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Publication Detail
Treatment of post-stroke dysphagia with repetitive transcranial magnetic stimulation
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Khedr EM, bo-Elfetoh N, Rothwell JC
  • Publication date:
    03/2009
  • Pagination:
    155, 161
  • Journal:
    Acta Neurologica Scandinavica
  • Volume:
    119
  • Issue:
    3
  • Print ISSN:
    0001-6314
  • Keywords:
    2, Aged, AMPLITUDE, article, Comparative Study, COMPLICATIONS, CONTROLLED TRIAL, CORTEX, Deglutition Disorders, DISABILITY, Dominance, Cerebral, Double-Blind Method, effect, Electromyography, esophagus, etiology, Evoked Potentials, Motor, Female, FOLLOW UP, Follow-Up Studies, GRIP, Hand, Hand Strength, HEMISPHERE, HUMANS, MAGNETIC STIMULATION, Male, MEP, Methods, Middle Aged, MOTOR, MOTOR CORTEX, motor evoked potential, Neurology, PATIENT, patients, Peristalsis, physiopathology, repetitive transcranial magnetic stimulation, Severity of Illness Index, STIMULATION, STRENGTH, stroke, therapy, threshold, TMS, transcranial magnetic stimulation, treatment
Abstract
BACKGROUND: Up to one-third of patients experience swallowing problems in the period immediately after a stroke. OBJECTIVE: To investigate the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on post-stroke dysphagia. MATERIALS AND METHODS: Twenty-six patients with post-stroke dysphagia due to monohemispheric stroke were randomly allocated to receive real (n = 14) or sham (n = 12) rTMS of the affected motor cortex. Each patient received a total of 300 rTMS pulses at an intensity of 120% hand motor threshold for five consecutive days. Clinical ratings of dysphagia and motor disability were assessed before and immediately after the last session and then again after 1 and 2 months. The amplitude of the motor-evoked potential (MEP) evoked by single-pulse TMS was also assessed before and at 1 month in 16 of the patients. RESULTS: There were no significant differences between patients who received real rTMS and the sham group in age, hand grip strength, Barthel Index or degree of dysphagia at the baseline assessment. Real rTMS led to a significantly greater improvement compared with sham in dysphagia and motor disability that was maintained over 2 months of follow-up. This was accompanied by a significant increase in the amplitude of the oesophageal MEP evoked from either the stroke or non-stroke hemisphere. CONCLUSION: rTMS may be a useful adjunct to conventional therapy for dysphagia after stroke
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