Repetitive Transcranial Magnetic Stimulation Over a Different Side of the Cortex for Rehabilitating Poststroke Dysphagia: A Randomized, Double-blind Clinical Trial.

OBJECTIVE

This randomized, sham-controlled, double-blind study investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on both bilateral and unilateral brain regions in patients with poststroke dysphagia.

METHODS

Seventy poststroke dysphagia patients were randomly divided into four intervention groups: the ipsilesional stimulation group (ISG), the contralesional stimulation group (CSG), the bilateral stimulation group (BSG), and the sham stimulation group (SSG) with 3 Hz rTMS administered for 4 weeks, five days per week. Outcomes were assessed using a videofluoroscopic swallowing study (VFSS) at three time points: at baseline before the intervention (T0), immediately after the intervention (T1), and four weeks after intervention cessation (T2). These assessments included the latency of wave V in brainstem auditory evoked potentials (BAEP), Dysphagia Outcome and Severity Scale (DOSS), Penetration and Aspiration Scale (PAS), and Videofluoroscopic Dysphagia Scale (VDS).

RESULTS

The swallowing improvement of BSG and CSG were showed significantly greater than SSG (p < 0.05), while the ISG exhibited no significant differences in the DOSS and total VDS scores (p > 0.05). Furthermore, some sub-items of the VDS were lower than those in the SSG (p < 0.05). The latency of wave V in BAEP of ipsilesional and contralesional was synchronized and shortened in the BSG at T1 and T2; similar results were observed in the CSG at T2. In contrast, in the ISG, only the latency of ipsilesional V was shortened at T1 and T2 (p < 0.05).

CONCLUSIONS

The results of the present study provide evidence that 3 Hz rTMS is more effective than traditional dysphagia therapies when applied to the bilateral and contralesional motor cortices, especially bilaterally over the cortical areas projecting to the mylohyoid muscles. Functional recovery was observed after real rTMS compared to the SSG, with the effects persisting at T2.

TRIAL REGISTRATION

Study on the imaging of swallowing function and multimodal brain function in stroke patients with dysphagia based on different lateral repetitive transcranial magnetic stimulation: a randomized controlled trial. ( http://www.chictr.org.cn/ , ChiCTR2100044993, April 3, 2021).