Repetitive Transcranial Magnetic Stimulation for Post-stroke Dysphagia: a Meta-analysis

Background. Dysphagia is common among post-stroke patients, causing disability due to malnutrition and pneumonia. Repetitive transcranial magnetic stimulation (rTMS) is a novel treatment modality to address this complication.

Objective. The study aimed to compare real versus sham rTMS in treating post-stroke dysphagia.

Methods. PubMed, Ovid, ClinicalKey, Herdin, and Google Scholar databases were searched from their earliest record to 31 July 2015 for randomized controlled trials that used rTMS to treat post-stroke dysphagia. The Jadad scale was used to assess the quality of the studies. The weighted mean difference (WMD) between baseline and post-treatment mean for Penetration Aspiration Scores (PAS) measured in the experimental and control groups were extracted for subsequent meta-analyses.

Results. Three studies were analyzed. The WMD in PAS score between rTMS and control using liquid bolus two weeks after treatment in two good quality studies was -1.14 (95% confidence interval (CI) = -1.80 – -0.48, P = 0.001, I2 = 0.0%), and after four weeks was -1.83 (CI = -3.22 – -0.44, P = 0.010, I2 = 0.0%).

Conclusion. Treatment of post-stroke dysphagia with rTMS improved PAS on subgroup analyses of studies using liquid bolus after two weeks, and between real and sham treatment after four weeks.