Neuromodulation With rTMS in Dysphagic Patients With Stroke

Taipei Veterans General Hospital, Taiwan5 enrolled

Overview

The patients with chronic dysphagia secondary to first-ever stroke were randomly assigned to 2 groups: Group A: sham stimulation for 10 minutes , Group B: real rTMS for 10 minutes. rTMS conditioning: daily rTMS 10 min for 10 days. Assessments: 1. videofluoroscopy，2.Functional outcome swallowing scale (3 scales). 3. MEP measurements

While the reﬂex component of swallowing depends on swallowing centres in the brainstem, initiation of swallowing is a voluntary action that involves the integrity of motor areas of the cerebral cortex. Oropharyngeal dysphagia occurs in more than 50% of stroke patients. Aspiration pneumonia occurs in up to 20% of acute stroke patients and is a major cause of mortality after discharge. Oropharyngeal dysphagia is both underestimated and underdiagnosed as a cause of major nutritional and respiratory complications in stroke patients. Recently, transcranial magnetic stimulation (TMS) has been used to study the cortical input to swallowing control and has revealed that the topographic representation of esophageal motor function in the human cerebral cortex is bilateral but with consistent interhemispheric asymmetry unrelated to handedness. In a number of recent studies, poststroke motor and dysphagia performance has been improved after daily treatment sessions with repetitive TMS (rTMS) using an excitatory frequency in patients with hemispheric ischaemic stroke due to occlusion of territories of the middle cerebral artery. Our hypothesis was that rTMS would facilitate dysphagia recovery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Transcranial Magnetic Stimulation

Interventions

repetitive transcranial magnetic stimulationDEVICE

rTMS

Eligibility

Sex: ALLMin age: 40 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. a diagnosis of stroke related dysphagia 2. no concurrent neurodegenerative or dementia history 3. an absence of TMS contraindications. Exclusion Criteria: * arrythmia, epilepsy, infection, hyperglycemia, pacemaker or implants, external ventricular drain or ventriculoperitoneal shunt

Outcomes

Primary Outcomes

functional outcome

points of Australian Therapy Outcome Measures-the Swallowing scale as assessed by a clinical therapist

Time frame: prior to treatment (baseline), on the next day after the 2 weeks treatment completion

Secondary Outcomes

videofluoroscopy

points of Penetration-Aspiration Scale as assessed by videofluoroscopy

Time frame: prior to treatment (baseline), on the next day after the 2 weeks treatment completion

cricopharyngeal motor evoked potentials

amplitude and latency measured by cricopharyngeal motor evoked potentials

Time frame: prior to treatment (baseline), on the next day after the 2 weeks treatment completion

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.