不同刺激参数的重复经颅磁刺激对脑卒中后吞咽困难的影响：一项随机对照试验的系统评价和荟萃分析
Effect of repetitive transcranial magnetic stimulation with different stimulation parameters on post-stroke dysphagia: a systematic review and meta-analysis of randomized controlled trials.
作者信息
Peng Xu-Miao, Gong Cheng, Xiao Mei-Xia, Chen Liang-Sheng, Li Yi, Chen Jie, Wang Mao-Yuan, Luo Yun
机构信息
College of Rehabilitation, Gannan Medical University, Ganzhou, China.
Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
出版信息
Front Neurol. 2025 May 22;16:1586734. doi: 10.3389/fneur.2025.1586734. eCollection 2025.
BACKGROUND
Previous studies have demonstrated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating post-stroke dysphagia (PSD). However, consensus on optimal clinical protocols for rTMS remains unclear. This study systematically evaluated the efficacy and safety of rTMS with different stimulation parameters in the treatment of PSD to provide evidence-based recommendations for clinical practice.
METHODS
Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, related randomized controlled trials (RCTs) were searched across five databases (PubMed, Web of Science, Embase, Cochrane Library, MEDLINE) up to November 2024. Two reviewers independently screened studies, extracted data, and assessed quality using RevMan 5.40. Heterogeneity was evaluated via values, with fixed/random effects models applied accordingly.
RESULTS
A total of 18 RCTs with 835 PSD patients were included in this study. The overall risk of bias in the included trials was evaluated as low, and the level of evidence recommendation was rated as "strong." Meta-analyses demonstrated that both cerebral and cerebellar rTMS treatments significantly improved the swallowing function of PSD patients ( < 0.05). Subgroup analysis of cerebral rTMS showed that high-frequency rTMS (HF-rTMS) could effectively improve the swallowing function of PSD patients ( < 0.05), while low-frequency rTMS (LF-rTMS) failed to improve the swallowing function of PSD patients compared with the control group ( > 0.05). Furthermore, bilateral cerebral rTMS demonstrated superior efficacy in enhancing swallowing function compared to unilateral cerebral rTMS ( < 0.05). Subgroup analyses based on the Penetration Aspiration Scale (PAS) and Dysphagia Outcome Severity Scale (DOSS) revealed that cerebellar rTMS was more effective than cerebral rTMS in improving swallowing function in patients with PSD ( < 0.05). Regarding safety profiles, only 5 of the 18 RCTs documented mild and transient adverse events, including isolated cases of dizziness, headache, and temporary hearing impairment during treatment sessions.
CONCLUSION
Both cerebral and cerebellar rTMS therapy can effectively and safely improve swallowing function in patients with PSD. Furthermore, cerebellar rTMS appears to be superior to cerebral rTMS in the treatment of PSD.
SYSTEMATIC REVIEW REGISTRATION
背景
先前的研究已证明重复经颅磁刺激（rTMS）在治疗中风后吞咽困难（PSD）方面的有效性。然而，关于rTMS的最佳临床方案仍未达成共识。本研究系统评价了不同刺激参数的rTMS治疗PSD的疗效和安全性，为临床实践提供循证建议。
方法
按照系统评价和Meta分析的首选报告项目（PRISMA）指南，检索了截至2024年11月的五个数据库（PubMed、科学网、Embase、Cochrane图书馆、MEDLINE）中的相关随机对照试验（RCT）。两名研究者独立筛选研究、提取数据，并使用RevMan 5.40评估质量。通过I²值评估异质性，并相应应用固定/随机效应模型。
结果
本研究共纳入18项RCT，涉及835例PSD患者。纳入试验的总体偏倚风险评估为低，证据推荐等级为“强”。Meta分析表明，大脑和小脑rTMS治疗均能显著改善PSD患者的吞咽功能（P<0.05）。大脑rTMS的亚组分析显示，高频rTMS（HF-rTMS）能有效改善PSD患者的吞咽功能（P<0.05），而低频rTMS（LF-rTMS）与对照组相比未能改善PSD患者的吞咽功能（P>0.05）。此外，双侧大脑rTMS在增强吞咽功能方面的疗效优于单侧大脑rTMS（P<0.05）。基于渗透误吸量表（PAS）和吞咽困难结果严重程度量表（DOSS）的亚组分析显示，小脑rTMS在改善PSD患者吞咽功能方面比大脑rTMS更有效（P<0.05）。关于安全性，18项RCT中只有5项记录了轻微和短暂的不良事件，包括治疗期间孤立的头晕、头痛和短暂听力障碍病例。
结论
大脑和小脑rTMS治疗均可有效且安全地改善PSD患者的吞咽功能。此外，小脑rTMS在PSD治疗中似乎优于大脑rTMS。
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