title: Effects of non-invasive brain stimulation on post-stroke dysphagia: A systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  The primary aim of this review is to evaluate the effects of non-invasive brain stimulation on post-stroke dysphagia.
  
  
  METHODS
  Thirteen databases were systematically searched through July 2014. Studies had to meet pre-specified inclusion and exclusion criteria. Each study's methodological quality was examined. Effect sizes were calculated from extracted data and combined for an overall summary statistic.
  
  
  RESULTS
  Eight randomized controlled trials were included. These trials revealed a significant, moderate pooled effect size (0.55; 95% CI=0.17, 0.93; p=0.004). Studies stimulating the affected hemisphere had a combined effect size of 0.46 (95% CI=-0.18, 1.11; p=0.16); studies stimulating the unaffected hemisphere had a combined effect size of 0.65 (95% CI=0.14, 1.16; p=0.01). At long-term follow up, three studies demonstrated a large but non-significant pooled effect size (0.81, p=0.11).
  
  
  CONCLUSIONS
  This review found evidence for the efficacy of non-invasive brain stimulation on post-stroke dysphagia. A significant effect size resulted when stimulating the unaffected rather than the affected hemisphere. This finding is in agreement with previous studies implicating the plasticity of cortical neurons in the unaffected hemisphere.
  
  
  CONCLUSIONS
  Non-invasive brain stimulation appears to assist cortical reorganization in post-stroke dysphagia but emerging factors highlight the need for more data.
authors.affiliation: Boston University Medical Center, FGH Building 820 Harrison Ave., Boston, MA 02118, United States; Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215, United States. Electronic address: jpisegna@bu.edu.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Pisegna
authors.affiliation: Boston University Medical Center, FGH Building 820 Harrison Ave., Boston, MA 02118, United States; Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215, United States. Electronic address: kaneoka@bu.edu.
authors.forename: Asako
authors.initials: A
authors.lastname: Kaneoka
authors.affiliation: Georgia Regents University, 1120 15th St., Augusta, GA 30912, United States. Electronic address: wpearson@gru.edu.
authors.forename: William G
authors.initials: WG
authors.lastname: Pearson
authors.affiliation: Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, United States. Electronic address: skumar@bidmc.harvard.edu.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Boston University Medical Center, FGH Building 820 Harrison Ave., Boston, MA 02118, United States; Boston University, Sargent College, 635 Commonwealth Ave., Boston, MA 02215, United States. Electronic address: langmore@bu.edu.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Langmore
mesh_terms: D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
keywords: Dysphagia; Non-invasive brain stimulation; Post-stroke population; Transcranial direct current stimulation (tDCS); Transcranial magnetic stimulation (TMS); Unilateral lesion