Chen Qingfa, Huang Huayao, Chen Guangliang, Chen Jianhua, Fang Fangshuang, Lei Hanhan, Zhang Yixian, Lin Jilan, Chen Xiuyun, Liu Nan, Li Jing, Chen Ronghua, Du Houwei
From the Department of Rehabilitation, Fujian Medical University Union Hospital, Fuzhou, China.
From the Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China.
Cerebrovasc Dis. 2022;51(6):706-711. doi: 10.1159/000524241. Epub 2022 May 9.
Cerebellum might be active during the task of swallowing. Little is known whether cerebellar repetitive transcranial magnetic stimulation (rTMS) could improve post-stroke dysphagia (PSD) due to occlusion in the posterior circulation. This paper describes the rationale and design of a randomized controlled trial that aims to determine the effect of cerebellar rTMS on dysphagia due to posterior circulation stroke.
Thirty patients with PSD due to occlusion in the posterior circulation will be randomly divided to receive real (n = 20) or sham (n = 10) cerebellar rTMS. Patients in the real rTMS group will receive 250 pulses rTMS at a low intensity with 10 Hz frequency for 10 days (five consecutive days per week). The severity of dysphagia will be assessed with videofluoroscopic swallowing study (VFSS) using the Rosenbek penetration aspiration scale (PAS), the pharyngeal constriction ratio (PCR), and the dysphagia outcome and severity scale (DOSS) before and immediately after the last session and then again after 1 and 3 months. The functional magnetic resonance imaging (fMRI) will be assessed before and after the last session and then again after 1 month and 3 months. The primary outcome is the improvement of swallowing function determined by PAS, PCR, and DOSS. The secondary outcomes include changes in brain connectivity network detected using fMRI.
This study will determine whether cerebellar rTMS improves dysphagia due to posterior circulation stroke in Chinese patients. Our findings will contribute to a new approach for swallowing function recovery after posterior circulation stroke.
吞咽任务期间小脑可能处于活跃状态。对于后循环闭塞所致的脑卒中后吞咽困难（PSD），小脑重复经颅磁刺激（rTMS）是否能改善尚不清楚。本文描述了一项随机对照试验的原理和设计，旨在确定小脑rTMS对后循环卒中所致吞咽困难的影响。
30例因后循环闭塞导致PSD的患者将被随机分为两组，分别接受真正的（n = 20）或假的（n = 10）小脑rTMS治疗。真正rTMS组的患者将接受低频（10Hz）、低强度（250次脉冲）的rTMS治疗，持续10天（每周连续5天）。吞咽困难的严重程度将通过电视荧光吞咽造影检查（VFSS），采用罗森贝克渗透误吸量表（PAS）、咽缩窄率（PCR）以及吞咽困难结果和严重程度量表（DOSS），在最后一次治疗前、治疗后即刻、治疗后1个月和3个月进行评估。功能磁共振成像（fMRI）将在最后一次治疗前、治疗后、治疗后1个月和3个月进行评估。主要结局是由PAS、PCR和DOSS所确定的吞咽功能改善情况。次要结局包括使用fMRI检测到的脑连接网络变化。
本研究将确定小脑rTMS是否能改善中国患者后循环卒中所致的吞咽困难。我们的研究结果将为后循环卒中后吞咽功能恢复提供一种新方法。
