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

Abstract

BackgroundRehabilitation of post-stroke dysphagia is an urgent clinical problem, and repetitive transcranial magnetic stimulation (rTMS) has been widely used in the study of post-stroke function. However, there is no reliable evidence-based medicine to support the effect of rTMS on post-stroke dysphagia. This review aims to evaluate the effectiveness and safety of rTMS on post-stroke dysphagia.MethodsEnglish-language literature published before December 20, 2021, were searched in six electronic databases. Identified articles were screened, data were extracted, and the methodological quality of included trials was assessed. Meta-analysis was performed using RevMan 5.3 software. The GRADE method was used to assess the quality of the evidence.ResultsA total of 10 studies with 246 patients were included. Meta-analysis showed that rTMS significantly improved overall swallowing function (standardized mean difference [SMD]−0.76, 95% confidence interval (CI)−1.07 to−0.46, p < 0.0001, n = 206; moderate-quality evidence), Penetration Aspiration Scale (PAS) (mean difference [MD]−1.03, 95% CI−1.51 to−0.55, p < 0.0001, n = 161; low-quality evidence) and Barthel index scale (BI) (MD 23.86, 95% CI 12.73 to 34.99, p < 0.0001, n = 136; moderate-quality evidence). Subgroup analyses revealed that (1) rTMS targeting the affected hemisphere and targeting both hemispheres significantly enhanced overall swallowing function and reduced aspiration. (2) Low-frequency rTMS significantly enhanced overall swallowing function and reduced aspiration, and there was no significant difference between high-frequency rTMS and control group in reducing aspiration (p = 0.09). (3) There was no statistical difference in the dropout rate (low-quality evidence) and adverse effects (moderate-quality evidence) between the rTMS group and the control group.ConclusionrTMS improved overall swallowing function and activity of daily living ability and reduced aspiration in post-stroke patients with good acceptability and mild adverse effects.

Transcranial Magnetic Stimulation, Connectome and Its Clinical Applications

“…rTMS is also shown to be effective in rehabilitation of dysphagia after stroke in recent published systematic reviews [54,55]. The mean difference was −1.03 with p value <0.0001 in Penetration Aspiration Scale after completion of TMS [55].…”

“…Neuropathic pain is one of the big topics in pain management, and TMS is shown to be an effective tool in managing those patients [52,53]. rTMS is also shown to be effective in rehabilitation of dysphagia after stroke in recent published systematic reviews [54,55]. The mean difference was −1.03 with p value <0.0001 in Penetration Aspiration Scale after completion of TMS [55].…”

Assessment and treatment of neurogenic dysphagia in stroke and Parkinson's disease

“…In terms of treatment acceptability, both rTMS and tDCS are well tolerated and no serious adverse effects have been reported [103,104 ▪▪ ].…”

“…Some meta-analyses found more significant effects of rTMS when using high-frequency stimulation, which increases cortical activity [102,105]. Conversely, other authors found more significant effects of inhibitory, low-frequency rTMS [103]. Conflicting findings are partly because of the low number of studies, assessing the therapeutic effects of low-frequency rTMS [106].…”

Commentary: The effectiveness of repetitive transcranial magnetic stimulation for post-stroke dysphagia: A systematic review and meta-analysis

“…The study by Zhu and Gu ( 2022 ) showed that rTMS increased swallowing function compared with the sham stimulation group [SMD = 1.08 (0.37, 1.80), I 2 = 81.2%, p < 0.001]. Xie et al ( 2022a , b ) reported two articles about the influence of rTMS for dysphasia after stroke, and the effect value showed [SMD = −0.76 (−1.07, −0.46), ( p < 0.001)] and [SMD = −0.87 (−1.22, −0.52), ( p < 0.001)], respectively.…”