The Effect of Repetitive Transcranial Magnetic Stimulation on Dysphagia After Stroke: A Systematic Review and Meta-Analysis

Abstract

Objective: The primary purpose of our study is to systemically evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on recovery of dysphagia after stroke.Search Methods: We searched randomized controlled trials (RCTs) and non-RCTs published by PubMed, the Cochrane Library, ScienceDirect, MEDLINE, and Web of Science from inception until April 24, 2021. Language is limited to English. After screening and extracting the data, and evaluating the quality of the selected literature, we carried out the meta-analysis with software RevMan 5.3 and summarized available evidence from non-RCTs.Results: Among 205 potentially relevant articles, 189 participants (from 10 RCTs) were recruited in the meta-analysis, and six non-RCTs were qualitatively described. The random-effects model analysis revealed a pooled effect size of SMD = 0.65 (95% CI = 0.04–1.26, p = 0.04), which indicated that rTMS therapy has a better effect than conventional therapy. However, the subgroup analysis showed that there was no significant difference between low-frequency and high-frequency groups. Even more surprisingly, there were no statistically significant differences between the two groups and the conventional training group in the subgroup analysis, but the combined effect was positive.Conclusion: Our study suggests that rTMS might be effective in treating patients with dysphagia after stroke.

Commentary: The Effect of Repetitive Transcranial Magnetic Stimulation on Dysphagia After Stroke: A Systematic Review and Meta-Analysis

“…The Effect of Repetitive Transcranial Magnetic Stimulation on Dysphagia After Stroke: A Systematic Review and Meta-Analysis by Yang, W., Cao, X., Zhang, X., Wang, X., Li, X., and Huai, Y. (2021).…”

“…Therefore, the article of Yang et al (2021) is very timely. Nevertheless, in this review, we have two main issues that question the validity of their results: (1) missing studies and (2) incorrect data extraction/analysis.…”

Repetitive transcranial magnetic stimulation of the primary motor cortex in stroke survivors-more than motor rehabilitation: A mini-review

“…Stimulation targets of the M1 have varied between the tongue, mylohyoid, pharyngeal, and esophageal representations at the M1 ( Yang et al, 2021 ). In addition, no significant difference in the swallowing recovery was noted between low- and high-frequency rTMS protocols ( Yang et al, 2021 ).…”

“…Stimulation targets of the M1 have varied between the tongue, mylohyoid, pharyngeal, and esophageal representations at the M1 ( Yang et al, 2021 ). In addition, no significant difference in the swallowing recovery was noted between low- and high-frequency rTMS protocols ( Yang et al, 2021 ). Nonetheless, bihemispheric M1-rTMS has shown better effects on the swallowing function compared to unilateral stimulation ( Cheng et al, 2020 ).…”

Transcranial Magnetic Stimulation for Improving Dysphagia After Stroke: A Meta-Analysis of Randomized Controlled Trials

“…In recent years, several meta-analyses (Yang et al, 2015(Yang et al, , 2021Liao et al, 2017;Lin et al, 2019;Cheng et al, 2021; have investigated the effects of rTMS on post-stroke dysphagia, suggesting that rTMS may have beneficial effects on swallowing disorders. However, some of reviews focused on non-invasive brain stimulation (NIBS), including rTMS, transcranial Direct Current Stimulation (tDCS) and other kinds of stimulation, while few of reviews further analyzed the effects of stimulation site, frequency and stimulation time on dysphagia.…”