Theta burst stimulation versus high-frequency repetitive transcranial magnetic stimulation for poststroke dysphagia: A randomized, double-blind, controlled trial

Xie Yu-Lei, Wang Shan, Yang Ju, Xie Yu-Han, Qing Wu, Wang Yin-Xu, Xie Yu-Lei, Wang Shan, Yang Ju, Xie Yu-Han, Qing Wu, Wang Yin-Xu

Abstract

Background: Repetitive transcranial magnetic stimulation (rTMS) of high-frequency (10 Hz) on suprahyoid motor cortex has been an evidence-based treatment for poststroke dysphagia. Intermittent theta burst stimulation (iTBS) can be performed in 3 minutes compared with 20 ± 5 minutes for 10 Hz rTMS. This study aimed to ensure the clinical efficacy, safety, and tolerability of iTBS compared with 10 Hz rTMS for patients with poststroke dysphagia.

Method: In this randomized, double-blind, single-center, controlled trial, 47 participants were randomly assigned to iTBS (n = 24) and rTMS (n = 23) group. Each participant received iTBS or rTMS daily at suprahyoid motor cortex of affected hemisphere for 10 consecutive days. The outcomes were assessed at baseline, immediately, and 2 weeks after intervention, including water-swallowing test, standardized swallowing assessment, Mann assessment of swallowing ability, Murray Secretion Scale, Yale Pharyngeal Residue Severity Rating Scale, Penetration-Aspiration Scale, and motor evoked potential (MEP) of bilateral suprahyoid muscle.

Results: There were no significant differences between groups. There was a significant improvement on all rating scales and MEP after rTMS and iTBS. No significant differences on water-swallowing test, Mann assessment of swallowing ability, standardized swallowing assessment, Murray Secretion Scale scores, and MEP were observed between groups. In particular, there was significant differences on Penetration-Aspiration Scale scores (viscous liquid: mean difference = 1.016; 95% CI: 0.32-1.71; effect size: 0.360; P = .005) and the residue rate of pyriform fossa (viscous liquid: mean difference = 0.732; 95% CI: 0.18-1.28; effect size: 0.248; P = .010) in between-group. Comparing the differences over the changes of all rating scales, only the residue rate of epiglottis valley between groups was found to be significantly different (dilute liquid: mean difference = -0.567; 95% CI: -0.98 to -0.15; P = .009). There was no severe adverse effect and high dropout rates in both groups.

Conclusion: The clinical efficacy, safety, and tolerability of iTBS showed non-inferior to 10 Hz rTMS for patients with poststroke dysphagia. The present study can be used to improve the clinicians' knowledge and clinical decision skills on iTBS and rTMS for poststroke dysphagia.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

Figures

Figure 1
Figure 1
Flow chart. T1 = immediately after the intervention.
Figure 2
Figure 2
Swallowing function assessments based on clinical severity and fiberoptic endoscopic evaluation of swallowing (FEES). (A1) changes in the standardized swallowing assessment (SSA) score. (A2) Changes in the Penetration-Aspiration Scale (PAS) score. (B1) Changes in the Yale Pharyngeal Residue Severity Rating Scale (YPRS) in severity of epiglottis valley residue. (B2) Changes in the Residue Severity Rating Scale (YPRS) in severity of pyriform fossa residue. Error bars represent the standard deviation for each condition. (∗) indicates that a significant difference was observed within both group (∗P < .05); T0 = baseline before the intervention, T1 = immediately after the intervention, T2 = 2 weeks after cessation of the intervention.

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