Transcranial direct current stimulation for post-stroke dysphagia: a meta-analysis

Abstract

Background Strokes may cause some swallowing difficulty or associated dysphagia in 25–80% of patients. This phenomenon has been linked to increased morbidity and mortality. Therefore, the aim of this study was to evaluate the efficacy of transcranial direct current stimulation in patients with dysphagia in post-stroke patients. Methods A systematic search in PubMed, Scopus, Web of Science and MEDLINE was conducted. The articles must have to evaluate an intervention that included transcranial direct current stimulation; the sample had to consist exclusively of patients with post-stroke dysphagia; and the experimental design consisted of randomized controlled trial. Difference in mean differences and their 95% confidence interval were calculated as the between-group difference in means divided by the pooled standard deviation. The I2 statistic was used to determine the degree of heterogeneity. Results Of the 9 investigations analyzed, all applied transcranial direct current stimulation in combination with conventional dysphagia therapy to the experimental group. All the studies analyzed identified improvements in swallowing function and meta-analysis confirmed their strong effect on reducing the risk of penetration and aspiration (Hedges’s g = 0.55). The results showed that participants who received transcranial direct current stimulation significantly improved swallowing function. Conclusions Transcranial direct current stimulation has positive effects in the treatment of poststroke dysphagia by improving swallowing function, oral and pharyngeal phase times and the risk of penetration and aspiration. Furthermore, its combination with conventional dysphagia therapy, balloon dilatation with catheter or training of the swallowing muscles ensures improvement of swallowing function. PROSPERO registration ID CRD42022314949

The impact of physical therapy on dysphagia in neurological diseases: a review

“…Dysphagia can also be ameliorated by tDCS in older adults with and without neurological conditions, which is associated with the induction of a polar-dependent shift in underlying cortical excitability, as well as a broad activation of pharyngeal motor cortex in both brain hemispheres ( Cosentino et al, 2020 ). Furthermore, stroke patients often choose tDCS as a treatment for dysphagia, with numerous therapeutic targets ( Gómez-García et al, 2023 ), related to the regions involved in the swallowing network and the fact that tDCS promotes neuroplasticity ( Ahn et al, 2017 ). For example, enhancing the excitability of the uninjured side of the swallowing cortex, the injured side of the swallowing cortex, the bilateral swallowing cortex, and the superior limbic gyrus can be beneficial for enhancing swallowing function ( Wang et al, 2020 ; Mao et al, 2022 ; Farpour et al, 2023 ).…”

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“…Dysphagia can also be ameliorated by tDCS in older adults with and without neurological conditions, which is associated with the induction of a polar-dependent shift in underlying cortical excitability, as well as a broad activation of pharyngeal motor cortex in both brain hemispheres (Cosentino et al, 2020). Furthermore, stroke patients often choose tDCS as a treatment for dysphagia, with numerous therapeutic targets (Gómez-García et al, 2023), related to the regions involved in the swallowing network and the fact that tDCS promotes neuroplasticity (Ahn et al, 2017). For example, enhancing the excitability of the uninjured side of the swallowing cortex, the injured side of the swallowing cortex, the bilateral swallowing cortex, and the superior limbic gyrus can be beneficial for enhancing swallowing function (Wang et al, 2020;Mao et al, 2022;Farpour et al, 2023).…”