Pubblicazioni

Comparative Efficacy of Non-invasive Neurostimulation Therapies for Acute and Subacute Post-Stroke Dysphagia: A Systematic Review and Network Meta-Analysis.

CF, Chiang; MT, Lin; MY, Hsiao; YC, Yeh; YC, Liang; TG, Wang

Abstract:

OBJECTIVE: To investigate the effectiveness of non-invasive neurostimulation therapies in patients with post-stroke dysphagia. DATA SOURCES: Electronic databases, including EMBASE, PubMed, Scopus, and the Cochrane Library were searched up to May 31, 2018. STUDY SELECTION: All published randomized controlled trials (RCTs) comparing neurostimulation therapies including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), surface neuromuscular electrical stimulation (NMES), and pharyngeal electrical stimulation (PES) in patients with acute and subacute post-stroke dysphagia were included. Nineteen RCTs were enrolled in the meta-analysis. DATA EXTRACTION: Full texts were independently reviewed. Two independent raters assessed the risk of bias of RCTs with the Cochrane Risk of Bias Tool. The primary outcome measure was swallowing function evaluated before and after neurostimulation therapy. DATA SYNTHESIS: Both pairwise and network meta-analysis revealed that rTMS, tDCS and surface NMES significantly improved post-stroke dysphagia compared with placebo. Differences in functional improvement between PES and placebo were not significant. Based on probability ranking, rTMS seemed the best treatment among the four neurostimulation therapies. In the network meta-analysis, rTMS showed the best efficacy compared with placebo (standardized mean difference [SMD]: 1.02, 95% confidence interval [CI]: 0.61 to 1.43). CONCLUSION: Among the four non-invasive neurostimulation therapies, rTMS, tDCS and surface NMES were effective for treating post-stroke dysphagia; furthermore, rTMS may be the most effective therapy according to probability ranking.

Patologie/Applicazioni:

• Stimolazione Magnetica Transcranica (TMS)
• Riabilitazione motoria
• Stroke

Anno:

2018

Tipo di pubblicazione:

Articolo

Parola chiave:

stimolazione magnetica transcranica; disfagia; Stroke; randomized study; riabilitazione motoria

Testata scientifica:

Archives of physical medicine and rehabilitation

Nota:

Tutti gli studi randomizzati controllati (RCT), hanno confrontato terapie di neurostimolazione compresa la stimolazione magnetica transcranica ripetitiva (rTMS), la stimolazione transcranica in corrente continua (tDCS), la stimolazione elettrica neuromuscolare superficiale (NMES) e la stimolazione elettrica faringea (PES) in pazienti con disfagia da post Stroke acuto e subacuto. Diciannove studi randomizzati sono stati arruolati nella meta-analisi. Tra le quattro terapie di neurostimolazione non invasive, rTMS, tDCS e NMES di superficie erano efficaci nel trattamento della disfagia post-ictus; inoltre la rTMS può essere la terapia più efficace in base alla classifica di probabilità.