Repetitive transcranial magnetic stimulation for post-stroke dysphagia: a systematic review of the literature

Objective To systematically review the efficacy and safety of repetitive transcranial magnetic stimulation( rTMS) for post-stroke dysphagia. Methods The clinical trials about rTMS for post-stroke dysphagia were searched on Pubmed,EMbase,MEDLINE,Cochrane library,China National Knowledge Infrastructure( CNKI),Chinese BioMedical Literature Database on disc( CBMdisc),and Wanfang database with computers. Two independent reviewers selected the literatures by the inclusion and exclusion criteria,data extraction and cross-checking,and then conducted the analysis. Results A total of seven trails( 228 patients,136 of them in a rTMS group and 92 in a control group) were included. Four randomized controlled trials( RCTs) were used for Meta-analysis( 54 patients in the rTMS group,42 in the control group). The other three non-RCTs were only reviewed systematically.( 1) Meta-analysis showed that the improvement of swallowing function score after rTMS was better than that of the control group( SMD = 1. 73,95% CI 0. 45 to 3. 01; P = 0. 008).( 2) After high-frequency rTMS( 1 Hz),there was significant difference in the improvement of swallowing function score between the two groups( SMD = 1. 60,95% CI 0. 10 to 3. 11; P = 0. 04). Compared to the control group,there were also significant differences in the improvement of some swallowing function scores in low-frequency rTMS( 1 Hz),suggesting the potential advantages of low-frequency therapy.( 3) After rTMS,there was no significant difference in the improvement of Barthel index in patients with stroke compared with the control group( MD =- 21. 60,95% CI- 36. 21 to- 7. 00; P = 0. 004).( 4) In terms of adverse reactions,seven trials did not report any adverse events, such as headache,tinnitus or epilepsy,etc. Conclusion Using rTMS may significantly promote the recovery of swallowing function for patients with post-stroke dysphagia,and it is both safe and effective.