Efficacy of non-invasive cerebellar stimulation in patients with post-stroke dysphagia: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials
Amr Elrosasy1, Moaz Elsayed1, Ahmed Elshahat2, Yehia Abdalla3, Maickel AbdelMeseh4, Hatem Eldeeb5, Mahmoud Hassan6, Mohammad Al Azzawi7, Ahmed Negida8
1Kasr Alainy Medical School, 2Al-Azhar medical school, 3Zagazig Medical school, 4Alexandria Medical school, 5Al-Azhar Medical school, 6Helwan Medical school, 7Medical school, National Ribat University, 8Virginia Commonwealth University
Objective:
Assess the efficacy of cerebellar repetitive transcranial magnetic stimulation (rTMS) and theta-burst stimulation (TBS) in Post-stroke dysphagia
Background:
Post-stroke dysphagia (PSD) is one of the most common stroke complications. The optimal protocol and target area for PSD using repetitive transcranial magnetic stimulation (rTMS) or theta-burst stimulation (TBS) remains uncertain. Existing studies often focus on the hemispheric cortex, neglecting the cerebellum. Limited studies explore cerebellar rTMS and TBS in PSD, so we aim to assess their efficacy.
Design/Methods:
Following the PRISMA guidelines. We searched databases to identify the relevant RCTs. Using RevMan 5.4 software, the analyzed primary outcome was the functional dysphagia scale (FDS) with subgroups based on the follow-up duration, side of stimulation (bilateral or unilateral), and stimulation modality (rTMS or TBS). Pooled standardized mean differences (SMD) and their 95% confidence intervals (CI) were analyzed using inverse variance
Results:
We included seven RCTs with a total of 358 patients. Compared to the sham group (control), Patients who received cerebellar rTMS had significantly greater improvement in FEDSS, with the four-week subgroup showing slightly better improvement than the two-week subgroup (SMD=-0.71; 95%CI [-0.98, -0.43]) and (SMD=-0.50; 95%CI [-0.93, -0.06]) respectively. Patients who received rTMS or bilateral stimulation (SMD=-0.88; 95%CI [-1.16, -0.61]) and (SMD=-1.12; 95%CI [-1.63, -0.61]), respectively, showed slightly better improvement than those who received TBS or unilateral stimulation (SMD=-0.52; 95%CI [-1.02, -0.02]) and (SMD=-0.85; 95%CI [-1.43, -0.26]), respectively, with all subgroups showing significant improvements compared to control.
Conclusions:
Cerebellar stimulation using rTMS or TBS is significantly efficacious in improving PSD, with TBS being more cost and time convenient. Further RCTs on diverse populations still need to be conducted.
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