Woo Chang Gok, Kim Ji Hyoun, Lee Jeong Hwan, Kim Hyo Jong
Department of Pathology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea.
Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea.
World J Clin Cases. 2023 Oct 6;11(28):6850-6856. doi: 10.12998/wjcc.v11.i28.6850.
Dysphagia is a common condition in older as well as young patients, and a variety of treatments have been reported depending on the cause. However, clinicians are challenged when the cause is unclear. This is the case with psychogenic dysphagia, which has typically been treated with supportive psychotherapy, medication, swallowing exercise, and dysphagia rehabilitation therapy. Here, we aimed to relieve the symptoms of a patient with refractory psychogenic dysphagia, who was unresponsive to conventional swallowing therapy, with repetitive transcranial magnetic stimulation (rTMS).
A relatively calm-looking 35-year-old female patient presented with a 2-year history of dysphagia. She showed little improvement with conventional swallowing treatments over the past 2 years. She was relatively compliant with in-hospital dysphagia therapy, but uncooperative with home exercise and medication. In particular, since she was resistant to drug treatment, we had to take a different approach than the treatment she had been receiving for the past 2 years. After much deliberation, we decided to initiate antidepressant rTMS treatment with her consent (IRB No. 2023-05-021). Antidepressant rTMS treatment was performed twice weekly for a total of 20 sessions over 10 wk. The results showed improvement in subjective symptoms and video fluoroscopic swallowing study findings. To the best of our knowledge, this is the first report of symptomatic improvement using antidepressant rTMS protocol for refractory psychogenic dysphagia.
This case demonstrates that rTMS with antidepressant protocol can be used to improve swallowing in patients with refractory psychogenic dysphagia.
吞咽困难在老年和年轻患者中均为常见病症，根据病因已有多种治疗方法的报道。然而，当病因不明时，临床医生会面临挑战。心因性吞咽困难就是这种情况，其通常采用支持性心理治疗、药物治疗、吞咽训练及吞咽困难康复治疗。在此，我们旨在通过重复经颅磁刺激（rTMS）缓解一名难治性心因性吞咽困难患者的症状，该患者对传统吞咽治疗无反应。
一名面容相对平静的35岁女性患者，有2年吞咽困难病史。在过去2年中，她接受传统吞咽治疗后改善甚微。她相对配合住院期间的吞咽困难治疗，但不配合家庭训练和药物治疗。特别是，由于她对药物治疗有抵触情绪，我们不得不采取与她过去2年所接受治疗不同的方法。经过深思熟虑，我们征得她的同意后开始进行抗抑郁rTMS治疗（伦理审查委员会编号：2023 - 05 - 021）。抗抑郁rTMS治疗每周进行2次，共20次，持续10周。结果显示主观症状和视频透视吞咽研究结果均有改善。据我们所知，这是首例使用抗抑郁rTMS方案治疗难治性心因性吞咽困难并取得症状改善的报告。
本病例表明，采用抗抑郁方案的rTMS可用于改善难治性心因性吞咽困难患者的吞咽功能。
