Bilateral repetitive transcranial magnetic stimulation combined with intensive swallowing rehabilitation for chronic stroke Dysphagia: a case series study

Abstract

The purpose of this study was to clarify the safety and feasibility of a 6-day protocol of bilateral repetitive transcranial magnetic stimulation (rTMS) combined with intensive swallowing rehabilitation for chronic poststroke dysphagia. In-hospital treatment was provided to 4 poststroke patients (age at treatment: 56-80 years; interval between onset of stroke and treatment: 24-37 months) with dysphagia. Over 6 consecutive days, each patient received 10 sessions of rTMS at 3 Hz applied to the pharyngeal motor cortex bilaterally, followed by 20 min of intensive swallowing rehabilitation exercise. The swallowing function was evaluated by the Penetration Aspiration Scale (PAS), Modified Mann Assessment of Swallowing Ability (MMASA), Functional Oral Intake Scale (FOIS), laryngeal elevation delay time (LEDT) and Repetitive Saliva-Swallowing Test (RSST) on admission and at discharge. All patients completed the 6-day treatment protocol and none showed any adverse reactions throughout the treatment. The combination treatment improved laryngeal elevation delay time in all patients. Our proposed protocol of rTMS plus swallowing rehabilitation exercise seems to be safe and feasible for chronic stroke dysphagia, although its efficacy needs to be confirmed in a large number of patients.

Keywords: Cardiovascular disease; Deglutition; Noninvasive brain stimulation.

Fig. 1

Treatment protocol. rTMS was performed twice daily, followed by swallowing exercise in the last 6 days.

Fig. 2

rTMS protocol. A figure-of-eight coil was positioned over the cortical area where stimulation produced the maximum MEP in pharyngeal muscles. Both hemispheres were stimulated.