Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Expert Rev Neurother. 2021 Oct;21(10):1135-1146. doi: 10.1080/14737175.2021.1974841. Epub 2021 Sep 17.
Studies have shown that noninvasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), can promote neuroplasticity, which is considered important for functional recovery of swallowing after stroke. Despite extensive studies on NIBS, there remains a gap between research and clinical practice.
In this article, we update the current knowledge on the benefits and challenges of rTMS and tDCS for post-stroke dysphagia. We identify some key limitations of these techniques that hinder the translation from clinical trials to routine practice. Finally, we discuss the future of NIBS as a treatment for post-stroke dysphagia in real-world settings.
Current evidence suggests that rTMS and tDCS show promise as a treatment for post-stroke dysphagia. However, these techniques are limited by the response variability, uncertainty on the safety in patients with comorbidities and difficulties in clinical study designs. Such limitations call for further work to enhance their utility through individualized approaches. Despite this, the last decade has seen a growing acceptance toward these techniques among clinical personnel. As such, we advocate caution but support optimism that NIBS will gradually be recognized as a mainstream treatment approach for post-stroke dysphagia in the future.
研究表明，非侵入性脑刺激（NIBS），包括重复经颅磁刺激（rTMS）和经颅直流电刺激（tDCS），可以促进神经可塑性，这被认为对中风后吞咽功能的恢复很重要。尽管对 NIBS 进行了广泛的研究，但研究与临床实践之间仍存在差距。
本文更新了 rTMS 和 tDCS 对中风后吞咽困难的益处和挑战的最新知识。我们确定了这些技术的一些关键限制，这些限制阻碍了从临床试验到常规实践的转化。最后，我们讨论了 NIBS 作为中风后吞咽困难的真实环境中的治疗方法的未来。
目前的证据表明，rTMS 和 tDCS 作为中风后吞咽困难的治疗方法具有一定的前景。然而，这些技术受到响应可变性、合并症患者安全性的不确定性以及临床研究设计困难的限制。这些局限性要求进一步的工作通过个性化方法来增强它们的实用性。尽管如此，在过去十年中，临床人员对这些技术的接受程度不断提高。因此，我们主张谨慎但乐观地认为，NIBS 将逐渐被公认为中风后吞咽困难的主流治疗方法。
