Effects Of Intermittent Theta Burst Stimulation On Swallowing Function And Cortical Excitability In Stroke Patients

Background:Swallowing disorders are a common complication of stroke,and conventional rehabilitation tools have limited efficacy.Repetitive transcranial magnetic stimulation(rTMS)has been widely used in the treatment of various dysfunctions related to stroke.theta burst stimulation(TBS)is a type of patterned transcranial magnetic stimulation that can Theta burst stimulation(TBS)is a form of patterned transcranial magnetic stimulation that produces similar biological effects to conventional rTMS with a shorter stimulation time.Intermittent theta burst stimulation(iTBS)has been shown to improve swallowing function in patients with primary or secondary dysphagia.iTBS needs to be further explored to determine whether it can help restore function in patients with post-stroke dysphagia and whether it can be used as a comparable but less time-consuming alternative stimulation option.Further investigation is needed.Objective:To investigate the effect of iTBS stimulation of the motor cortex area of the supraglottis muscle group on swallowing function in stroke patients and compare the efficacy with that of traditional rTMS stimulation mode,and to further determine the effect of iTBS on cortical excitability in stroke patients.Materials and Methods:Patients aged 18 to 78 years with swallowing dysfunction 2 weeks or more after their first unilateral stroke were included in this study,and patients were randomly assigned(1:1:1)to the iTBS,rTMS,and control groups using a random number table,with participants and outcome assessors unaware of the grouping.All subjects will receive regular swallowing rehabilitation during the intervention and iTBS,rTMS and sham stimulation in the motor cortex area of the affected supraglottis muscle group for 5 days per week for 2 weeks,depending on the subgroup.The primary outcome index was the standardized swallowing assessment(SSA),and the secondary outcome value was the water-swallowing test(WST);the modified Mann assessment of swallowing ability(MASA).swallowing ability(MASA);the Murray Secretion Scale(MSS);the Penetration-Aspiration Scale(PAS);and the motor evoked potentials(MEP)of the supraglottis muscle group.(MEP).Assessments were performed before(T0),at the end of treatment(T1),and two weeks after treatment(T2).All data were entered and analyzed using SPSS 22.0 statistical software.Results.:Sixty-nine patients with a mean age of(65.55± 11.90)years were included,including 47 males and 22 females;48 cases of cerebral infarction and 21 cases of cerebral hemorrhage.The mean time of onset was(27.07±12.99)days,and there were no statistically significant differences between the test group and the control group in terms of age,sex,time of onset,stroke type,and location of hemiparesis.All patients did not have any adverse effects.(1)Effects on swallowing function:SSA scores improved in all three groups.At T1,SSA scores were lower in the iTBS and rTMS groups than in the control group,with no statistically significant difference between groups(P=0.060,P=0.172);at T2,SSA scores were lower in the iTBS and rTMS groups than in the control group,with a statistically significant difference between groups(P=0.016,P=0.042);at T1 and T2,there was no statistically significant difference between SSA scores in the iTBS and rTMS groups compared(P=1.000).wST scores improved with time in all three groups,but there was no statistically significant difference between WST scores in the control group at T1 compared to T0(P=0.179);at T1,WST scores were lower in the iTBS group compared to the control group(P=0.033),and the difference between WST scores in the rTMS group compared with the control group was not statistically significant(P=0.309);at T2,WST scores in the iTBS and rTMS groups were lower than those in the control group,and the difference between groups was statistically different(P=0.017,P=0.025);at T1 and T2,the difference between groups in WST scores in the iTBS and rTMS groups compared At T1 and T2,there was no statistically significant difference between the iTBS and rTMS groups in terms of WST scores(P=1.000).3 groups showed improvement in MASA scores with increasing time;at T1,MASA scores were higher in the iTBS group compared to the control group(P=0.016),and there was no statistically significant difference between MASA scores in the rTMS group compared to the control group(P=0.116);at T2,there was no statistically significant(P=0.062),and the difference between MASA scores in the rTMS group compared with the control group was statistically significant(P=0.046);at T1 and T2,the difference between MASA scores in the iTBS and rTMS groups was not statistically significant(P=0.598,P=0.932).(2)Effect on oral secretion:MSS scores improved with increasing time in all three groups;at T1,there was no statistically significant difference between the MSS scores of the three groups in a two-way comparison(P>0.05).(3)Effect on the occurrence of osmotic misabsorption:PAS scores improved with increasing time in all 3 groups;using dilute liquid to detect PAS scores,at T1,there was a statistically significant difference between PAS scores in the iTBS group compared with the control group(P=0.016),and no statistically significant difference between PAS scores in the rTMS group compared with the control and iTBS groups(P=0.248,P=0.298);using thick liquids to detect PAS scores,at T1,there was no statistically significant difference in PAS scores in the iTBS group compared with the control group(P=0.002),and no statistically significant difference in PAS scores in the rTMS group compared with the control and iTBS groups(P=0.076,P=0.076);for change values,whether thick or thin liquids were used to measure patients’PAS scores,the There was a statistically significant difference between the iTBS and rTMS groups compared with the control group(P<0.05),and there was no statistically significant difference between the two groups for intergroup comparison(P>0.05).(4)Effects on cortical excitability:The MEP latency of the supraglottis muscle group in the three groups did not change significantly over time,regardless of whether the affected or the healthy cerebral cortex was affected,and the differences were not statistically significant in intra-and inter-group comparisons(P>0.05);at T1 and T2,for the affected cerebral cortex,the MEP wave amplitude of the supraglottis muscle group was significantly higher in the iTBS and rTMS groups compared with T0,and the differences were statistically significant in intra-group comparisons(The difference was statistically significant(P<0.05),while the MEP amplitude of the supraglottis muscle group in the control group was increased compared with T0,but the difference was not statistically significant(P=0.306,P=0.094).For the robust cerebral cortex,there was a statistically significant difference in MEP wave amplitude in the iTBS group compared to T0 supraglottis muscle group at T1(P=0.018)and no statistically significant difference compared to T0 at T2(P=0.317),and there was a statistically significant difference in MEP wave amplitude in the rTMS group compared to T0 supraglottis muscle group at T2(P=0.001)and no statistically significant difference compared to T0 at T1 For the control group,there was a statistically significant difference in MEP wave amplitude in the supraglottis muscle group at T2 compared with T0(P=0.007).There was no statistically significant difference in the MEP wave amplitude scores of the supraglottis muscle group between the 3 groups,regardless of whether the affected or the healthy side of the cerebral cortex was present(P>0.05).Conclusion:The results of this study showed that the combination of iTBS in the supraglottis motor cortex area with conventional swallowing rehabilitation therapy significantly improved swallowing function and cortical excitability in stroke patients.There was no significant difference between supraglottis motor cortical area iTBS or conventional rTMS stimulation on the recovery of swallowing function in stroke patients.The supraglottis motor cortical area iTBS intervention is a non-invasive strategy to promote the recovery of swallowing function in stroke patients.(China Clinical Trials Registry registration number:ChiCTR2100053896).