Cortical and peripheral neurostimulation to improve swallowing function, aspiration, and dysphagia severity in dysphagia management: A network meta-analysis of randomized controlled trials

IF 7.9 2区医学 Q1 NUTRITION & DIETETICS

Clinical nutrition Pub Date : 2026-02-01 Epub Date: 2025-12-30 DOI:10.1016/j.clnu.2025.106567

Kondwani J. Banda , Hsin Chu , Chien-Mei Sung , Ruey Chen , Pi-Yu Su , Li-Fang Chang , Li-Chung Pien , Chu-Yi Wang , Kuei-Ru Chou

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引用次数: 0

Abstract

Background

Dysphagia compromises swallowing safety and efficiency, leading to malnutrition, dehydration, aspiration pneumonia, and frequent hospitalizations. Cortical neurostimulation therapies including transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and theta burst stimulation (TBS), peripheral neurostimulation therapies including, neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES), and paired associative stimulation (PAS) complement swallowing rehabilitative therapy (SRT) in dysphagia management. Despite growing evidence of their therapeutic potential, comparative evaluation of cortical and peripheral neurostimulation therapies in dysphagia management remains unexplored. Therefore, we conducted the first network meta-analysis (NMA) to explore comparative evidence of cortical and peripheral neurostimulation therapies on swallowing function, aspiration, and dysphagia severity for individuals with dysphagia.

Methods

Cochrane Library, EBSCOHost, Embase, PubMed, CINAHL, and Web of Science were searched until June, 2025. MetaInsight, an interactive web-based application for conducting NMA, employing Frequentist and Bayesian approaches was used for data analysis presenting standardized mean difference with corresponding 95 % confidence intervals. Surface Under the Cumulative Ranking (SUCRA) was used for ranking of neurostimulation therapies.

Results

A total of 72 randomized controlled trials with 3589 individuals with dysphagia were included. PAS + SRT 3.47 [1.43−5.50], TBS + SRT 2.56 [0.31−4.82], NMES + SRT 2.34 [0.60−4.07], tDCS + SRT 2.28 [0.51−4.06], and rTMS + SRT 2.12 [0.38−3.85] significantly improved global swallowing function with very-large effect. NMES + SRT −0.50 [−0.76−(−0.24)], rTMS + SRT −0.45 [−0.74−(−0.17)], and SRT −0.28 [−0.54−(−0.02)] significantly reduced pharyngeal transit time (PTT) with moderate to small effect. TBS + SRT −1.81 [−3.47−(−0.16)] and rTMS −1.58 [−3.04−(−0.12)] significantly reduced aspiration with very-large effect. PAS + SRT −5.43 [−8.81−(−2.04)], NMES + SRT −5.22 [−8.46−(−1.99)], NMES −4.90 [−8.50−(−1.30)], TBS + SRT −4.79 [−8.13−(−1.46)], tDCS + SRT −4.79 [−8.05−(−1.54)], PES + SRT −4.59 [−8.05−(−1.13)], and rTMS + SRT −4.58 [−7.74−(−1.43)], SRT −3.99 [−7.14−(−0.84)], rTMS −3.94 [−7.02−(−0.87)], and PAS −0.80 [−1.37−(−0.22)] significantly reduced dysphagia severity with very-large effect. SUCRA ranking revealed PAS + SRT for global swallowing function (94.6 %) and dysphagia severity (87.3 %), NMES + SRT for PTT (86.9 %), tDCS + SRT for OTT (87.2 %), and TBS + SRT for aspiration (91.0 %) as first ranked neurostimulation therapies.

Conclusion

The findings suggest that the integration of PAS, followed by either cortical (tDCS, rTMS, TBS) or peripheral (NMES) neurostimulation therapies in combination with SRT, promote superior therapeutic benefits for improving swallowing recovery and safeguarding nutritional status of individuals with dysphagia.

Registration

PROSPERO CRD420251031629.

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皮质和周围神经刺激改善吞咽功能、误吸和吞咽困难严重程度：一项随机对照试验的网络荟萃分析

背景：吞咽困难影响吞咽的安全性和效率，导致营养不良、脱水、吸入性肺炎和频繁住院。皮层神经刺激疗法包括经颅直流电刺激（tDCS）、重复经颅磁刺激（rTMS）和θ波爆发刺激（TBS），周围神经刺激疗法包括神经肌肉电刺激（NMES）和咽电刺激（PES），以及配对联想刺激（PAS）补充吞咽障碍治疗中的吞咽康复治疗（SRT）。尽管越来越多的证据表明它们的治疗潜力，皮质和周围神经刺激疗法在吞咽困难治疗中的比较评估仍未被探索。因此，我们进行了第一次网络荟萃分析（NMA），以探索皮层和周围神经刺激疗法对吞咽困难患者吞咽功能、误吸和吞咽困难严重程度的比较证据。方法：检索Cochrane Library、EBSCOHost、Embase、PubMed、CINAHL、Web of Science至2025年6月。MetaInsight是一个交互式的基于网络的应用程序，用于进行NMA，采用Frequentist和Bayesian方法进行数据分析，给出了相应95%置信区间的标准化平均差。采用表面累积排序法（SUCRA）对神经刺激疗法进行排序。结果：共纳入72项随机对照试验，共纳入3589例吞咽困难患者。PAS + SRT 3.47[1.43-5.50]、TBS + SRT 2.56[0.31-4.82]、NMES + SRT 2.34[0.60-4.07]、tDCS + SRT 2.28[0.51-4.06]、rTMS + SRT 2.12[0.38-3.85]均可显著改善整体吞咽功能，且效果非常大。NMES + SRT -0.50[-0.76-(-0.24)]、rTMS + SRT -0.45[-0.74-(-0.17)]、SRT -0.28[-0.54-(-0.02)]均可显著降低咽部过境时间（PTT），效果中至小。TBS + SRT -1.81[-3.47-(-0.16)]和rTMS -1.58[-3.04-(-0.12)]显著减少误吸，效果非常大。不是+ SRT -5.43(-8.81 -(-2.04)),纳米+ SRT -5.22 [-8.46 - (-1.99)], -4.90 nm [-8.50 - (-1.30)], TBS + SRT -4.79 [-8.13 - (-1.46)], tDCS + SRT -4.79 [-8.05 - (-1.54)], PES + SRT -4.59[-8.05 -(-1.13)],和rTMS + SRT -4.58 [-7.74 - (-1.43)], SRT -3.99 [-7.14 - (-0.84)], rTMS -3.94[-7.02 -(-0.87)],并不是-0.80(-1.37 -(-0.22))显著减少吞咽困难严重和非常大的效果。SUCRA排名显示，PAS + SRT治疗整体吞咽功能（94.6%）和吞咽困难严重程度（87.3%），NMES + SRT治疗PTT (86.9%)， tDCS + SRT治疗OTT（87.2%）和TBS + SRT治疗吸进（91.0%）是排名第一的神经刺激疗法。结论：研究结果表明，PAS与皮质（tDCS、rTMS、TBS）或外周（NMES）神经刺激疗法联合SRT，在改善吞咽恢复和保护吞咽困难患者营养状况方面具有更好的治疗效果。注册号：PROSPERO CRD420251031629。

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来源期刊

Clinical nutrition 医学-营养学

CiteScore

14.10

自引率

6.30%

发文量

356

审稿时长

28 days

期刊介绍： Clinical Nutrition, the official journal of ESPEN, The European Society for Clinical Nutrition and Metabolism, is an international journal providing essential scientific information on nutritional and metabolic care and the relationship between nutrition and disease both in the setting of basic science and clinical practice. Published bi-monthly, each issue combines original articles and reviews providing an invaluable reference for any specialist concerned with these fields.