A Clinical Study Of RTMS Combined With Balloon Dilation In The Treatment Of Cricopharyngeus Achalasia After Stroke

Background:In recent years,the incidence of dysphagia caused by cricopharyngeus achalasia in patients after stroke has increased.There are various treatment methods for dysphagia,but all of them have shortcomings.This study aims to provide a feasible treatment method to promote the recovery process of dysphagia.Objective:To observe the efficacy of low frequency repeated transcranial magnetic stimulation combined with balloon dilation in the treatment of cricopharyngeus achalasia after stroke.Methods: Eighty patients with post-stroke cricopharyngeus achalasia were randomly divided into four groups,namely balloon dilation group,r TMS group,combined treatment group and control group,using random number table method.Each group was treated with conventional medicine,acupuncture and rehabilitation techniques for two weeks.Gugging Swallowing Screen（GUSS）,video fluoroscopic swallow study（VFSS）and surface electromyography（s EMG）were used to evaluate the swallowing level of each group before and two weeks after treatment,and the scores were recorded.Results: The GUSS and VFSS scores of the four groups before and after treatment showed statistically significant differences（P < 0.05）.The score of the control group was the lowest after treatment,and the score of the combined treatment group was the highest.The differences among the four groups were also statistically significant（P < 0.05）.Comparison of the difference between the four groups before and after treatment,the combined treatment group had the largest difference,the control group had the smallest difference,the difference between the four groups was statistically significant（P < 0.05）;The surface em G evaluation showed that the mean amplitude of the submental muscle group and PES area in the four groups were improved in different degrees after treatment compared with before treatment in three different swallowing states,and the difference was statistically significant（P < 0.05）.The control group was the lowest,and the combined treatment group was the highest,and the difference among the four groups was statistically significant（P < 0.05）.After treatment,the mean amplitude difference between the two groups decreased significantly.The comprehensive results under the three swallowing states showed that the difference was the lowest in the combined treatment group and the highest in the control group,with statistical significance（P <0.05）.The difference of albumin index between the four groups before and after treatment was statistically significant（P < 0.05）.The difference between the four groups before and after treatment was the largest in the combined treatment group and the smallest in the control group.The difference was statistically significant（P < 0.05）.Conclusion: The efficacy of low-frequency r TMS combined with balloon dilation in the treatment of post-stroke cricopharyngeus apalasia was significantly better than that of each group alone.Low frequency r TMS and balloon dilation combined with traditional rehabilitation training had better therapeutic effect than traditional rehabilitation training alone.s EMG is a portable,quantitative,non-invasive test with electromyographic values associated with constriction of pharyngeal muscle groups and opening of cricopharyngeus muscles,which may assist in the early assessment of cricopharyngeus apalasia.