Ann Rehabil Med.  2015 Jun;39(3):432-439. 10.5535/arm.2015.39.3.432.

Effect of Repetitive Transcranial Magnetic Stimulation According to the Stimulation Site in Stroke Patients With Dysphagia

• Lee JH
• Kim SB
• Lee KW
• Lee SJ
• Lee JU

• KMID: 2165647
• DOI: http://doi.org/10.5535/arm.2015.39.3.432

Abstract

OBJECTIVE
To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) according to the stimulation site in subacute stroke patients with dysphagia.
METHODS
This study was designed as a matched comparative study. Twenty-four patients who had dysphagia after ischemic stroke were recruited, and they were divided into two groups after matching for age and stroke lesion. The patients in group A received rTMS over the brain cortex where motor evoked potential (MEP) was obtained from the suprahyoid muscle. Group B received rTMS over the brain cortex where MEP was obtained from the abductor pollicis brevis muscle. rTMS was performed at 110% of MEP threshold, 10 Hz frequency for 10 seconds, and then repeated every minute for 10 minutes. Dysphagia status was measured by the Functional Dysphagia Scale (FDS), the Penetration-Aspiration Scale (PAS), and the Dysphagia Outcome and Severity Scale (DOSS) using the results of a videofluoroscopic swallowing study. These evaluations were measured before, immediately, and 4 weeks after rTMS.
RESULTS
Group A showed significant improvement compared to group B in the DOSS score immediately and 4 weeks after rTMS. There were no significant differences in the changes of FDS and PAS scores between groups A and B immediately and 4 weeks after rTMS.
CONCLUSION
rTMS over a hot spot for the suprahyoid muscle caused more improvement in swallowing function when compared to that over the interconnected site.

Keyword

Transcranial Magnetic Stimulation; Stroke; Deglutition Disorders

MeSH Terms

Brain
Deglutition
Deglutition Disorders*
Dioctyl Sulfosuccinic Acid
Evoked Potentials, Motor
Humans
Stroke*
Transcranial Magnetic Stimulation*
Dioctyl Sulfosuccinic Acid

Figure

• 

  Fig. 1 Stimulation sites included the following: for group A, to stimulate a specific dysphagia site, a hot spot was obtained from motor evoked potentials (MEP) of the suprahyoid muscle (A); for group B, to stimulate an interconnected remote site related to dysphagia, a hot spot was obtained from MEP of the abductor pollicis brevis muscle (B).

• 

  Fig. 2 In repeated measures analysis of variance test, all dysphagia scores were improved over time up to 4 weeks after rTMS in group A and only FDS score was improved in group B. There was no significant group-time interaction in all dysphagia scores. FDS, Functional Dysphagia Scale; PAS, Penetration-Aspiration Scale; DOSS, Dysphagia Outcome and Severity Scale; rTMS, repetitive transcranial magnetic stimulation; group A, rTMS over the cortex representing the suprahyoid muscle; group B, rTMS over the cortex representing the abductor pollicis brevis. *p<0.05.

• 

  Fig. 3 In repeated measures analysis of variance test, MMSE score was not significantly improved over time up to 4 weeks after rTMS, and there was no significant group-time interaction (A). K-MBI was improved over time up to 4 weeks after rTMS, while there was no significant group-time interaction (B). MMSE, Mini-Mental Status Examination; K-MBI, Korean version of the Modified Barthel Index; rTMS, repetitive transcranial magnetic stimulation; group A, rTMS over the cortex representing the suprahyoid muscle; group B, rTMS over the cortex representing the abductor pollicis brevis. *p<0.05.

• 

  Fig. 4 Treatment effects in (A) FDS, (B) PAS, and (C) DOSS scores. Group A showed significantly bigger increase in DOSS scores than group B both immediately after and 4 weeks after rTMS. ΔFDS, ΔPAS, ΔDOSS, amounts of changes from before rTMS. FDS, Functional Dysphagia Scale; PAS, Penetration-Aspiration Scale; DOSS, Dysphagia Outcome and Severity Scale; rTMS, repetitive transcranial magnetic stimulation; group A, rTMS over the cortex representing the suprahyoid muscle; group B, rTMS over the cortex representing the abductor pollicis brevis. *p<0.05.

• 

  Fig. 5 When the treatment effects from baseline to immediately and 4 weeks after rTMS were compared between the two groups, no difference in improvement of the MMSE and K-MBI scores was observed (A, B). ΔMMSE, ΔK-MBI, amount of change from before rTMS. rTMS, repetitive transcranial magnetic stimulation; Group A, rTMS over the cortex representing the suprahyoid muscle; Group B, rTMS over the cortex representing the abductor pollicis brevis; MMSE, Mini-Mental Status Examination; K-MBI, Korean version of the Modified Barthel Index.

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