Repetitive Transcranial Magnetic Stimulation at Different Sites for Dysphagia After Stroke: A Randomized, Observer-Blind Clinical Trial

Background: The clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) protocols on patients with poststroke dysphagia is still unclear.Objective: This trial aimed to explore and analyze the effectiveness of 5 Hz rTMS on the unaffected hemisphere, affected hemisphere, and cerebellum in stroke patients with dysphagia.Methods: This observer-blind and randomized controlled trial included a total of 147 patients with stroke. Patients were divided into four treatment groups: the unaffected hemispheric group, the affected hemispheric group, the cerebellum group and the control group. Each group received traditional dysphagia treatment 5 days a week for 2 weeks. All recruited patients except for those in the control group underwent 10 consecutive rTMS sessions for 2 weeks. For the affected hemispheric group and unaffected hemispheric group, 5 Hz rTMS was applied to the affected mylohyoid cortical region or to the unaffected mylohyoid cortical region. For the cerebellum group, 5 Hz rTMS was applied to the mylohyoid cortical representation of the cerebellum (4.3 cm lateral and 2.4 cm below the inion). The Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), Penetration/Aspiration Scale (PAS), Gugging Swallowing Screen (GUSS), and Standardized Swallowing Assessment (SSA) were used to evaluate clinical swallowing function before the intervention (baseline), immediately after the intervention and 2 weeks after the intervention.Results: There were significant time and intervention interaction effects on the FEDSS, PAS, SSA, and GUSS scores (p < 0.05). In a direct comparison of the swallowing parameters of the four groups, the changes in FEDSS, PAS, SSA, and GUSS scores showed a significantly greater improvement in the unaffected hemispheric group, the affected hemispheric group and cerebellum group than in the control group (p < 0.05).Conclusions: Whether stimulating the unaffected hemisphere or the affected hemisphere, 5 Hz high-frequency rTMS on mylohyoid cortical tissue might have a positive effect on poststroke patients with dysphagia. In addition, cerebellar rTMS is a safe method that represents a potential treatment for poststroke dysphagia, and more clinical trials are needed to develop this technique further.Clinical Trial Registration:chictr.org.cn, identifier: ChiCTR2000032255.

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Efficacy of repetitive transcranial magnetic stimulation combined with visual scanning treatment on cognitive and behavioral symptoms of left hemispatial neglect in right hemispheric stroke patients: study protocol for a randomized controlled trial

Trials ◽

10.1186/s13063-020-04943-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Francesco Di Gregorio ◽

Fabio La Porta ◽

Emanuela Casanova ◽

Elisabetta Magni ◽

Roberta Bonora ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Controlled Trial ◽

Hemispatial Neglect ◽

Visual Scanning ◽

Stroke Patients ◽

Rehabilitation Protocol ◽

Randomized Controlled

Abstract Background Left hemispatial neglect (LHN) is a neuropsychological syndrome often associated with right hemispheric stroke. Patients with LHN have difficulties in attending, responding, and consciously representing the right side of space. Various rehabilitation protocols have been proposed to reduce clinical symptoms related to LHN, using cognitive treatments, or on non-invasive brain stimulation. However, evidence of their benefit is still lacking; in particular, only a few studies focused on the efficacy of combining different approaches in the same patient. Methods In the present study, we present the SMART ATLAS trial (Stimolazione MAgnetica Ripetitiva Transcranica nell’ATtenzione LAteralizzata dopo Stroke), a multicenter, randomized, controlled trial with pre-test (baseline), post-test, and 12 weeks follow-up assessments based on a novel rehabilitation protocol based on the combination of brain stimulation and standard cognitive treatment. In particular, we will compare the efficacy of inhibitory repetitive-transcranial magnetic stimulation (r-TMS), applied over the left intact parietal cortex of LHN patients, followed by visual scanning treatment, in comparison with a placebo stimulation (SHAM control) followed by the same visual scanning treatment, on visuospatial symptoms and neurophysiological parameters of LHN in a population of stroke patients. Discussion Our trial results may provide scientific evidence of a new, relatively low-cost rehabilitation protocol for the treatment of LHN. Trial registration ClinicalTrials.gov NCT04080999. Registered on September 2019.

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Effects of high- and low-frequency repetitive transcranial magnetic stimulation on motor recovery in early stroke patients: Evidence from a randomized controlled trial with clinical, neurophysiological and functional imaging assessments

NeuroImage Clinical ◽

10.1016/j.nicl.2018.101620 ◽

2019 ◽

Vol 21 ◽

pp. 101620 ◽

Cited By ~ 9

Author(s):

Juan Du ◽

Fang Yang ◽

Jianping Hu ◽

Jingze Hu ◽

Qiang Xu ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Transcranial Magnetic Stimulation ◽

Functional Imaging ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Controlled Trial ◽

Low Frequency ◽

Stroke Patients ◽

Randomized Controlled ◽

Early Stroke

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Effects of Neuromuscular Electrical Stimulation with 5 Hz High Frequency Repetitive Transcranial Magnetic Stimulation on Cerebral Activity in Chronic Stroke Patients (Randomized Controlled Trial)

Journal of Magnetics ◽

10.4283/jmag.2021.26.4.467 ◽

2021 ◽

Vol 26 (4) ◽

pp. 467-474

Author(s):

Jung-Woo Jeong ◽

Sung-Ryong Ma ◽

Bo-Kyoung Song

Keyword(s):

Randomized Controlled Trial ◽

Electrical Stimulation ◽

Transcranial Magnetic Stimulation ◽

High Frequency ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Controlled Trial ◽

Neuromuscular Electrical Stimulation ◽

Stroke Patients ◽

Randomized Controlled

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Repetitive Transcranial Magnetic Stimulation (rTMS) in the rehabilitation of visuo-spatial neglect in human stroke patients: Details from an ongoing multicentric double blind clinical trial

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2011.07.405 ◽

2011 ◽

Vol 54 ◽

pp. e219-e220

Author(s):

F. Rastelli ◽

M. Toba ◽

C. Tchokotche ◽

M.C. Nierat ◽

R. Migliaccio ◽

...

Keyword(s):

Clinical Trial ◽

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Spatial Neglect ◽

Stroke Patients ◽

Double Blind ◽

Double Blind Clinical Trial ◽

Human Stroke

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Repetitive transcranial magnetic stimulation effects on hemiparetic limb spasticity in stroke patients: A double blinded randomized controlled trial

Journal of the Neurological Sciences ◽

10.1016/j.jns.2021.119716 ◽

2021 ◽

Vol 429 ◽

pp. 119716

Author(s):

Hussein Mousa ◽

Sura Albaker

Keyword(s):

Randomized Controlled Trial ◽

Transcranial Magnetic Stimulation ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Controlled Trial ◽

Stroke Patients ◽

Randomized Controlled ◽

Limb Spasticity ◽

Double Blinded

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Repetitive Transcranial Magnetic Stimulation on the Affected Hemisphere Enhances Hand Functional Recovery in Subacute Adult Stroke Patients: A Randomized Trial

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.636184 ◽

2021 ◽

Vol 13 ◽

Author(s):

Yawen Yang ◽

Huijuan Pan ◽

Wenxiu Pan ◽

Yang Liu ◽

Xiaohui Song ◽

...

Keyword(s):

Clinical Trial ◽

Transcranial Magnetic Stimulation ◽

Grip Strength ◽

Functional Recovery ◽

Magnetic Stimulation ◽

Repetitive Transcranial Magnetic Stimulation ◽

Motor Evoked Potential ◽

Training Group ◽

Stroke Patients ◽

Hand Grip

Objectives: Either motor training or repetitive transcranial magnetic stimulation (rTMS) could modulate the neural plasticity after stroke. Therefore, synchronizing the two interventions may optimize the efficiency of recovery. In the present study, we aim to investigate the effect of rTMS along with hand grip training on the neurobehavioral and hand functional recovery in one cohort of subacute stroke patients.Methods: Thirty-nine stroke patients were enrolled in a single-center, single-blinded, randomized clinical trial. We tested different intervention effects of rTMS and hand grip training (group A), rTMS alone (group B), and hand grip training alone (group C). For the rTMS-treated groups, patients received 10 consecutive sessions of 5-Hz stimulation over the affected hemisphere with 750 pulses. Jebsen–Taylor Hand Function Test (JTHFT), Fugl-Meyer assessment of upper extremity (FMA-UE), grip strength, modified Barthel index (mBI), and ipsilesional motor evoked potential (iMEP) latency were assessed and compared across the groups.Results: We found that only rTMS along with hand grip training group all improved in JTHFT, FMA-UE, grip strength, and mBI (p ≤ 0.01) compared with the baseline among the three groups. Furthermore, this study demonstrated that rTMS plus hand grip training had much better results in improvement of neurobehavioral outcomes compared to the rTMS alone- and hand grip training alone-treated patients (p < 0.05). However, no significant differences were detected in neurophysiologic outcome between intra-groups and inter-groups (p > 0.05).Conclusion: These proof-of-concept results suggested that rTMS alone with hand grip training was a unique approach to promote hand functional recovery in stroke patients. It provided important information to design a large-scale multi-center clinical trial to further demonstrate the efficiency of the combination of central and peripheral stimulation.Clinical Trial Registration:http://www.chictr.org.cn (#ChiCTR1900023443).

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