Transcranial Magnetic Stimulation
Conditions
Keywords
Dysphagia, Repetitive Transcranial Magnetic Stimulation, Stroke
Brief summary
The patients with chronic dysphagia secondary to first-ever stroke were randomly assigned to 2 groups: Group A: sham stimulation for 10 minutes , Group B: real rTMS for 10 minutes. rTMS conditioning: daily rTMS 10 min for 10 days. Assessments: 1. videofluoroscopy，2.Functional outcome swallowing scale (3 scales). 3. MEP measurements
Detailed description
While the reflex component of swallowing depends on swallowing centres in the brainstem, initiation of swallowing is a voluntary action that involves the integrity of motor areas of the cerebral cortex. Oropharyngeal dysphagia occurs in more than 50% of stroke patients. Aspiration pneumonia occurs in up to 20% of acute stroke patients and is a major cause of mortality after discharge. Oropharyngeal dysphagia is both underestimated and underdiagnosed as a cause of major nutritional and respiratory complications in stroke patients. Recently, transcranial magnetic stimulation (TMS) has been used to study the cortical input to swallowing control and has revealed that the topographic representation of esophageal motor function in the human cerebral cortex is bilateral but with consistent interhemispheric asymmetry unrelated to handedness. In a number of recent studies, poststroke motor and dysphagia performance has been improved after daily treatment sessions with repetitive TMS (rTMS) using an excitatory frequency in patients with hemispheric ischaemic stroke due to occlusion of territories of the middle cerebral artery. Our hypothesis was that rTMS would facilitate dysphagia recovery.
Interventions
DEVICErepetitive transcranial magnetic stimulation
rTMS
Sponsors
Taipei Veterans General Hospital, Taiwan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. a diagnosis of stroke related dysphagia 2. no concurrent neurodegenerative or dementia history 3. an absence of TMS contraindications.
Exclusion criteria
* arrythmia, epilepsy, infection, hyperglycemia, pacemaker or implants, external ventricular drain or ventriculoperitoneal shunt
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| functional outcome | prior to treatment (baseline), on the next day after the 2 weeks treatment completion | points of Australian Therapy Outcome Measures-the Swallowing scale as assessed by a clinical therapist |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| videofluoroscopy | prior to treatment (baseline), on the next day after the 2 weeks treatment completion | points of Penetration-Aspiration Scale as assessed by videofluoroscopy |
| cricopharyngeal motor evoked potentials | prior to treatment (baseline), on the next day after the 2 weeks treatment completion | amplitude and latency measured by cricopharyngeal motor evoked potentials |
Outcome results
None listed