Wu Xiaomin, Zhang Baixiang, Ambler Gareth, Chen Qingfa, Huang Huayao, Lin Huiying, Fang Shuangfang, Liu Nan, Du Houwei
Stroke Research Center, Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China; Institute of Clinical Neurology, Fujian Medical University, Fuzhou, China; Clinical Research Center for Precision Diagnosis and Treatment of Neurological Diseases of Fujian Province, Fuzhou, China.
Department of Rehabilitation Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.
Arch Phys Med Rehabil. 2025 Aug;106(8):1248-1257. doi: 10.1016/j.apmr.2024.12.018. Epub 2024 Dec 30.
Repetitive transcranial magnetic stimulation (rTMS) is a promising approach in improving swallowing function after stroke. However, comparative efficacy of different rTMS protocols for poststroke dysphagia (PSD) remains unclear.
PubMed, Embase, and Cochrane database were systematically searched for eligible random controlled trials (RCTs) from inception to August 30, 2024.
RCTs comparing rTMS with control or head-to-head comparisons of 2 rTMS protocols in patients with PSD.
Data were extracted by 2 independent reviewers. A network meta-analysis combining direct and indirect evidence was conducted to assess the pooled findings of RCTs with standard mean difference (SMD) with 95% credible interval (CrI).
Eighteen RCTs involving 760 participants (mean age of 62.4 [range 49.7-74.7] years; 45.7% women) were included. Pooled data showed that high frequency (HF)/ipsilesional hemisphere (ipsi-hemi) (SMD, -0.94; 95% CrI, -1.51 to -0.44), HF/bilateral hemisphere (bi-hemi) (SMD, -2.59; 95% CrI, -3.50 to -1.72), HF/ipsilesional cerebellar (ipsi-CRB) (SMD, -0.79; 95% CrI, -1.55 to -0.10), HF/bilateral cerebellar (bi-CRB) (SMD, -1.02; 95% CrI, -1.83 to -0.29), and HF/ipsi-hemi + low frequency (LF)/contralesional hemisphere (contra-hemi) (SMD, -2.72; 95% CrI, -4.12 to -1.41) rTMS all significantly improved swallowing function compared with control. For patients with acute stroke, HF/ipsi-hemi rTMS had a positive effect (SMD, -1.36; 95% CrI, -2.86 to -0.02); in subacute stage, HF/ipsi-hemi + LF/contra-hemi rTMS showed the best efficacy (SMD, -2.68; 95% CrI, -4.26 to -1.26). However, rTMS failed to improve swallowing function in chronic stage.
This network meta-analysis showed that most of the rTMS protocols (HF/ipsi-hemi, HF/bi-hemi, HF/ipsi-CRB, HF/bi-CRB, and HF/ipsi-hemi + LF/contra-hemi) may improve swallowing function in patients with PSD. The HF/ipsi-hemi rTMS had a positive effect in acute stage and the HF/ipsi-hemi + LF/contra-hemi protocol seemed to have the best efficacy when applied in subacute stroke.
重复经颅磁刺激（rTMS）是改善卒中后吞咽功能的一种有前景的方法。然而，不同rTMS方案对卒中后吞咽困难（PSD）的比较疗效仍不明确。
对PubMed、Embase和Cochrane数据库进行系统检索，以查找从数据库建立至2024年8月30日符合条件的随机对照试验（RCT）。
比较rTMS与对照组或两种rTMS方案在PSD患者中进行直接对比的RCT。
由2名独立的审阅者提取数据。进行了一项结合直接和间接证据的网络荟萃分析，以评估RCT的汇总结果，采用标准平均差（SMD）和95%可信区间（CrI）。
纳入了18项RCT，涉及760名参与者（平均年龄62.4岁[范围49.7 - 74.7岁]；45.7%为女性）。汇总数据显示，与对照组相比，高频（HF）/患侧半球（患侧半脑）（SMD，-0.94；95% CrI，-1.51至-0.44）、HF/双侧半球（双侧半脑）（SMD，-2.59；95% CrI，-3.50至-1.72）、HF/患侧小脑（患侧CRB）（SMD，-0.79；95% CrI，-1.55至-0.10）、HF/双侧小脑（双侧CRB）（SMD，-1.02；95% CrI，-1.83至-0.29）以及HF/患侧半脑 + 低频（LF）/对侧半球（对侧半脑）（SMD，-2.72；95% CrI，-4.12至-1.41）的rTMS均能显著改善吞咽功能。对于急性卒中患者，HF/患侧半脑rTMS有积极作用（SMD，-1.36；95% CrI，-2.86至-0.02）；在亚急性期，HF/患侧半脑 + LF/对侧半脑rTMS显示出最佳疗效（SMD，-2.68；95% CrI，-4.26至-1.26）。然而，rTMS在慢性期未能改善吞咽功能。
这项网络荟萃分析表明，大多数rTMS方案（HF/患侧半脑、HF/双侧半脑、HF/患侧CRB、HF/双侧CRB以及HF/患侧半脑 + LF/对侧半脑）可能改善PSD患者的吞咽功能。HF/患侧半脑rTMS在急性期有积极作用，而HF/患侧半脑 + LF/对侧半脑方案在亚急性卒中中应用时似乎具有最佳疗效。
