Treatment of post-stroke dysphagia with repetitive transcranial magnetic stimulation.
BACKGROUND
Up to one-third of patients experience swallowing problems in the period immediately after a stroke.


OBJECTIVE
To investigate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke dysphagia.


METHODS
Twenty-six patients with post-stroke dysphagia due to monohemispheric stroke were randomly allocated to receive real (n = 14) or sham (n = 12) rTMS of the affected motor cortex. Each patient received a total of 300 rTMS pulses at an intensity of 120% hand motor threshold for five consecutive days. Clinical ratings of dysphagia and motor disability were assessed before and immediately after the last session and then again after 1 and 2 months. The amplitude of the motor-evoked potential (MEP) evoked by single-pulse TMS was also assessed before and at 1 month in 16 of the patients.


RESULTS
There were no significant differences between patients who received real rTMS and the sham group in age, hand grip strength, Barthel Index or degree of dysphagia at the baseline assessment. Real rTMS led to a significantly greater improvement compared with sham in dysphagia and motor disability that was maintained over 2 months of follow-up. This was accompanied by a significant increase in the amplitude of the oesophageal MEP evoked from either the stroke or non-stroke hemisphere.


CONCLUSIONS
rTMS may be a useful adjunct to conventional therapy for dysphagia after stroke.
Khedr
E M
EM
Department of Neurology, Assiut University Hospital, Assiut, Egypt. emankhedr99@yahoo.com
Abo-Elfetoh
N
N
Rothwell
J C
JC
D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004292:Dominance, Cerebral; D004311:Double-Blind Method; D004576:Electromyography; D004947:Esophagus / Q000503:physiopathology; D019054:Evoked Potentials, Motor; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D010528:Peristalsis; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*; D050781:Transcranial Magnetic Stimulation / Q000379:methods