Advertisement

Dysphagia

pp 1–12 | Cite as

Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Swallowing Function and Quality of Life of Post-stroke Patients

  • Nezehat Özgül ÜnlüerEmail author
  • Çağrı Mesut Temuçin
  • Numan Demir
  • Selen Serel Arslan
  • Aynur Ayşe Karaduman
Original Article
  • 68 Downloads

Abstract

Repetitive transcranial magnetic stimulation (rTMS) is one of the non-invasive techniques, which is used to modulate cortical regions in patients with stroke. The aim of this single blind, controlled study was to investigate the effect of rTMS on swallowing function and quality of life of mono-hemispheric post-stroke patients with dysphagia. Twenty-eight patients were randomized and split between study and control group. Each group received conventional dysphagia rehabilitation 3 days a week for 4 weeks, and study group also received 1 Hz rTMS to unaffected hemisphere in the final week. The descriptive information was noted. The clinical and radiological swallowing evaluation and quality of life assessment have been performed at four different times including before and after the treatment, 1 month and 3 months after the treatment. At baseline, no significant differences were observed between groups in terms of demographic and clinical features (p > 0.05). Swallowing function and quality of life of the patients were statistically improved in both groups towards the third month (p < 0.05). Swallowing function was comparable between two groups. However, a significant improvement was observed on appetite, fear of eating, and mental health parameters of quality of life assessment in the study group compared to the control group (p < 0.05). In conclusion, despite positive changes in some aspects of quality of life, rTMS did not enhance the swallowing function when compared conventional dysphagia rehabilitation. Therefore, the application of 1 Hz rTMS should be reconsidered to improve swallowing function in the chronic period.

Keywords

Stroke Deglutition Repetitive transcranial magnetic stimulation Deglutition disorders Quality of life 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest with regard to this research.

Ethical Approval

All the procedures performed in the studies involving human participants were conducted in accordance with the ethical standards of the institutional research committee, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all the individual participants included in this study.

References

  1. 1.
    Speyer R, Baijens L, Heijnen M, Zwijnenberg I. Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review. Dysphagia. 2010;25(1):40–65.CrossRefGoogle Scholar
  2. 2.
    Ridding MC, Rothwell JC. Is there a future for therapeutic use of transcranial magnetic stimulation? Nat Rev Neurosci. 2007;8(7):559.CrossRefGoogle Scholar
  3. 3.
    Fregni F, Boggio PS, Valle AC, Rocha RR, Duarte J, Ferreira MJ, Wagner T, Fecteau S, Rigonatti SP, Riberto M. A sham-controlled trial of a 5-day course of repetitive transcranial magnetic stimulation of the unaffected hemisphere in stroke patients. Stroke. 2006;37(8):2115–22.CrossRefGoogle Scholar
  4. 4.
    Mansur C, Fregni F, Boggio P, Riberto M, Gallucci-Neto J, Santos C, Wagner T, Rigonatti S, Marcolin M, Pascual-Leone A. A sham stimulation-controlled trial of rTMS of the unaffected hemisphere in stroke patients. Neurology. 2005;64(10):1802–4.CrossRefGoogle Scholar
  5. 5.
    Hummel F, Celnik P, Giraux P, Floel A, Wu W-H, Gerloff C, Cohen LG. Effects of non-invasive cortical stimulation on skilled motor function in chronic stroke. Brain. 2005;128(3):490–9.CrossRefGoogle Scholar
  6. 6.
    Peinemann A, Reimer B, Löer C, Quartarone A, Münchau A, Conrad B, Siebner HR. Long-lasting increase in corticospinal excitability after 1800 pulses of subthreshold 5 Hz repetitive TMS to the primary motor cortex. Clin Neurophysiol. 2004;115(7):1519–26.CrossRefGoogle Scholar
  7. 7.
    Kim L, Chun MH, Kim BR, Lee SJ. Effect of repetitive transcranial magnetic stimulation on patients with brain injury and dysphagia. Ann Rehabil Med. 2011;35(6):765–71.CrossRefGoogle Scholar
  8. 8.
    Khedr EM, Abo-Elfetoh N. Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brainstem infarction. J Neurol Neurosurg Psychiatr. 2010;81(5):495–9.CrossRefGoogle Scholar
  9. 9.
    Khedr E, Abo-Elfetoh N, Rothwell J. Treatment of post-stroke dysphagia with repetitive transcranial magnetic stimulation. Acta Neurol Scand. 2009;119(3):155–61.CrossRefGoogle Scholar
  10. 10.
    Verin E, Leroi A. Poststroke dysphagia rehabilitation by repetitive transcranial magnetic stimulation: a noncontrolled pilot study. Dysphagia. 2009;24(2):204.CrossRefGoogle Scholar
  11. 11.
    Cramer SC, Nelles G, Benson RR, Kaplan JD, Parker RA, Kwong KK, Kennedy DN, Finklestein SP, Rosen BR. A functional MRI study of subjects recovered from hemiparetic stroke. Stroke. 1997;28(12):2518–27.CrossRefGoogle Scholar
  12. 12.
    Boroojerdi B, Diefenbach K, Ferbert A. Transcallosal inhibition in cortical and subcortical cerebral vascular lesions. J Neurol Sci. 1996;144(1):160–70.CrossRefGoogle Scholar
  13. 13.
    Murase NDJ, Mazzocchio R, Cohen LG. Influence of interhemispheric interactions on motor function in chronic stroke. Ann Neurol. 2004;55(3):400–9.CrossRefGoogle Scholar
  14. 14.
    Hummel FC, Cohen LG. Non-invasive brain stimulation: a new strategy to improve neurorehabilitation after stroke? Lancet Neurol. 2006;5(8):708–12.CrossRefGoogle Scholar
  15. 15.
    Homan RW, Herman J, Purdy P. Cerebral location of international 10–20 system electrode placement. Electroencephalogr Clin Neurophysiol. 1987;66(4):376–82.CrossRefGoogle Scholar
  16. 16.
    Hamdy S, Aziz Q, Rothwell JC, Singh KD, Barlow J, Hughes DG, Tallis RC, Thompson DG. The cortical topography of human swallowing musculature in health and disease. Nat Med. 1996;2(11):1217–24.CrossRefGoogle Scholar
  17. 17.
    Kasner SE, Chalela JA, Luciano JM, Cucchiara BL, Raps EC, McGarvey ML, Conroy MB, Localio AR. Reliability and validity of estimating the NIH stroke scale score from medical records. Stroke. 1999;30(8):1534–7.CrossRefGoogle Scholar
  18. 18.
    Kucukdeveci A, Yavuzer G, Tennant A, Suldur N, Sonel B, Arasil T. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med. 2000;32(2):87–92.CrossRefGoogle Scholar
  19. 19.
    Banks JL, Marotta CA. Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke. 2007;38(3):1091–6.CrossRefGoogle Scholar
  20. 20.
    Ojo O, Brooke J. The use of enteral nutrition in the management of stroke. Nutrients. 2016;8(12):827.CrossRefGoogle Scholar
  21. 21.
    McHorney CA, Robbins J, Lomax K, Rosenbek JC, Chignell K, Kramer AE, Bricker DE. The SWAL–QOL and SWAL–CARE outcomes tool for oropharyngeal dysphagia in adults: III. Documentation of reliability and validity. Dysphagia. 2002;17(2):97–114.CrossRefGoogle Scholar
  22. 22.
    Demir N, Arslan SS, İnal Ö, Ünlüer NÖ, Karaduman AA. Reliability and validity of the Turkish version of the swallow quality of life questionnaire. Türk Fizyoterapi ve Rehabilitasyon Dergisi. 2016;27(1):19–24.CrossRefGoogle Scholar
  23. 23.
    Kipping P. Swallowing ability and function evaluation. Austin: pro-ed; 2003.Google Scholar
  24. 24.
    Rugiu M. Role of videofluoroscopy in evaluation of neurologic dysphagia. Acta Otorhinolaryngol Ital. 2007;27(6):306.Google Scholar
  25. 25.
    Groher ME. The detection of aspiration and videofluoroscopy. Dysphagia. 1994;9(3):147–8.CrossRefGoogle Scholar
  26. 26.
    Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia. 1996;11(2):93–8.CrossRefGoogle Scholar
  27. 27.
    Karaduman AA, Serel S, Ünlüer NÖ, Demir N. The penetration aspiration scale: interrater realiability study. Fizyoterap Rehabil. 2012;23:151–5.Google Scholar
  28. 28.
    Logemann J. Instrumental techniques for the study of swalloing. Evaluation and treatment of swallowing disorders. Austin: pro-ed; 1998.Google Scholar
  29. 29.
    Park JW, Oh JC, Lee JW, Yeo JS, Ryu K. The effect of 5 Hz high-frequency rTMS over contralesional pharyngeal motor cortex in post-stroke oropharyngeal dysphagia: a randomized controlled study. Neurogastroenterol Motil. 2013;25(4):324.CrossRefGoogle Scholar
  30. 30.
    Lim K-B, Lee H-J, Yoo J, Kwon Y-G. Effect of low-frequency rTMS and NMES on subacute unilateral hemispheric stroke with dysphagia. Ann Rehabil Med. 2014;38(5):592–602.CrossRefGoogle Scholar
  31. 31.
    Du J, Yang F, Liu L, Hu J, Cai B, Liu W, Xu G, Liu X. Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia: a randomized, double-blind clinical trial. Clin Neurophysiol. 2016;127(3):1907–13.CrossRefGoogle Scholar
  32. 32.
    Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–46.CrossRefGoogle Scholar
  33. 33.
    Michou E, Raginis-Zborowska A, Watanabe M, Lodhi T, Hamdy S. Repetitive transcranial magnetic stimulation: a novel approach for treating oropharyngeal dysphagia. Curr Gastroenterol Rep. 2016;18(2):10.CrossRefGoogle Scholar
  34. 34.
    Cheng IK, Chan KM, C-s Wong, Li LS, Chiu KM, Cheung RT, Yiu EM. Neuronavigated high-frequency repetitive transcranial magnetic stimulation for chronic post-stroke dysphagia: a randomized controlled study. J Rehabil Med. 2017;49(6):475–81.CrossRefGoogle Scholar
  35. 35.
    Finestone HM, Greene-Finestone LS, Wilson ES, Teasell RW. Malnutrition in stroke patients on the rehabilitation service and at follow-up: prevalence and predictors. Arch Phys Med Rehabil. 1995;76(4):310–6.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Health Sciences, Department of Physiotherapy and RehabilitationAnkara Yıldırım Beyazıt UniversityÇubukTurkey
  2. 2.Faculty of Medicine Neurology DepartmentHacettepe UniversitySıhhıyeTurkey
  3. 3.Faculty of Health Sciences, Department of Physiotherapy and RehabilitationHacettepe UniversitySıhhıyeTurkey

Personalised recommendations