Zhang Haiquan, Tan Jingyun, Lu Wei, Han Junting, Kong Shanshan, Meng Yang, Chen Feng, Liu Min, Wang Shanshan
Department of Rehabilitation Medicine, Shandong Provincial Third Hospital, Jinan, Shandong, China.
Faculty of Sports and Exercise Science, University of Malaya, Kuala Lumpur, Malaysia.
Neuromodulation. 2025 Aug 2. doi: 10.1016/j.neurom.2025.06.015.
Intermittent theta burst stimulation (iTBS) may enhance cortical excitability and induce neuroplastic changes through specific pulse patterns. This study aimed to investigate whether bilateral cerebellar hemisphere iTBS improves swallowing function in patients with subacute stroke and promotes reorganization of brain networks.
In this sham-controlled, single-blind, randomized trial with blinded outcome assessment, both groups initially underwent conventional swallowing therapy including oropharyngeal training and Shaker exercises; 64 patients with subacute stroke with dysphagia received either active iTBS or sham-iTBS interventions. The stimulation parameters were 100% resting motor threshold, 50-Hz intraburst frequency, 5-Hz interburst frequency, and 1200 pulses per session. Swallowing function was assessed using the Standardized Swallowing Assessment (SSA) and Penetration-Aspiration Scale (PAS) at baseline and after a four-week intervention period. Functional near-infrared spectroscopy (fNIRS) was used to evaluate resting-state functional connectivity and task-induced cortical activation patterns.
Both groups showed significant improvements in SSA and PAS scores after treatment (p < 0.05). However, the iTBS group exhibited significantly greater reductions in SSA and PAS scores than did the sham group (p < 0.05). fNIRS analysis revealed enhanced activation in the prefrontal cortex (PFC) and strengthened functional connectivity between the PFC and key regions, including the primary somatosensory cortex (S1), primary motor cortex, and right premotor cortex (RPM) in the iTBS group (p < 0.05). Notably, improvements in SSA scores correlated positively with strengthened functional connectivity between the RPM and left PFC (LPFC), in addition to between the LPFC and left premotor cortex (LPM) (p < 0.05).
Bilateral cerebellar iTBS effectively enhances swallowing function in patients with subacute stroke, accompanied by increased interregional functional connectivity and heightened cortical excitability. The observed correlations between clinical improvements and specific connectivity patterns suggest that RPM-LPFC and LPFC-LPM pathways may represent key neuromodulatory targets for swallowing rehabilitation in this population.
The Chinese Clinical Trial Registry number for the study is ChiCTR2300071303.
间歇性theta爆发刺激（iTBS）可能通过特定的脉冲模式增强皮质兴奋性并诱导神经可塑性变化。本研究旨在探讨双侧小脑半球iTBS是否能改善亚急性中风患者的吞咽功能并促进脑网络重组。
在这项有假刺激对照、单盲、随机且结果评估设盲的试验中，两组患者最初均接受常规吞咽治疗，包括口咽训练和摇头运动；64例亚急性中风伴吞咽困难的患者接受了主动iTBS或假iTBS干预。刺激参数为100%静息运动阈值、50赫兹的簇内频率、5赫兹的簇间频率以及每次治疗1200个脉冲。在基线和四周干预期后，使用标准化吞咽评估（SSA）和渗透-误吸量表（PAS）评估吞咽功能。功能近红外光谱（fNIRS）用于评估静息态功能连接和任务诱发的皮质激活模式。
两组治疗后SSA和PAS评分均有显著改善（p < 0.05）。然而，iTBS组的SSA和PAS评分降低幅度显著大于假刺激组（p < 0.05）。fNIRS分析显示，iTBS组前额叶皮质（PFC）激活增强，PFC与关键区域之间的功能连接增强，这些关键区域包括初级体感皮质（S1）、初级运动皮质和右侧运动前皮质（RPM）（p < 0.05）。值得注意的是，SSA评分的改善与RPM和左侧PFC（LPFC）之间以及LPFC和左侧运动前皮质（LPM）之间功能连接的增强呈正相关（p < 0.05）。
双侧小脑iTBS能有效增强亚急性中风患者的吞咽功能，同时伴有区域间功能连接增加和皮质兴奋性提高。临床改善与特定连接模式之间的相关性表明，RPM-LPFC和LPFC-LPM通路可能是该人群吞咽康复的关键神经调节靶点。
该研究在中国临床试验注册中心的注册号为ChiCTR2300071303。
