TITLE
Effects of Bilateral Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia
AUTHORS
Park E; Kim MS; Chang WH; Oh SM; Kim YK; Lee A; Kim YH. Institution Park, Eunhee. Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea. Kim, Min Su. Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 895 Muwang-Ro, Iksan, Jeonlabuk-do 54538, Republic of Korea. Chang, Won Hyuk. Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea. Oh, Su Mi. Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea. Kim, Yun Kwan. Sungkyunkwan University School of Cognitive Science, 25-2, Sungkyunkwan-ro, Jongro-gu, Seoul 03063, Republic of Korea. Lee, Ahee. Department of Health Sciences and Technology, Department of Medical Device Management & Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea. Kim, Yun-Hee. Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea; Sungkyunkwan University School of Cognitive Science, 25-2, Sungkyunkwan-ro, Jongro-gu, Seoul 03063, Republic of Korea; Department of Health Sciences and Technology, Department of Medical Device Management & Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
ELECTRONIC ADDRESS
yunkim@skku.edu
SOURCE
Brain Stimulation. 10(1):75-82, 2017 Jan – Feb.
BACKGROUND
Optimal protocol of repetitive transcranial magnetic stimulation (rTMS) on post-stroke dysphagia remains uncertain with regard to its clinical efficacy.
OBJECTIVE
The aim of the present study is to investigate the effects of high-frequency rTMS at the bilateral motor cortices over the cortical representation of the mylohyoid muscles in the patients with post-stroke dysphagia.
METHODS
This study was a single-blind, randomized controlled study with a blinded observer. Thirty-five stroke patients were randomly divided into three intervention groups: the bilateral stimulation group, the unilateral stimulation group, and the sham stimulation group. For the bilateral stimulation group, 500 pulses of 10Hz rTMS over the ipsilesional and 500 pulses of 10Hz rTMS over the contralesional motor cortices over the cortical areas that project to the mylohyoid muscles were administered daily for 2 consecutive weeks. For the unilateral stimulation group, 500 pulses of 10Hz rTMS over the ipsilesional motor cortex over the cortical representation of the mylohyoid muscle and the same amount of sham rTMS over the contralesional hemisphere were applied. For the sham stimulation group, sham rTMS was applied at the bilateral motor cortices. Clinical swallowing function and videofluoroscopic swallowing studies were assessed before the intervention (T0), immediately after the intervention (T1) and 3 weeks after the intervention (T2) using Clinical Dysphagia Scale (CDS), Dysphagia Outcome and Severity Scale (DOSS), Penetration Aspiration Scale (PAS), and Videofluoroscopic Dysphagia Scale (VDS).
RESULTS
There were significant time and intervention interaction effects in the CDS, DOSS, PAS, and VDS scores (p<0.05). In the direct comparison of the changes in the swallowing parameters among the three groups, the change in CDS scores at T1 and T2 showed a significantly higher improvement in the bilateral simulation group than in two other groups (p<0.05). There was a significantly larger change in the DOSS, PAS, and VDS scores at T1 in the bilateral stimulation group than in two other groups (p<0.05).
CONCLUSIONS
The results of the present study provide substantial evidence that 10Hz rTMS at the bilateral motor cortices over the cortical areas projecting to the mylohyoid muscles is effective as an additional treatment strategy to traditional dysphagia therapies.
