Treatment of post-stroke dysphagia with repetitive transcranial magnetic stimulation
Treatment of post-stroke dysphagia with repetitive transcranial magnetic stimulation
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DOI：
10.1111/j.1600-0404.2008.01093.x
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发表时间：
2009-03-01
影响因子：
3.5
通讯作者：
Rothwell, J. C.
中科院分区：
文献类型：
--
作者：
Khedr, E. M.;Abo-Elfetoh, N.;Rothwell, J. C.
多达三分之一的患者在卒中后即刻出现吞咽困难，为了研究重复经颅磁刺激（rTMS）对卒中后吞咽困难的治疗效果，将26例因单半球卒中导致卒中后吞咽困难的患者随机分为两组，分别接受真实的（n = 14）和假（n = 12）受影响运动皮层的rTMS。每位患者连续5天接受强度为120%手运动阈值的300次rTMS脉冲。在最后一次治疗前和治疗后立即评估吞咽困难和运动障碍的临床评分，然后在1个月和2个月后再次评估。16例患者在治疗前和治疗1个月时进行单脉冲经颅磁刺激诱发的运动诱发电位（MEP）波幅的评估，接受真实的rTMS的患者与假手术组相比，在基线评估时年龄、握力、Barthel指数或吞咽困难程度均无显著差异。与假手术相比，真实的rTMS导致吞咽困难和运动障碍的显著更大改善，并在2个月的随访中得以维持。这是伴随着从中风或非中风半球诱发的食管MEP的幅度显着增加。rTMS可能是一个有用的辅助治疗中风后吞咽困难。
Up to one-third of patients experience swallowing problems in the period immediately after a stroke.To investigate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke dysphagia.Twenty-six patients with post-stroke dysphagia due to monohemispheric stroke were randomly allocated to receive real (n = 14) or sham (n = 12) rTMS of the affected motor cortex. Each patient received a total of 300 rTMS pulses at an intensity of 120% hand motor threshold for five consecutive days. Clinical ratings of dysphagia and motor disability were assessed before and immediately after the last session and then again after 1 and 2 months. The amplitude of the motor-evoked potential (MEP) evoked by single-pulse TMS was also assessed before and at 1 month in 16 of the patients.There were no significant differences between patients who received real rTMS and the sham group in age, hand grip strength, Barthel Index or degree of dysphagia at the baseline assessment. Real rTMS led to a significantly greater improvement compared with sham in dysphagia and motor disability that was maintained over 2 months of follow-up. This was accompanied by a significant increase in the amplitude of the oesophageal MEP evoked from either the stroke or non-stroke hemisphere.rTMS may be a useful adjunct to conventional therapy for dysphagia after stroke.