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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 - Ann Rehabil Med (2015)

Bottom Line: This study was designed as a matched comparative study.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. rTMS over a hot spot for the suprahyoid muscle caused more improvement in swallowing function when compared to that over the interconnected site.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea.

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.

No MeSH data available.


Related in: MedlinePlus

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).
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Figure 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).

Mentions: Before the rTMS, motor evoked potentials (MEPs) were evaluated using a MagPro (MagVenture Inc., Farum, Denmark). Subjects were seated comfortably in an armchair. The point of intersection between the midsagittal line that connects the nasion and inion and the interaural line was designated as Cz. Cz was designated the origin (0, 0); the interaural line was designated the x-axis; and the midsagittal line was designated the y-axis. Fabric, with markings at 2.5-cm increments with Cz at the center, was fixed to the scalp. Magnetic stimulation was performed using a figure-of-eight coil (diameter, 2 mm×96 mm). The target muscle in group A was the suprahyoid muscle of the affected side, while that in group B was the APB muscle of the affected side. Similar to previous studies [1920], for the suprahyoid muscle, an active electrode was attached 2 cm lateral to the midline of the lower chin and the reference electrode was attached to the mandibular angle (Fig. 1). The motor threshold was defined as the minimal stimulus intensity required to produce MEP >50 µV peak-to-peak amplitude in five of ten consecutive trials on each muscle. The location yielding the largest response amplitude was termed the 'hot spot', and we delivered magnetic stimulation to that point.


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 - Ann Rehabil Med (2015)

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496515&req=5

Figure 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).
Mentions: Before the rTMS, motor evoked potentials (MEPs) were evaluated using a MagPro (MagVenture Inc., Farum, Denmark). Subjects were seated comfortably in an armchair. The point of intersection between the midsagittal line that connects the nasion and inion and the interaural line was designated as Cz. Cz was designated the origin (0, 0); the interaural line was designated the x-axis; and the midsagittal line was designated the y-axis. Fabric, with markings at 2.5-cm increments with Cz at the center, was fixed to the scalp. Magnetic stimulation was performed using a figure-of-eight coil (diameter, 2 mm×96 mm). The target muscle in group A was the suprahyoid muscle of the affected side, while that in group B was the APB muscle of the affected side. Similar to previous studies [1920], for the suprahyoid muscle, an active electrode was attached 2 cm lateral to the midline of the lower chin and the reference electrode was attached to the mandibular angle (Fig. 1). The motor threshold was defined as the minimal stimulus intensity required to produce MEP >50 µV peak-to-peak amplitude in five of ten consecutive trials on each muscle. The location yielding the largest response amplitude was termed the 'hot spot', and we delivered magnetic stimulation to that point.

Bottom Line: This study was designed as a matched comparative study.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. rTMS over a hot spot for the suprahyoid muscle caused more improvement in swallowing function when compared to that over the interconnected site.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation and Regional Cardiocerebrovascular Center, Dong-A University College of Medicine, Busan, Korea.

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.

No MeSH data available.


Related in: MedlinePlus