Evaluating the Impact of Transcranial Electrical Stimulation on Post-stroke Dysphagia: a Systematic Review and Meta-analysis

Overview

Journal J Int Med Res

Publisher Sage Publications

Specialty General Medicine

Date 2024 Oct 30

PMID 39474766

Authors

Yanan Zhao

Zhicheng Zhang

Cuicui Wang

Hui Zhang

Ying Wang

Jing Bian

Affiliations

Soon will be listed here.

Abstract

Objective: To conduct a systematic review and meta-analysis to assess the impact of transcranial electrical stimulation (TES), proposed as a potential therapy for post-stroke dysphagia, on swallowing function in stroke survivors.

Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for relevant studies on TES for post-stroke dysphagia. Search results were reviewed following PRISMA guidelines, and the following data were extracted from included studies: study characteristics, demographics, and outcomes. Bias was assessed using the Cochrane tool. Heterogeneity and effect sizes were analysed using I statistics and appropriate effects models. The study protocol was registered with PROSPERO (registration No. CRD42024578243).

Results: Six randomized controlled trials met the inclusion criteria (I = 0.0%). The meta-analysis indicated a significant improvement in dysphagia with TES (standardized mean difference [SMD] 0.43, 95% confidence interval [CI] 0.13, 0.73). Subgroup analysis suggested that low-intensity TES was effective (SMD 0.46, 95% CI 0.09, 0.82), whereas high-intensity TES showed no significant improvement (SMD 0.37, 95% CI -0.17, 0.91). No publication bias was detected.

Conclusion: TES may improve swallowing in stroke patients, with potential benefits from low-intensity protocols.

References

Labeit B, Muhle P, Dziewas R, Suntrup-Krueger S . [Diagnostics and treatment of post-stroke dysphagia]. Nervenarzt. 2023; 94(8):676-683. DOI: 10.1007/s00115-023-01483-7. View

Jones C, Colletti C, Ding M . Post-stroke Dysphagia: Recent Insights and Unanswered Questions. Curr Neurol Neurosci Rep. 2020; 20(12):61. PMC: 7604228. DOI: 10.1007/s11910-020-01081-z. View

Pingue V, Priori A, Malovini A, Pistarini C . Dual Transcranial Direct Current Stimulation for Poststroke Dysphagia: A Randomized Controlled Trial. Neurorehabil Neural Repair. 2018; 32(6-7):635-644. DOI: 10.1177/1545968318782743. View

Ahn Y, Sohn H, Park J, Ahn T, Shin Y, Park M . Effect of bihemispheric anodal transcranial direct current stimulation for dysphagia in chronic stroke patients: A randomized clinical trial. J Rehabil Med. 2016; 49(1):30-35. DOI: 10.2340/16501977-2170. View

Arnold M, Liesirova K, Broeg-Morvay A, Meisterernst J, Schlager M, Mono M . Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome. PLoS One. 2016; 11(2):e0148424. PMC: 4749248. DOI: 10.1371/journal.pone.0148424. View

Farpour S, Asadi-Shekaari M, Haghighi A, Farpour H . Improving Swallowing Function and Ability in Post Stroke Dysphagia: A Randomized Clinical Trial. Dysphagia. 2022; 38(1):330-339. PMC: 9205412. DOI: 10.1007/s00455-022-10470-0. View

Cheng I, Hamdy S . Current perspectives on the benefits, risks, and limitations of noninvasive brain stimulation (NIBS) for post-stroke dysphagia. Expert Rev Neurother. 2021; 21(10):1135-1146. DOI: 10.1080/14737175.2021.1974841. View

Higgins J, Altman D, Gotzsche P, Juni P, Moher D, Oxman A . The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011; 343:d5928. PMC: 3196245. DOI: 10.1136/bmj.d5928. View

Marin S, Serra-Prat M, Ortega O, Audouard Fericgla M, Valls J, Palomera E . Healthcare costs of post-stroke oropharyngeal dysphagia and its complications: malnutrition and respiratory infections. Eur J Neurol. 2021; 28(11):3670-3681. DOI: 10.1111/ene.14998. View

10.

Kumar S, Wagner C, Frayne C, Zhu L, Selim M, Feng W . Noninvasive brain stimulation may improve stroke-related dysphagia: a pilot study. Stroke. 2011; 42(4):1035-40. PMC: 3116809. DOI: 10.1161/STROKEAHA.110.602128. View

11.

Alabdulaali L, Hickman L, Punt T, Jenkinson N . Effectiveness of transcranial direct current stimulation on hand dexterity in stroke patients: a protocol for a systematic review and meta-analysis. BMJ Open. 2022; 12(2):e056064. PMC: 8852708. DOI: 10.1136/bmjopen-2021-056064. View

12.

Gomez-Garcia N, Alvarez-Barrio L, Leiros-Rodriguez R, Soto-Rodriguez A, Andrade-Gomez E, Hernandez-Lucas P . Transcranial direct current stimulation for post-stroke dysphagia: a meta-analysis. J Neuroeng Rehabil. 2023; 20(1):165. PMC: 10712182. DOI: 10.1186/s12984-023-01290-w. View

13.

Banda K, Chu H, Kang X, Liu D, Pien L, Jen H . Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis. BMC Geriatr. 2022; 22(1):420. PMC: 9103417. DOI: 10.1186/s12877-022-02960-5. View

14.

Li K, Fu C, Xie Z, Zhang J, Zhang C, Li R . The impact of physical therapy on dysphagia in neurological diseases: a review. Front Hum Neurosci. 2024; 18:1404398. PMC: 11187312. DOI: 10.3389/fnhum.2024.1404398. View

15.

Suntrup-Krueger S, Ringmaier C, Muhle P, Wollbrink A, Kemmling A, Hanning U . Randomized trial of transcranial direct current stimulation for poststroke dysphagia. Ann Neurol. 2018; 83(2):328-340. DOI: 10.1002/ana.25151. View

16.

Yang E, Baek S, Shin J, Lim J, Jang H, Kim Y . Effects of transcranial direct current stimulation (tDCS) on post-stroke dysphagia. Restor Neurol Neurosci. 2012; 30(4):303-11. DOI: 10.3233/RNN-2012-110213. View

17.

Dziewas R, Michou E, Trapl-Grundschober M, Lal A, Arsava E, Bath P . European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J. 2021; 6(3):LXXXIX-CXV. PMC: 8564153. DOI: 10.1177/23969873211039721. View

18.

Pisegna J, Kaneoka A, Pearson Jr W, Kumar S, Langmore S . Effects of non-invasive brain stimulation on post-stroke dysphagia: A systematic review and meta-analysis of randomized controlled trials. Clin Neurophysiol. 2015; 127(1):956-968. PMC: 5326549. DOI: 10.1016/j.clinph.2015.04.069. View

19.

Qin Y, Tang Y, Liu X, Qiu S . Neural basis of dysphagia in stroke: A systematic review and meta-analysis. Front Hum Neurosci. 2023; 17:1077234. PMC: 9896523. DOI: 10.3389/fnhum.2023.1077234. View

20.

Su F, Xu W . Enhancing Brain Plasticity to Promote Stroke Recovery. Front Neurol. 2020; 11:554089. PMC: 7661553. DOI: 10.3389/fneur.2020.554089. View