Effects of Neurostimulation on Poststroke Dysphagia: A Synthesis of Current Evidence From Randomized Controlled Trials.
Effects of Neurostimulation on Poststroke Dysphagia: A Synthesis of Current Evidence From Randomized Controlled Trials.
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DOI：
10.1111/ner.13327
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发表时间：
2021-12
期刊：
影响因子：
2.8
通讯作者：
Hamdy, Shaheen
中科院分区：
文献类型：
--
作者：
Cheng, Ivy;Sasegbon, Ayodele;Hamdy, Shaheen
关键词：
根据随机对照试验(RCT)的证据，评价神经刺激，包括重复经颅磁刺激(RTMS)、经颅直流电刺激(Tdcs)和咽电刺激(PES)对卒中后吞咽困难的疗效。在1985年1月至2020年6月期间系统地搜索了电子数据库，并根据预先指定的选择标准纳入了研究。由两名独立的评价者对研究的质量进行评估，并提取和综合数据。主要的结果衡量标准是与吞咽相关的临床特征的改变。根据随访期和刺激参数进行亚组分析。来自26项随机对照试验的852名中风患者的数据被收集。与对照组相比，主动神经刺激治疗显示出显著和中等的效应大小(0.69[95%CI=0.50，0.89]；p <； 0.001)。RTMS的效应大小最大(0.73[95%CI=0.49，0.98]；p <； 0.001)，其次是PES(0.68[95%CI=0.22，1.14]；p=0.004)和tDCS(0.65[95%CI=100.25，1.04]；p=0.001)。所有治疗在前两个 周内显示出相似的效果大小。在3个 周和2个 月之间，TDCs的疗效最大(1.0 2[95%CI=0.45，1.5 9]；p <； 0.001)。超过三个 月的治疗没有显著效果的报道。当应用于急性(14 天)卒中时，联合作用大(0.8[95%CI=0.34，1.26]；p <； 0.001)。对于无创脑刺激(NIB)，双侧大脑半球刺激的效应最大(0.93[95%CI=0.53，1.33]；p <； 0.001)。相比之下，使用单侧高频刺激的单侧rTMS的综合效应大小为0.83(95%可信区间=0.14，1.52；P=0.02)。对于TDCs，只有在对侧大脑半球施加阳极刺激时才有显著的效应大小(1.04[95%CI=0.54，1.53]；p <； 0.001)。结果表明，神经刺激可使卒中后吞咽困难患者受益。在急性中风患者和使用 的前两个月内，治疗效果最强。对于NIBs，双半球刺激似乎是最有效的。RTMS和tDCs对单侧刺激最有利的半球不同。这些发现为今后的研究和临床实践提供了平台。
To evaluate the effects of neurostimulation, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and pharyngeal electrical stimulation (PES), for poststroke dysphagia based on evidence from randomized controlled trials (RCTs). Electronic databases were systematically searched between January 1985 and June 2020 and studies were included based on prespecified selection criteria. The quality of studies was evaluated and data were extracted and synthesized by two independent reviewers. The primary outcome measure was change in (any) relevant clinical swallowing‐related characteristic. Subgroup analysis were conducted based on follow‐up period and stimulation parameters. Data from 852 stroke patients were collected from 26 RCTs studies. Active neurostimulation treatments demonstrated a significant and moderate effect size compared to control treatment (0.69 [95% CI = 0.50, 0.89]; p < 0.001). The effect size of rTMS was the largest (0.73 [95% CI = 0.49, 0.98]; p < 0.001), followed by PES (0.68 [95% CI = 0.22, 1.14]; p = 0.004) and tDCS (0.65 [95% CI = 0.25, 1.04]; p = 0.001). All treatments showed comparable effect sizes within the first two weeks. Between three weeks and two months, tDCS demonstrated the largest effects (1.02 [95% CI = 0.45, 1.59]; p < 0.001) among the three treatments. No significant treatment effects were reported beyond three months. The combined effect size was large when applied in acute (<14 days) stroke (0.8 [95% CI = 0.34, 1.26]; p < 0.001). For noninvasive brain stimulation (NIBS), bihemispheric stimulation demonstrated the strongest effect size (0.93 [95% CI = 0.53, 1.33]; p < 0.001). In contrast, unilateral rTMS using ipsilesional high‐frequency stimulation had a combined effect size of 0.83 (95% CI = 0.14, 1.52; p = 0.02). For tDCS, a significant effect size was found only with anodal stimulation applied over the contralesional hemisphere (1.04 [95% CI = 0.54, 1.53]; p < 0.001). The results show that neurostimulation can benefit patients with poststroke dysphagia. The treatment effects were the strongest in acute stroke patients and within the first two months of application. For NIBS, bihemispheric stimulation appeared to be most effective. The most beneficial hemisphere for unilateral stimulation differed between rTMS and tDCS. These findings provide a platform for future studies and clinical practice.
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