Transcranial Magnetic Stimulation for Improving Dysphagia After Stroke: A Meta-Analysis of Randomized Controlled Trials
BackgroundRehabilitation of post-stroke dysphagia is an urgent clinical problem, and repetitive transcranial magnetic stimulation (rTMS) has been widely used in the study of post-stroke function. However, there is no reliable evidence-based medicine to support the effect of rTMS on post-stroke dysph...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-04-01
|
| Series: | Frontiers in Neuroscience |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fnins.2022.854219/full |
| _version_ | 1828415215908159488 |
|---|---|
| author | Yu-lei Xie Yu-lei Xie Shan Wang Shan Wang Shan Wang Jia-meng Jia Jia-meng Jia Yu-han Xie Xin Chen Xin Chen Wu Qing Wu Qing Yin-xu Wang Yin-xu Wang |
| author_facet | Yu-lei Xie Yu-lei Xie Shan Wang Shan Wang Shan Wang Jia-meng Jia Jia-meng Jia Yu-han Xie Xin Chen Xin Chen Wu Qing Wu Qing Yin-xu Wang Yin-xu Wang |
| author_sort | Yu-lei Xie |
| collection | DOAJ |
| description | BackgroundRehabilitation of post-stroke dysphagia is an urgent clinical problem, and repetitive transcranial magnetic stimulation (rTMS) has been widely used in the study of post-stroke function. However, there is no reliable evidence-based medicine to support the effect of rTMS on post-stroke dysphagia. This review aims to evaluate the effectiveness and safety of rTMS on post-stroke dysphagia.MethodsEnglish-language literature published before December 20, 2021, were searched in six electronic databases. Identified articles were screened, data were extracted, and the methodological quality of included trials was assessed. Meta-analysis was performed using RevMan 5.3 software. The GRADE method was used to assess the quality of the evidence.ResultsA total of 10 studies with 246 patients were included. Meta-analysis showed that rTMS significantly improved overall swallowing function (standardized mean difference [SMD]−0.76, 95% confidence interval (CI)−1.07 to−0.46, p < 0.0001, n = 206; moderate-quality evidence), Penetration Aspiration Scale (PAS) (mean difference [MD]−1.03, 95% CI−1.51 to−0.55, p < 0.0001, n = 161; low-quality evidence) and Barthel index scale (BI) (MD 23.86, 95% CI 12.73 to 34.99, p < 0.0001, n = 136; moderate-quality evidence). Subgroup analyses revealed that (1) rTMS targeting the affected hemisphere and targeting both hemispheres significantly enhanced overall swallowing function and reduced aspiration. (2) Low-frequency rTMS significantly enhanced overall swallowing function and reduced aspiration, and there was no significant difference between high-frequency rTMS and control group in reducing aspiration (p = 0.09). (3) There was no statistical difference in the dropout rate (low-quality evidence) and adverse effects (moderate-quality evidence) between the rTMS group and the control group.ConclusionrTMS improved overall swallowing function and activity of daily living ability and reduced aspiration in post-stroke patients with good acceptability and mild adverse effects. |
| first_indexed | 2024-12-10T13:42:10Z |
| format | Article |
| id | doaj.art-2f45b289d93544f7a3ded8716fa579e8 |
| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-12-10T13:42:10Z |
| publishDate | 2022-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neuroscience |
| spelling | doaj.art-2f45b289d93544f7a3ded8716fa579e82022-12-22T01:46:39ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2022-04-011610.3389/fnins.2022.854219854219Transcranial Magnetic Stimulation for Improving Dysphagia After Stroke: A Meta-Analysis of Randomized Controlled TrialsYu-lei Xie0Yu-lei Xie1Shan Wang2Shan Wang3Shan Wang4Jia-meng Jia5Jia-meng Jia6Yu-han Xie7Xin Chen8Xin Chen9Wu Qing10Wu Qing11Yin-xu Wang12Yin-xu Wang13Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, ChinaNorth Sichuan Medical College, Nanchong, ChinaDepartment of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, ChinaNorth Sichuan Medical College, Nanchong, ChinaDepartment of Rehabilitation Medicine, Chengdu Second People's Hospital, Chengdu, ChinaDepartment of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, ChinaNorth Sichuan Medical College, Nanchong, ChinaUniversity of South China, Hengyang, ChinaDepartment of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, ChinaNorth Sichuan Medical College, Nanchong, ChinaDepartment of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, ChinaNorth Sichuan Medical College, Nanchong, ChinaDepartment of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, ChinaNorth Sichuan Medical College, Nanchong, ChinaBackgroundRehabilitation of post-stroke dysphagia is an urgent clinical problem, and repetitive transcranial magnetic stimulation (rTMS) has been widely used in the study of post-stroke function. However, there is no reliable evidence-based medicine to support the effect of rTMS on post-stroke dysphagia. This review aims to evaluate the effectiveness and safety of rTMS on post-stroke dysphagia.MethodsEnglish-language literature published before December 20, 2021, were searched in six electronic databases. Identified articles were screened, data were extracted, and the methodological quality of included trials was assessed. Meta-analysis was performed using RevMan 5.3 software. The GRADE method was used to assess the quality of the evidence.ResultsA total of 10 studies with 246 patients were included. Meta-analysis showed that rTMS significantly improved overall swallowing function (standardized mean difference [SMD]−0.76, 95% confidence interval (CI)−1.07 to−0.46, p < 0.0001, n = 206; moderate-quality evidence), Penetration Aspiration Scale (PAS) (mean difference [MD]−1.03, 95% CI−1.51 to−0.55, p < 0.0001, n = 161; low-quality evidence) and Barthel index scale (BI) (MD 23.86, 95% CI 12.73 to 34.99, p < 0.0001, n = 136; moderate-quality evidence). Subgroup analyses revealed that (1) rTMS targeting the affected hemisphere and targeting both hemispheres significantly enhanced overall swallowing function and reduced aspiration. (2) Low-frequency rTMS significantly enhanced overall swallowing function and reduced aspiration, and there was no significant difference between high-frequency rTMS and control group in reducing aspiration (p = 0.09). (3) There was no statistical difference in the dropout rate (low-quality evidence) and adverse effects (moderate-quality evidence) between the rTMS group and the control group.ConclusionrTMS improved overall swallowing function and activity of daily living ability and reduced aspiration in post-stroke patients with good acceptability and mild adverse effects.https://www.frontiersin.org/articles/10.3389/fnins.2022.854219/fulldeglutition disorderstranscranial magnetic stimulationstrokemeta-analysissystematic review |
| spellingShingle | Yu-lei Xie Yu-lei Xie Shan Wang Shan Wang Shan Wang Jia-meng Jia Jia-meng Jia Yu-han Xie Xin Chen Xin Chen Wu Qing Wu Qing Yin-xu Wang Yin-xu Wang Transcranial Magnetic Stimulation for Improving Dysphagia After Stroke: A Meta-Analysis of Randomized Controlled Trials Frontiers in Neuroscience deglutition disorders transcranial magnetic stimulation stroke meta-analysis systematic review |
| title | Transcranial Magnetic Stimulation for Improving Dysphagia After Stroke: A Meta-Analysis of Randomized Controlled Trials |
| title_full | Transcranial Magnetic Stimulation for Improving Dysphagia After Stroke: A Meta-Analysis of Randomized Controlled Trials |
| title_fullStr | Transcranial Magnetic Stimulation for Improving Dysphagia After Stroke: A Meta-Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Transcranial Magnetic Stimulation for Improving Dysphagia After Stroke: A Meta-Analysis of Randomized Controlled Trials |
| title_short | Transcranial Magnetic Stimulation for Improving Dysphagia After Stroke: A Meta-Analysis of Randomized Controlled Trials |
| title_sort | transcranial magnetic stimulation for improving dysphagia after stroke a meta analysis of randomized controlled trials |
| topic | deglutition disorders transcranial magnetic stimulation stroke meta-analysis systematic review |
| url | https://www.frontiersin.org/articles/10.3389/fnins.2022.854219/full |
| work_keys_str_mv | AT yuleixie transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT yuleixie transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT shanwang transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT shanwang transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT shanwang transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT jiamengjia transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT jiamengjia transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT yuhanxie transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT xinchen transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT xinchen transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT wuqing transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT wuqing transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT yinxuwang transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials AT yinxuwang transcranialmagneticstimulationforimprovingdysphagiaafterstrokeametaanalysisofrandomizedcontrolledtrials |