Application Research Of Repetitive Transcranial Magnetic Pre-Stimulation In Post-Stroke Dysphagia

Background: Swallowing is an indispensable behavior in our daily life,and the neuroanatomical structure of it is quite complex.Post-stroke dysphagia(PSD)can lead to a range of complications,of which malnutrition and aspiration pneumonia are the most common and troublesome consequences.It increased the risk of death in elderly and very sick patients.Furthermore,aspiration pneumonia is also the most common cause of death in patients with neurological disorders associated with dysphagia.Therefore PSD is one of the major projects in rehabilitation departments.In the last decade,there has been an increasing number of studies about neuromodulation techniques such as repetitive transcranial magnetism(r TMS)in the direction of PSD,although the parameter settings of r TMS for PSD are still highly controversial,the latest research reports that pre-stimulation r TMS may affect the swallowing function to some extent.However,there is no research to verify the effectiveness of pre-stimulation r TMS in the direction of PSD.We put forward a hypothesis: delivering pre-stimulation r TMS to the bilateral cerebral hemispheres of PSD patients can activate the corresponding cortical motor areas in advance,which can produce better results than traditional r TMS only,and has a more obvious improvement effect.Purpose: The aim of this study was to observe that whether bilateral prestimulation treatment could excite the cerebral cortex more effectively than HF r TMS treatment alone and to compare the efficacy of two types of HF r TMS in patients with PSD.Methods: We selected the patients with post-stroke dysphagia who were admitted to the rehabilitation department of the Nantong University Faciliated Hospital from October 2021 to December 2022,and divided them into a pre-stimulation group and a control group according to the random number table method.The pre-stimulation group receiving bilateral cerebral hemisphere 1 Hz r TMS as pre-stimulation followed by bilateral 10 Hz r TMS and the control group receiving bilateral ineffective pre-stimulation followed by same 10 Hz r TMS.And each patient received regular swallowing function training after every complete r TMS treatment,and all the above treatments were given once a day for a total of 10 times.Patients in both groups received multiple scales before and after treatment,such as the Kubota drinking test,clinical dysphagia scale(CDS),standardized swallowing assessment(SSA),dysphagia outcome and severity scale(DOSS),measuring of suprahyoid motor evoked potential(MEP)amplitude,and to have video fluoroscopic swallowing study(VFSS)with analysis based on the results of penetration-aspiration scale(PAS)and other behavioral manifestations of swallowing.Results: A total of 36 patients meeting the criteria were included in this research.18 patients in each group,of which 15 in the prestimulation group and 16 in the control group completed the study eventually,resulting in a total of 31 patients completed.The baseline status of patients in both groups was comparable.After 10 treatments,the assessment was performed again.In terms of scale assessment,there was a great improvement in Kubota drinking ratings,CDS,SSA and DOSS between after treatment(P < 0.05),and there was a significant difference between the two groups after treatment(P < 0.05).In the performance of suprahyoid MEP amplitude,there was a significant difference between the two groups before and after treatment(P < 0.05),and there was no statistically difference after treatment(P > 0.05),but there was a significant group difference in the degree of change in MEP amplitude(P < 0.05).In the VFSS examination,swallowing behavioral performances and PAS ratings were significantly improved compared with the same group before treatment(P < 0.05),and further analysis showed that behavioral performances such as severity of swallowing disorder,food residue,and swallow initiation speed under VFSS were better in the pre-stimulation group than in the control group(P < 0.05).There were no significant group differences in PAS ratings as well as oral food delivery speed after treatment(P > 0.05),but the degree of improvement in PAS before and after treatment was more pronounced in the pre-stimulation group(P < 0.05).Conclusion: Both r TMS methods above can increase cortical excitability and improve swallowing function in patients recovering from stroke,and pre-stimulation r TMS can induce greater MEP wave amplitude and thus improve swallowing function in patients with PSD more effectively.This study provides a new therapeutic idea and a basis for clinical treatment options for patients with PSD.