Effects of Bilateral Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia.
Optimal protocol of repetitive transcranial magnetic stimulation (rTMS) on post-stroke dysphagia remains uncertain with regard to its clinical efficacy.



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.



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 10 Hz rTMS over the ipsilesional and 500 pulses of 10 Hz 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 10 Hz 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).



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).



The results of the present study provide substantial evidence that 10 Hz 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.
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.
Eunhee
E
Park
Department of Rehabilitation Medicine, College of Medicine, Wonkwang University, 895 Muwang-Ro, Iksan, Jeonlabuk-do 54538, Republic of Korea.
Min Su
MS
Kim
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.
Won Hyuk
WH
Chang
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.
Su Mi
SM
Oh
Sungkyunkwan University School of Cognitive Science, 25-2, Sungkyunkwan-ro, Jongro-gu, Seoul 03063, Republic of Korea.
Yun Kwan
YK
Kim
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.
Ahee
A
Lee
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.
Yun-Hee
YH
Kim
D000328:Adult; D000368:Aged; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology; D011446:Prospective Studies; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
Dysphagia; Repetitive transcranial magnetic stimulation; Stroke