Content » Vol 49, Issue 6

Original report

Neuronavigated high-frequency repetitive transcranial magnetic stimulation for chronic post-stroke dysphagia: A randomized controlled study

Ivy K.Y. Cheng, Karen M.K. Chan, Chun-sing Wong, Leonard S.W. Li, Karen M.Y. Chiu, Raymond T.F. Cheung, Edwin M.L. Yiu
Division of Speech and Hearing Sciences, The University of Hong Kong, Hong Kong
DOI: 10.2340/16501977-2235


Objective: There are potential benefits of repetitive transcranial magnetic stimulation (rTMS) in improving swallowing functions after stroke; however, few studies have been performed in the chronic stroke population. This study aims to distil the key effects of rTMS on swallowing functions and swallowing-related quality of life.
Methods: Twenty-two participants with chronic post-stroke dysphagia were randomly assigned into active or sham rTMS groups. Seven participants withdrew from the study, thus data from 15 participants (mean age 64. 6 years) were analysed. Participants received 3,000 pulses of 5 Hz rTMS (active: n = 11; sham: n = 4) on the tongue area of the motor cortex for 10 days over a period of 2 weeks. All participants were assessed 1 week before, and 2 months, 6 months and 12 months after stimulation. Outcomes were measured by a videofluoroscopic swallowing study, swallowing-related quality-of-life questionnaire and Iowa Oral Performance Instrument.
Results: No statistically significant effects were identified for any outcome measures.
Conclusion: This study indicates that 5 Hz rTMS applied over the tongue area of the motor cortex is not effective for improving swallowing function in individuals with chronic post-stroke dysphagia. Possible explanations for these non-significant results are dis
cussed. Future studies should explore the potential of the current protocol in conjunction with conventional dysphagia therapy.

Lay Abstract

When stroke damages brain regions that are related to the control of swallowing, survivors may experience long-term swallowing difficulties after stroke. We studied if the post-stroke survivors’ swallowing functions can be improved by using external electromagnetic stimulation on the brain. 15 stroke patients who had swallowing difficulties for more than one year participated in the study. We performed brain stimulation treatment on 11 patients and sham stimulation (placebo treatment) on 4 patients. The results showed that both groups of patients did not change in swallowing functions over the 12-month follow-up period. This study does not support the use of the examined stimulation protocol as treatment for long-term swallowing difficulties after stroke. Future studies are needed to determine the optimal use of brain stimulation to improve swallowing functions for stroke patients.


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