Active rTMS combined with rehabilitation showed greater improvement in language and swallowing outcomes compared with sham stimulation in 113 post-stroke patients.
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Key Takeaway
Consider rTMS as an adjunct to rehabilitation, but note that mechanisms and durability require further investigation in randomized studies.
This sham-controlled prospective study enrolled 113 patients with post-stroke communication and swallowing impairment to evaluate the effects of active rTMS combined with conventional rehabilitation versus sham stimulation plus the same rehabilitation program. The intervention aimed to enhance recovery in patients experiencing post-stroke language impairment and dysphagia. Outcomes were assessed after treatment completion.
The active rTMS group showed greater improvement in language-related and swallowing-related outcomes compared with the sham stimulation group. Additionally, the active rTMS group maintained a more favorable recovery profile at follow-up compared with sham stimulation plus rehabilitation. Directionally similar trends were observed across groups for secondary clinical and care-related indicators. No increase in safety risk was identified during the study period, and tolerability was acceptable.
Key limitations include the lack of neurophysiological or neuroimaging markers, which limited mechanistic interpretation to theory-informed inference. The study also had a short-term follow-up and lacked direct neurophysiological measures. Durability of benefit and patient-level heterogeneity in treatment response remain uncharacterized. Causality cannot be definitively established without further randomized studies with longer follow-up and direct neurophysiological measures.
Practice relevance suggests that findings support further investigation of rTMS as an adjunct to multidisciplinary neurorehabilitation. However, mechanisms, durability of benefit, and patient-level heterogeneity need further investigation in randomized studies with longer follow-up and direct neurophysiological measures.
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View Original Abstract ↓
BackgroundPost-stroke language impairment and dysphagia frequently co-occur and can substantially hinder recovery, daily communication, and safe oral intake. Repetitive transcranial magnetic stimulation (rTMS) has been proposed as an adjunct to conventional rehabilitation, yet evidence on coordinated improvement across both domains remains limited, particularly in studies using clinically interpretable outcome measures.MethodsIn this sham-controlled prospective study, 113 patients with post-stroke communication and swallowing impairment were enrolled and allocated to either active rTMS combined with conventional rehabilitation or sham stimulation plus the same rehabilitation program. The intervention lasted 2 weeks, with follow-up assessment after treatment completion. Clinical outcomes were evaluated at baseline, immediately after the intervention, and at follow-up using established measures of language performance, swallowing safety, and oral intake. Safety events and selected care-related indicators were also documented. Because no neurophysiological or neuroimaging markers were collected, mechanistic interpretation was limited to theory-informed inference based on observed clinical patterns.ResultsBoth groups improved over time. Compared with sham stimulation plus rehabilitation, the active rTMS group showed greater improvement in language-related and swallowing-related outcomes and maintained a more favorable recovery profile at follow-up. Directionally similar trends were observed across secondary clinical indicators, and no increase in safety risk was identified during the study period.ConclusionsrTMS administered before task-oriented rehabilitation was associated with improved short-term recovery in post-stroke language and swallowing function, with acceptable tolerability. These findings support further investigation of rTMS as an adjunct to multidisciplinary neurorehabilitation. Future randomized studies with longer follow-up and direct neurophysiological measures are needed to clarify mechanisms, durability of benefit, and patient-level heterogeneity in treatment response.
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