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Review
. 2022 Feb 14;11(4):993.
doi: 10.3390/jcm11040993.

Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Controlled Trials-Part II: Brain Neurostimulation

Renée Speyer  1   2   3 , Anna-Liisa Sutt  4   5 , Liza Bergström  6   7 , Shaheen Hamdy  8 , Timothy Pommée  9 , Mathieu Balaguer  9 , Anett Kaale  1   10 , Reinie Cordier  2   11
Affiliations
Review

Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Controlled Trials-Part II: Brain Neurostimulation

Renée Speyer et al. J Clin Med. .

Abstract

Objective. To assess the effects of brain neurostimulation (i.e., repetitive transcranial magnetic stimulation [rTMS] and transcranial direct current stimulation [tDCS]) in people with oropharyngeal dysphagia (OD). Methods. Systematic literature searches were conducted in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed) to retrieve randomised controlled trials (RCTs) only. Using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), the methodological quality of included studies was evaluated, after which meta-analysis was conducted using a random-effects model. Results. In total, 24 studies reporting on brain neurostimulation were included: 11 studies on rTMS, 9 studies on tDCS, and 4 studies on combined neurostimulation interventions. Overall, within-group meta-analysis and between-group analysis for rTMS identified significant large and small effects in favour of stimulation, respectively. For tDCS, overall within-group analysis and between-group analysis identified significant large and moderate effects in favour of stimulation, respectively. Conclusion. Both rTMS and tDCS show promising effects in people with oropharyngeal dysphagia. However, comparisons between studies were challenging due to high heterogeneity in stimulation protocols and experimental parameters, potential moderators, and inconsistent methodological reporting. Generalisations of meta-analyses need to be interpreted with care. Future research should include large RCTs using standard protocols and reporting guidelines as achieved by international consensus.

Keywords: RCT; deglutition; intervention; rTMS; repetitive transcranial magnetic stimulation; swallowing disorders; tDCS; transcranial direct current stimulation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the reviewing process according to PRISMA.
Figure 2
Figure 2
Risk of bias summary for all included studies (n = 24) in accordance with RoB 2 [21].
Figure 3
Figure 3
Risk of bias summary for individual studies (n = 24) in accordance with RoB 2 [21,27,28,29,30,31,32,33,34,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50]. Note. If one or more yellow circles (domains) have been identified for a particular study, the Overall score (last column) shows an exclamation mark, indicating that the study shows some concerns (yellow circle with exclamation mark).
Figure 4
Figure 4
rTMS within intervention group pre-post meta-analysis [32,33,35,42,43,44,50,51]. Notes. Kim et al. (2011a): high frequency, Kim et al. (2011b): low frequency; Park et al. (2017a): unilateral stimulation, Park et al. (2017b): bilateral stimulation; Tarameshu et al. (2019a): rTMS, Tarameshu et al. (2019b): rTMS plus DT.
Figure 5
Figure 5
rTMS between group post meta-analysis [32,34,35,37,47,49]. Notes. Kim et al. (2011a): high frequency versus sham, Kim et al. (2011b): low frequency versus sham; Park et al. (2017a): unilateral stimulation versus sham, Park et al. (2017b): bilateral stimulation versus sham.
Figure 6
Figure 6
tDCS within intervention group pre-post meta-analysis [27,29,36,37,38,39,40,41].
Figure 7
Figure 7
tDCS between group post meta-analysis [27,29,36,37,38,39,40,41].
See this image and copyright information in PMC

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