Han Dongmiao, Cheng Jinling, Chen Yanfeng, Du Hui, Lin Zhanxiang, Zhong Renlong, Liu Zicai
Department of Rehabilitation Therapy Teaching and Research, Gannan Healthcare Vocational College, Ganzhou, Jiangxi Province, 341000, China.
Department of Rehabilitation Medicine, Shaoguan First People's Hospital, Shaoguan, Guangdong Province, 512000, China.
Dysphagia. 2025 Feb;40(1):54-65. doi: 10.1007/s00455-024-10729-8. Epub 2024 Jul 15.
Dysphagia is the most common serious complication after stroke, with an incidence of about 37-78%, which seriously affects the independence of patients in daily life and clinical recovery. Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive neuromodulation technique, is an emerging option for post-stroke dysphagia. Theta burst stimulation (TBS) is a new mode of transcranial magnetic stimulation that simulates the frequency of pulses released in the hippocampus.Intermittent theta burst stimulation (iTBS) has been shown to increase cortical excitability and improve swallowing function in patients. Our study sought to summarize existing clinical randomized controlled trials to provide evidence-based medical evidence for the clinical use of iTBS. A computer search was conducted on 4 Chinese (Chinese Biomedical Literature Database, VIP Information Resource System, CNKI, and Wanfang Medical Science) and 4 English (including Cochrane Library, Embase, PubMed, Web of Science) databases to retrieve all randomized controlled trials in Chinese and English that explored the effects of Intermittent Theta Burst Stimulation for post-stroke dysphagia. The retrieval years are from database construction to 23 November 2023. The primary outcome measure was a change in Penetration/Aspiration Scale (PAS), Standardized Swallowing Assessment (SSA) and Functional Oral Intake Scale (FOIS), Secondary outcomes included Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), water-swallowing test (WST) etc. A meta-analysis by Standardized Mean Difference (SMD) and 95% confidence interval (CI) was performed with RevMan 5.3. we appraise risk of bias(RoB) of each study with the Cochrane RoB tool. Detailed instructions for using the Cochrane RoB tool are provided in the Cochrane Handbook for Systematic Reviews of Interventions (The Cochrane Handbook). Nine studies were obtained from eight databases after screening by inclusion and exclusion criteria, 567 patients from 9 studies were included in the meta-analysis, and one study was included in the qualitative analysis due to different control groups. Two of the nine studies had an unclear risk of bias, and four studies were at low risk. The results showed that iTBS significantly improved SSA, PAS, FOIS, and PAS scores in stroke patients compared to the control group(P < 0.05), and promoted swallowing function recovery. Our systematic review provides the first evidence of the efficacy of iTBS in improving dysphagia in stroke patients. However, the number of available studies limits the persuasiveness of the evidence and further validation by additional randomized controlled trials is needed.
吞咽困难是中风后最常见的严重并发症，发生率约为37%-78%，严重影响患者日常生活的独立性和临床康复。重复经颅磁刺激（rTMS）作为一种非侵入性神经调节技术，是中风后吞咽困难的一种新兴治疗选择。theta爆发刺激（TBS）是一种新的经颅磁刺激模式，模拟海马体中释放的脉冲频率。间歇性theta爆发刺激（iTBS）已被证明可提高皮层兴奋性并改善患者的吞咽功能。我们的研究旨在总结现有的临床随机对照试验，为iTBS的临床应用提供循证医学证据。通过计算机检索4个中文数据库（中国生物医学文献数据库、维普资讯资源系统、中国知网和万方医学网）和4个英文数据库（包括Cochrane图书馆、Embase、PubMed、Web of Science），检索所有探索间歇性theta爆发刺激对中风后吞咽困难影响的中英文随机对照试验。检索年份从数据库建库至2023年11月23日。主要结局指标为渗透/误吸量表（PAS）、标准化吞咽评估（SSA）和功能性经口进食量表（FOIS）的变化，次要结局包括纤维内镜吞咽困难严重程度量表（FEDSS）、饮水试验（WST）等。使用RevMan 5.3软件进行标准化均数差（SMD）和95%置信区间（CI）的Meta分析。我们使用Cochrane偏倚风险（RoB）工具评估每项研究的偏倚风险。Cochrane干预措施系统评价手册（The Cochrane Handbook）中提供了使用Cochrane RoB工具的详细说明。经过纳入和排除标准筛选，从8个数据库中获得9项研究，9项研究中的567例患者纳入Meta分析，1项研究因对照组不同纳入定性分析。9项研究中有2项偏倚风险不明确，4项研究偏倚风险较低。结果显示，与对照组相比，iTBS显著改善了中风患者的SSA、PAS、FOIS及PAS评分（P＜0.05），促进了吞咽功能恢复。我们的系统评价首次提供了iTBS改善中风患者吞咽困难疗效的证据。然而，现有研究数量限制了证据的说服力，需要更多随机对照试验进一步验证。
