Poststroke Dysphagia Rehabilitation by Repetitive Transcranial Magnetic Stimulation: A Noncontrolled Pilot Study
Poststroke Dysphagia Rehabilitation by Repetitive Transcranial Magnetic Stimulation: A Noncontrolled Pilot Study
复制标题
DOI：
10.1007/s00455-008-9195-7
复制
发表时间：
2009-06-01
期刊：
影响因子：
2.6
通讯作者：
Leroi, A. M.
中科院分区：
文献类型：
--
作者：
Verin, E.;Leroi, A. M.
卒中后吞咽困难是常见的，并显著增加患者死亡率。在三分之二的病例中，在几周内会有自发的改善，但在另外三分之一的病例中，口咽吞咽困难持续存在。重复经颅磁刺激（rTMS）是已知的兴奋或抑制皮层神经元，取决于刺激频率。这项非对照先导研究的目的是评估1hz rTMS对脑卒中后吞咽困难的可行性和效果，已知其具有抑制作用。7例患者（3名女性，年龄65 +/- 10岁），均为6个月以上（56 +/- 50个月）通过显像透视诊断为脑卒中后吞咽困难。1 Hz rTMS每天20分钟，连续5天作用于健康半球，以减少经胼胝体抑制。评估采用吞咽障碍指数和显像透视。吞咽困难指数显示患者有轻度口咽吞咽困难。最初，评分为43 +/- a9（120分），经rTMS后降至30 +/- a7 （p < 0.05）。rTMS后，吞咽协调性得到改善，液体吞咽反应时间减少（p = 0.0506），膏体吞咽反应时间减少（p < 0.01），但口腔过境时间、咽过境时间和喉关闭时间没有改变。液体吸吸评分显著降低（p < 0.05），膏体残留评分显著降低（p < 0.05）。这项初步研究表明，rTMS治疗脑卒中后吞咽困难是可行的，可以改善吞咽协调。我们的结果现在需要在更大的患者群体中进行随机对照研究来证实。
Poststroke dysphagia is frequent and significantly increases patient mortality. In two thirds of cases there is a spontaneous improvement in a few weeks, but in the other third, oropharyngeal dysphagia persists. Repetitive transcranial magnetic stimulation (rTMS) is known to excite or inhibit cortical neurons, depending on stimulation frequency. The aim of this noncontrolled pilot study was to assess the feasibility and the effects of 1-Hz rTMS, known to have an inhibitory effect, on poststroke dysphagia. Seven patients (3 females, age = 65 +/- A 10 years), with poststroke dysphagia due to hemispheric or subhemispheric stroke more than 6 months earlier (56 +/- A 50 months) diagnosed by videofluoroscopy, participated in the study. rTMS at 1 Hz was applied for 20 min per day every day for 5 days to the healthy hemisphere to decrease transcallosal inhibition. The evaluation was performed using the dysphagia handicap index and videofluoroscopy. The dysphagia handicap index demonstrated that the patients had mild oropharyngeal dysphagia. Initially, the score was 43 +/- A 9 of a possible 120 which decreased to 30 +/- A 7 (p < 0.05) after rTMS. After rTMS, there was an improvement of swallowing coordination, with a decrease in swallow reaction time for liquids (p = 0.0506) and paste (p < 0.01), although oral transit time, pharyngeal transit time, and laryngeal closure duration were not modified. Aspiration score significantly decreased for liquids (p < 0.05) and residue score decreased for paste (p < 0.05). This pilot study demonstrated that rTMS is feasible in poststroke dysphagia and improves swallowing coordination. Our results now need to be confirmed by a randomized controlled study with a larger patient population.