Effect of cerebellar transcranial magnetic stimulation with double-cone coil on dysphagia after subacute infratentorial stroke: A randomized, single-blinded, controlled trial
Effect of cerebellar transcranial magnetic stimulation with double-cone coil on dysphagia after subacute infratentorial stroke: A randomized, single-blinded, controlled trial
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DOI：
10.1016/j.brs.2023.05.023
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发表时间：
2023-06-27
影响因子：
7.7
通讯作者：
Dou，Zulin
中科院分区：
文献类型：
--
作者：
Dai，Meng;Qiao，Jia;Dou，Zulin
背景：10hz小脑重复经颅磁刺激（rTMS）可提高健康人的皮质球束兴奋性。然而，其对脑卒中后吞咽困难（PSD）的临床疗效尚不清楚。目的探讨10hz小脑rTMS治疗PSD合并幕下脑卒中（IS）的疗效。方法将42例伴有亚急性IS的PSD患者分为双侧小脑rTMS （biCRB-rTMS）组、单侧小脑rTMS （uniCRB-rTMS）组和假rTMS组。刺激参数为5组，每组50次，每次10 Hz，间隔10 s，在90%的鱼际静息运动阈值（RMT）下刺激。在T0（基线）、T1（干预后第0天）和T2（干预后第14天）评估功能性口服摄入量表（FOIS），而在T0和T1评估吞咽困难结局和严重程度量表（DOSS）、穿透性吸入量表（PAS）和神经生理参数。结果FOIS评分存在显著的时间效应和干预交互效应（F = 3.045, p = 0.022）。biCRB-rTMS组T1、T2时FOIS评分变化均显著高于sham-rTMS组（p < 0.05）。与sham-rTMS组相比，uniCRB-rTMS和biCRB-rTMS组在T1时的DOSS和PAS变化更大（p < 0.05）。与T0相比，biCRB-rTMS组和uniCRB-rTMS组在T1时双侧皮质球束兴奋性部分增加。T1时三组间皮质球束兴奋性参数变化百分比无差异。结论10hz双侧小脑rTMS治疗亚急性幕下PSD是一种很有前途的无创治疗方法。
BackgroundA 10-Hz cerebellar repetitive transcranial magnetic stimulation (rTMS) could increase corticobulbar tract excitability in healthy individuals. However, its clinical efficacy for poststroke dysphagia (PSD) remains unclear.ObjectiveTo investigate the effectiveness of 10-Hz cerebellar rTMS in PSD patients with infratentorial stroke (IS).MethodsIn this single-blinded, randomized controlled trial, 42 PSD patients with subacute IS were allocated to three groups: bilateral cerebellar rTMS (biCRB-rTMS), unilateral cerebellar rTMS (uniCRB-rTMS), or sham-rTMS. The stimulation parameters were 5 trains of 50 stimuli at 10 Hz with an interval of 10 s at 90% of the thenar resting motor threshold (RMT). The Functional Oral Intake Scale (FOIS) was assessed at T0 (baseline), T1 (day 0 after intervention), and T2 (day 14 after intervention), whereas the Dysphagia Outcome and Severity Scale (DOSS), Penetration Aspiration Scale (PAS), and neurophysiological parameters were evaluated at T0 and T1.ResultsSignificant time and intervention interaction effects were observed for the FOIS score (F = 3.045, p = 0.022). The changes in the FOIS scores at T1 and T2 were both significantly higher in the biCRB-rTMS group than in the sham-rTMS group (p < 0.05). The uniCRB-rTMS and biCRB-rTMS groups demonstrated greater changes in the DOSS and PAS at T1, compared with the sham-rTMS group (p < 0.05). Bilateral corticobulbar tract excitability partly increased in the biCRB-rTMS and uniCRB-rTMS groups at T1, compared with T0. The percent changes in corticobulbar tract excitability parameters at T1 showed no difference among three groups.ConclusionsA 10-Hz bilateral cerebellar rTMS is a promising, noninvasive treatment for subacute infratentorial PSD.