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The Effect of Repetitive Transcranial Magnetic Stimulation With Different Stimulation Methods on Post-Stroke
Li Jiayao1,2, Liu Zejian2, Zhao Henan1,2
1School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China.
Journal of Oral Rehabilitation
|June 17, 2025
Summary
Bilateral repetitive transcranial magnetic stimulation (rTMS) and early ipsilateral high-frequency rTMS (iHF-rTMS) show the most promise for improving swallowing in post-stroke dysphagia patients. Further research with standardized protocols is needed for optimal treatment.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Clinical Neurology
Background:
- Post-stroke dysphagia (PSD) significantly impacts patient quality of life.
- Repetitive transcranial magnetic stimulation (rTMS) is a promising non-invasive brain stimulation technique for PSD.
- Optimal rTMS protocols for PSD remain underexplored, with varying approaches based on different recovery theories.
Purpose of the Study:
- To conduct a network and traditional meta-analysis evaluating the efficacy of diverse rTMS methods for PSD.
- To identify the most effective rTMS stimulation strategy for improving swallowing function in PSD patients.
Main Methods:
- Systematic literature search across eight databases for rTMS treatment of PSD.
- Meta-analysis using Stata 17.0, with Cochrane risk bias assessment for study quality.
- Standardized Swallowing Assessment (SSA), Penetration Aspiration Scale (PAS), and Dysphagia Outcome and Severity Scale (DOSS) as primary outcome measures.
Main Results:
- Twenty-seven studies involving 1694 patients were analyzed, comparing five rTMS methods against placebo.
- Bilateral high-frequency rTMS (biHF-rTMS) and ipsilateral high-frequency plus contralateral low-frequency rTMS (iHF-cLF-rTMS) demonstrated superior improvements in SSA.
- Early application (post-stroke time < 1 month) of iHF-rTMS showed significant SSA improvement, while later application (≥ 1 month) benefited from cHF-rTMS and iHF-rTMS.
Conclusions:
- Bilateral stimulation protocols (biHF-rTMS, iHF-cLF-rTMS) offer greater efficacy than unilateral approaches for PSD.
- Early iHF-rTMS application is advantageous for swallowing rehabilitation.
- Methodological limitations necessitate high-powered randomized controlled trials with standardized protocols for precise rTMS rehabilitation strategies.
