Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Arch Phys Med Rehabil. 2019 Apr;100(4):739-750.e4. doi: 10.1016/j.apmr.2018.09.117. Epub 2018 Oct 21.
To investigate the effectiveness of noninvasive neurostimulation therapies in patients with poststroke dysphagia.
Electronic databases, including Embase, PubMed, Scopus, and the Cochrane Library, were searched up to May 31, 2018.
All published randomized controlled trials (RCTs) comparing neurostimulation therapies, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), surface neuromuscular electrical stimulation (sNMES), and pharyngeal electrical stimulation (PES), in patients with acute and subacute poststroke dysphagia were included. Nineteen RCTs were enrolled in the meta-analysis.
Full texts were independently reviewed. Two independent raters assessed the risk of bias of RCTs with the Cochrane risk-of-bias tool. The primary outcome measure was swallowing function evaluated before and after neurostimulation therapy.
Both pairwise and network meta-analysis revealed that rTMS, tDCS, and sNMES significantly improved poststroke dysphagia compared with placebo. Differences in functional improvement between PES and placebo were not significant. Based on probability ranking, rTMS seemed the best treatment among the 4 neurostimulation therapies. In the network meta-analysis, rTMS showed the best efficacy compared with placebo (standardized mean difference=1.02, 95% confidence interval, 0.61-1.43).
Among the 4 noninvasive neurostimulation therapies, rTMS, tDCS, and sNMES were effective for treating poststroke dysphagia; furthermore, rTMS may be the most effective therapy according to probability ranking.
研究非侵入性神经刺激疗法对脑卒中后吞咽障碍患者的疗效。
电子数据库，包括 Embase、PubMed、Scopus 和 Cochrane 图书馆，检索至 2018 年 5 月 31 日。
纳入所有比较神经刺激疗法（包括重复经颅磁刺激（rTMS）、经颅直流电刺激（tDCS）、表面神经肌肉电刺激（sNMES）和咽部电刺激（PES））的已发表随机对照试验（RCTs），用于治疗急性和亚急性脑卒中后吞咽障碍患者。共有 19 项 RCT 纳入荟萃分析。
独立审查全文。两名独立评估者使用 Cochrane 偏倚风险工具评估 RCT 的偏倚风险。主要结局指标为神经刺激治疗前后的吞咽功能评估。
无论是两两比较还是网络荟萃分析均表明，rTMS、tDCS 和 sNMES 均显著改善脑卒中后吞咽障碍，优于安慰剂。PES 与安慰剂在功能改善方面的差异无统计学意义。基于概率排序，rTMS 似乎是 4 种神经刺激疗法中最佳治疗方法。在网络荟萃分析中，rTMS 与安慰剂相比显示出最佳疗效（标准化均数差=1.02，95%置信区间，0.61-1.43）。
在 4 种非侵入性神经刺激疗法中，rTMS、tDCS 和 sNMES 对治疗脑卒中后吞咽障碍均有效；此外，根据概率排序，rTMS 可能是最有效的治疗方法。
