吞咽障碍是脑卒中后常见并发症，文献报道小脑重复磁刺激（rTMS）可以提高皮质延髓束的兴奋性，我们研究团队也曾采用经小脑重复磁刺激（rTMS）对卒中后吞咽障碍患者进行干预，其吞咽功能有改善，但作用机制尚不明确。本课题组采用fMRI和DTI检查发现rTMS干预后小脑齿状核与对侧橄榄核、孤束核之间的纤维束明显增多。据此，我们认为小脑参与吞咽调控的方式除大脑层级投射的神经通路外，与橄榄核和吞咽中枢模式发生器（CPG）之间也可能形成功能上的网络连接。本研究拟采用rTMS刺激小脑，针对小脑、脑干卒中患者以及健康人大脑皮质虚拟损伤受试者，通过咽腔内电极记录咽肌运动诱发电位（PMEPs）变化，同时采用静息态fMRI图论分析、DTI纤维示踪结合MRS检测GABA等递质的方法，评估小脑、大脑皮质与脑干吞咽CPG的重要神经节点连接及递质的变化。旨在阐明小脑磁刺激干预后是否通过神经通路及功能网络连接双通路模式恢复小脑、脑干卒中后吞咽功能，为rTMS干预小脑神经调控治疗吞咽障碍提供新的理论基础和循证依据。

Based on clinical evidence, we found that swallowing disorders can be a major consequence of stroke. Some studies found that cerebellum rTMS can increase the excitement of cortical-medulla.Here, we successfully used repetitive transcranial magnetic stimulation (rTMS) of the cerebellum to improve neuromotor control of swallowing on patients with cerebellar stroke, but the neural mechanisms are still unclear. Neuroimaging demonstrated that the direct fiber connections between the cerebellar nucleus (dentate nucleus) and brainstem nucleuses (contralateral inferior olivary nucleus and solitary nucleus) were enhanced after treatment in pilot study.Therefore, we hypothesized that there are direct functional network among cerebellum and inferior olivary nucleus as well as swallowing CPG, in addition to cerebello-thalamo-cortical pathway via hierarchical projection. In this study, we try to determinate the effects of cerebellar rTMS on neural network of swallowing by applying rTMS over the cerebellar hemisphere among patients with cerebellar stroke, patients with brainstem stroke, and healthy subjects with “virtual lesion” on the pharyngeal motor cortex. The outcome measurements include pharyngeal motor evoked potentials (PMEPs) detected by intraluminal pharyngeal electrodes, functional connections analyzed by Graph theory in resting state functional magnetic resonance imaging (rsfMRI) and fibers tracking by diffusion tensor imaging (DTI) combined with measures of neurotransmitters, such as GABA/Glu, by magnetic resonance spectroscopy (MRS). The results of this study would expound neural mechαnisms of a dual pathway modulation of the cerebellum on recovery of swallowing after cerebellar rTMS. This research would provide new theory and clinical evidences for the application of cerebellar rTMS in dysphagic stroke patients.