困难治疗相结合的潜力。

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