The Effect of Repetitive Transcranial Magnetic Stimulation With Different Stimulation Methods on Post-Stroke Dysphagia: A Network Meta-Analysis

IF 4 3区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of oral rehabilitation Pub Date : 2025-06-16 DOI:10.1111/joor.14038

Li Jiayao, Liu Zejian, Zhao Henan, Chen Yuan, Qi Hongjing, Zhang Jun, Sun Jie

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引用次数: 0

Abstract

Background

Multiple studies have substantiated that repetitive transcranial magnetic stimulation (rTMS) is effective in improving the swallowing function of patients with post-stroke dysphagia (PSD). Nevertheless, the choice of stimulation methods diverges, underpinned by different recovery theories. Among the distinct stimulation approaches currently in use, which one yields the most optimal therapeutic outcomes remains unexplored.

Objective

To evaluate the rehabilitation efficacy of different rTMS methods on the swallowing function of PSD patients through network meta-analysis and traditional meta-analysis.

Methods

We searched eight databases to identify articles on rTMS treatment for PSD from inception to May 5, 2024, and screened them using EndNote 20.0. The quality of articles was evaluated by Cochrane risk bias assessment criteria, and Stata 17.0 was adopted for meta-analysis. Standardised swallowing assessment (SSA), penetration aspiration scale (PAS), and dysphagia outcome and severity scale (DOSS) served as the outcome measures of the study.

Results

A total of 27 articles involving 1694 patients were selected. The studies encompassed five types of stimulation methods: high-frequency rTMS on the ipsilateral hemisphere (iHF-rTMS), low-frequency rTMS on the contralateral hemisphere (cLF-rTMS), high-frequency rTMS on the contralateral hemisphere (cHF-rTMS), high-frequency rTMS on the bilateral hemispheres (biHF-rTMS), and iHF-rTMS + cLF-rTMS (iHF-cLF-rTMS). Compared with placebo, iHF-cLF-rTMS [mean difference (MD) = −11.34, 95% confidence interval (CI): −14.57 to −8.12], biHF-rTMS (MD = −6.52, 95% CI: −8.50 to −4.55), cHF-rTMS (MD = −2.84, 95% CI: −4.37 to −1.31), and iHF-rTMS (MD = −1.89, 95% CI: −2.82 to −0.96) showed significantly better effects on improving SSA of patients with PSD. According to traditional meta-analysis, for patients with post-stroke time < 1 month, iHF-rTMS (MD = −0.558, 95% CI: −0.966 to −0.150) demonstrated a superior therapeutic outcome of SSA, while for those with post-stroke time ≥ 1 month, SSA was more significantly improved in cHF-rTMS (MD = −0.760, 95% CI: −1.193 to −0.327) and iHF-rTMS (MD = −0.428, 95% CI: −0.665 to −0.129) groups, when compared with placebo.

Conclusions

Bilateral stimulation protocols (biHF-rTMS and iHF-cLF-rTMS) confer superior efficacy over unilateral approaches. Early application of iHF-rTMS shows advantages. However, methodological limitations, including heterogeneity in stimulation parameters, small sample sizes in subgroup analyses, and insufficient long-term follow-up, warrant cautious interpretation. Future high-powered RCTs with standardised protocols are imperative to optimise rTMS-based precision rehabilitation.

查看原文本刊更多论文

不同刺激方式的重复经颅磁刺激对脑卒中后吞咽困难的影响：网络荟萃分析。

背景：多项研究证实，重复经颅磁刺激（rTMS）可有效改善脑卒中后吞咽困难（PSD）患者的吞咽功能。然而，在不同的采收率理论的支持下，增产方法的选择存在分歧。在目前使用的不同刺激方法中，哪一种产生最理想的治疗效果仍未被探索。目的：通过网络meta分析和传统meta分析，评价不同rTMS方法对PSD患者吞咽功能的康复效果。方法：检索8个数据库，检索自成立至2024年5月5日有关rTMS治疗PSD的文章，并使用EndNote 20.0进行筛选。采用Cochrane风险偏倚评价标准评价文章质量，meta分析采用Stata 17.0。标准化吞咽评估（SSA）、渗透吸入量表（PAS）和吞咽困难结局及严重程度量表（DOSS）作为研究的结局测量指标。结果：共纳入文献27篇，患者1694例。研究包括5种刺激方法：同侧半球高频rTMS （iHF-rTMS）、对侧半球低频rTMS （cLF-rTMS）、对侧半球高频rTMS （cHF-rTMS）、双侧半球高频rTMS （biHF-rTMS）和iHF-rTMS + cLF-rTMS （iHF-cLF-rTMS）。与安慰剂相比，iHF-cLF-rTMS[平均差值(MD) = -11.34, 95%可信区间（CI）： -14.57 ~ -8.12]、biHF-rTMS （MD = -6.52, 95% CI: -8.50 ~ -4.55）、cHF-rTMS （MD = -2.84, 95% CI: -4.37 ~ -1.31）和iHF-rTMS （MD = -1.89, 95% CI: -2.82 ~ -0.96）对改善PSD患者SSA的效果显著优于安慰剂。结论：双侧刺激方案（biHF-rTMS和iHF-cLF-rTMS）比单侧入路具有更好的疗效。iHF-rTMS的早期应用显示出优势。然而，方法上的局限性，包括刺激参数的异质性，亚组分析的样本量小，以及长期随访不足，需要谨慎解释。未来具有标准化协议的高功率随机对照试验是优化基于rtms的精确康复的必要条件。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of oral rehabilitation 医学-牙科与口腔外科

CiteScore

5.60

自引率

10.30%

发文量

116

审稿时长

4-8 weeks

期刊介绍： Journal of Oral Rehabilitation aims to be the most prestigious journal of dental research within all aspects of oral rehabilitation and applied oral physiology. It covers all diagnostic and clinical management aspects necessary to re-establish a subjective and objective harmonious oral function. Oral rehabilitation may become necessary as a result of developmental or acquired disturbances in the orofacial region, orofacial traumas, or a variety of dental and oral diseases (primarily dental caries and periodontal diseases) and orofacial pain conditions. As such, oral rehabilitation in the twenty-first century is a matter of skilful diagnosis and minimal, appropriate intervention, the nature of which is intimately linked to a profound knowledge of oral physiology, oral biology, and dental and oral pathology. The scientific content of the journal therefore strives to reflect the best of evidence-based clinical dentistry. Modern clinical management should be based on solid scientific evidence gathered about diagnostic procedures and the properties and efficacy of the chosen intervention (e.g. material science, biological, toxicological, pharmacological or psychological aspects). The content of the journal also reflects documentation of the possible side-effects of rehabilitation, and includes prognostic perspectives of the treatment modalities chosen.