Wu, Xiaomin;
Zhang, Baixiang;
Ambler, Gareth;
Chen, Qingfa;
Huang, Huayao;
Lin, Huiying;
Fang, Shuangfang;
... Du, Houwei; + view all
(2024)
Repetitive Transcranial Magnetic Stimulation Strategies for Poststroke Dysphagia: A Systematic Review and Network Meta-analysis.
Archives of Physical Medicine and Rehabilitation
10.1016/j.apmr.2024.12.018.
(In press).
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Abstract
Objective: Repetitive transcranial magnetic stimulation (rTMS) is a promising approach in improving swallowing function after stroke. However, comparative efficacy of different rTMS protocols for poststroke dysphagia (PSD) remains unclear. // Data Sources: PubMed, Embase, and Cochrane database were systematically searched for eligible random controlled trials (RCTs) from inception to August 30, 2024. // Study Selection: RCTs comparing rTMS with control or head-to-head comparisons of 2 rTMS protocols in patients with PSD. // Data Extraction: Data were extracted by 2 independent reviewers. A network meta-analysis combining direct and indirect evidence was conducted to assess the pooled findings of RCTs with standard mean difference (SMD) with 95% credible interval (CrI). // Data Synthesis: Eighteen RCTs involving 760 participants (mean age of 62.4 [range 49.7-74.7] years; 45.7% women) were included. Pooled data showed that high frequency (HF)/ipsilesional hemisphere (ipsi-hemi) (SMD, −0.94; 95% CrI, −1.51 to −0.44), HF/bilateral hemisphere (bi-hemi) (SMD, −2.59; 95% CrI, −3.50 to −1.72), HF/ipsilesional cerebellar (ipsi-CRB) (SMD, −0.79; 95% CrI, −1.55 to −0.10), HF/bilateral cerebellar (bi-CRB) (SMD, −1.02; 95% CrI, −1.83 to −0.29), and HF/ipsi-hemi + low frequency (LF)/contralesional hemisphere (contra-hemi) (SMD, −2.72; 95% CrI, −4.12 to −1.41) rTMS all significantly improved swallowing function compared with control. For patients with acute stroke, HF/ipsi-hemi rTMS had a positive effect (SMD, −1.36; 95% CrI, −2.86 to −0.02); in subacute stage, HF/ipsi-hemi + LF/contra-hemi rTMS showed the best efficacy (SMD, −2.68; 95% CrI, −4.26 to −1.26). However, rTMS failed to improve swallowing function in chronic stage. // Conclusions: This network meta-analysis showed that most of the rTMS protocols (HF/ipsi-hemi, HF/bi-hemi, HF/ipsi-CRB, HF/bi-CRB, and HF/ipsi-hemi + LF/contra-hemi) may improve swallowing function in patients with PSD. The HF/ipsi-hemi rTMS had a positive effect in acute stage and the HF/ipsi-hemi + LF/contra-hemi protocol seemed to have the best efficacy when applied in subacute stroke.
| Type: | Article |
|---|---|
| Title: | Repetitive Transcranial Magnetic Stimulation Strategies for Poststroke Dysphagia: A Systematic Review and Network Meta-analysis |
| Location: | United States |
| DOI: | 10.1016/j.apmr.2024.12.018 |
| Publisher version: | https://doi.org/10.1016/j.apmr.2024.12.018 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Dysphagia; Hemorrhage; Rehabilitation; Stroke; Transcranial magnetic stimulation |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > Dept of Statistical Science |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10204579 |
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