{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T09:39:23Z","timestamp":1793612363360,"version":"4.5.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T00:00:00Z","timestamp":1621987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007162","name":"Guangdong Science and Technology Department","doi-asserted-by":"publisher","award":["201803010"],"award-info":[{"award-number":["201803010"]}],"id":[{"id":"10.13039\/501100007162","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    The clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) protocols on patients with poststroke dysphagia is still unclear.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Objective:<\/jats:bold>\n                    This trial aimed to explore and analyze the effectiveness of 5 Hz rTMS on the unaffected hemisphere, affected hemisphere, and cerebellum in stroke patients with dysphagia.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    This observer-blind and randomized controlled trial included a total of 147 patients with stroke. Patients were divided into four treatment groups: the unaffected hemispheric group, the affected hemispheric group, the cerebellum group and the control group. Each group received traditional dysphagia treatment 5 days a week for 2 weeks. All recruited patients except for those in the control group underwent 10 consecutive rTMS sessions for 2 weeks. For the affected hemispheric group and unaffected hemispheric group, 5 Hz rTMS was applied to the affected mylohyoid cortical region or to the unaffected mylohyoid cortical region. For the cerebellum group, 5 Hz rTMS was applied to the mylohyoid cortical representation of the cerebellum (4.3 cm lateral and 2.4 cm below the inion). The Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), Penetration\/Aspiration Scale (PAS), Gugging Swallowing Screen (GUSS), and Standardized Swallowing Assessment (SSA) were used to evaluate clinical swallowing function before the intervention (baseline), immediately after the intervention and 2 weeks after the intervention.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    There were significant time and intervention interaction effects on the FEDSS, PAS, SSA, and GUSS scores (\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.05). In a direct comparison of the swallowing parameters of the four groups, the changes in FEDSS, PAS, SSA, and GUSS scores showed a significantly greater improvement in the unaffected hemispheric group, the affected hemispheric group and cerebellum group than in the control group (\n                    <jats:italic>p<\/jats:italic>\n                    &amp;lt; 0.05).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Whether stimulating the unaffected hemisphere or the affected hemisphere, 5 Hz high-frequency rTMS on mylohyoid cortical tissue might have a positive effect on poststroke patients with dysphagia. In addition, cerebellar rTMS is a safe method that represents a potential treatment for poststroke dysphagia, and more clinical trials are needed to develop this technique further.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Clinical Trial Registration:<\/jats:bold>\n                    <jats:ext-link>chictr.org.cn<\/jats:ext-link>\n                    , identifier: ChiCTR2000032255.\n                  <\/jats:p>","DOI":"10.3389\/fneur.2021.625683","type":"journal-article","created":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T01:25:44Z","timestamp":1621992344000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":60,"title":["Repetitive Transcranial Magnetic Stimulation at Different Sites for Dysphagia After Stroke: A Randomized, Observer-Blind Clinical Trial"],"prefix":"10.3389","volume":"12","author":[{"given":"Lida","family":"Zhong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinzhu","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiyu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1111\/nmo.12112","article-title":"Post-stroke dysphagia: progress at last","volume":"25","author":"Rofes","year":"2013","journal-title":"Neurogastroenterol Motil."},{"key":"B2","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1159\/000339986","article-title":"Pathophysiology, relevance and natural history of oropharyngeal dysphagia among older people","volume":"72","author":"Clav\u00e9","year":"2012","journal-title":"Nestle Nutr Inst Workshop Ser."},{"key":"B3","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1007\/s40141-014-0061-2","article-title":"Dysphagia management in acute and sub-acute stroke","volume":"2","author":"Vose","year":"2014","journal-title":"Curr Phys Med Rehabil Rep."},{"key":"B4","doi-asserted-by":"publisher","first-page":"CD000323","DOI":"10.1002\/14651858.CD000323.pub3","article-title":"Swallowing therapy for dysphagia in acute and subacute stroke","volume":"10","author":"Bath","year":"2018","journal-title":"Cochrane Database Syst Re."},{"key":"B5","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/jebm.12386","article-title":"Evidence-based practice guideline on integrative medicine for stroke 2019","volume":"13","author":"Ni","year":"2020","journal-title":"J Evid Based Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/S1474-4422(05)70126-5","article-title":"Improving disability in stroke with RTMS","volume":"4","author":"Ziemann","year":"2005","journal-title":"Lancet Neurol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.clinph.2005.10.014","article-title":"Safety of rTMS to non-motor cortical areas in healthy participants and patients","volume":"117","author":"Machii","year":"2006","journal-title":"Clin Neurophysiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1016\/j.clinph.2003.12.001","article-title":"Induction of long-term plasticity in human swallowing motor cortex following repetitive cortical stimulation","volume":"115","author":"Gow","year":"2004","journal-title":"Clin Neurophysiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1111\/nmo.12063","article-title":"The effect of 5Hz high-frequency rTMS over contralesional pharyngeal motor cortex in post-stroke oropharyngeal dysphagia: a randomized controlled study","volume":"25","author":"Park","year":"2013","journal-title":"Neurogastroenterol Motil."},{"key":"B10","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1136\/jnnp.2009.188482","article-title":"Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brainstem infarction","volume":"81","author":"Khedr","year":"2010","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"B11","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1111\/j.1600-0404.2008.01093.x","article-title":"Treatment of post-stroke dysphagia with repetitive transcranial magnetic stimulation","volume":"119","author":"Khedr","year":"2009","journal-title":"Acta Neurol Scand."},{"key":"B12","doi-asserted-by":"publisher","first-page":"432","DOI":"10.5535\/arm.2015.39.3.432","article-title":"Effect of repetitive transcranial magnetic stimulation according to the stimulation site in stroke patients with dysphagia","volume":"39","author":"Lee","year":"2015","journal-title":"Ann Rehabil Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1907","DOI":"10.1016\/j.clinph.2015.11.045","article-title":"Repetitive transcranial magnetic stimulation for rehabilitation of poststroke dysphagia: a randomized, double-blind clinical trial","volume":"127","author":"Du","year":"2016","journal-title":"Clin Neurophysiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1007\/s00455-015-9619-0","article-title":"Effectiveness of non-invasive brain stimulation in dysphagia subsequent to stroke: a systemic review and meta-analysis","volume":"30","author":"Yang","year":"2015","journal-title":"Dysphagia."},{"key":"B15","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1016\/j.clinph.2015.04.069","article-title":"Effects of non-invasive brain stimulation on post-stroke dysphagia: a systematic review and meta-analysis of randomized controlled trials","volume":"127","author":"Pisegna","year":"2016","journal-title":"Clin Neurophysiol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.brs.2013.09.005","article-title":"Characterizing the mechanisms of central and peripheral forms of neurostimulation in chronic dysphagic stroke patients","volume":"7","author":"Michou","year":"2014","journal-title":"Brain Stimul."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1917","DOI":"10.1152\/jn.1999.81.4.1917","article-title":"Identification of the cerebral loci processing human swallowing with H2(15)O PET activation","volume":"81","author":"Hamdy","year":"1999","journal-title":"J Neurophysiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s12311-020-01191-x","article-title":"The effects of midline cerebellar rTMS on human pharyngeal cortical activity in the intact swallowing motor system","volume":"20","author":"Sasegbon","year":"2021","journal-title":"Cerebellum."},{"key":"B19","doi-asserted-by":"publisher","first-page":"4963","DOI":"10.1113\/JP270817","article-title":"High-frequency focal repetitive cerebellar stimulation induces prolonged increases in human pharyngeal motor cortex excitability","volume":"593","author":"Vasant","year":"2015","journal-title":"J Physiol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e13609","DOI":"10.1111\/nmo.13609","article-title":"Rapid improvement in brain and swallowing behavior induced by cerebellar repetitive transcranial magnetic stimulation in poststroke dysphagia: a single patient case-controlled study","volume":"31","author":"Vasant","year":"2019","journal-title":"Neurogastroenterol Motil."},{"key":"B21","doi-asserted-by":"publisher","first-page":"104586","DOI":"10.1016\/j.jstrokecerebrovasdis.2019.104586","article-title":"An exploration of the application of noninvasive cerebellar stimulation in the neuro-rehabilitation of dysphagia after stroke (EXCITES) protocol","volume":"29","author":"Wilkinson","year":"2020","journal-title":"J Stroke Cerebrovasc Dis."},{"key":"B22","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1111\/jebm.12384","article-title":"Clinical research methods for treatment, diagnosis, prognosis, etiology, screening, and prevention: a narrative review","volume":"13","author":"Yao","year":"2020","journal-title":"J Evid Based Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1038\/nm1196-1217","article-title":"The cortical topography of human swallowing musculature in health and disease","volume":"2","author":"Hamdy","year":"1996","journal-title":"Nat Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2533","DOI":"10.1113\/JP277545","article-title":"Cerebellar repetitive transcranial magnetic stimulation restores pharyngeal brain activity and swallowing behaviour after disruption by a cortical virtual lesion","volume":"597","author":"Sasegbon","year":"2019","journal-title":"J Physiol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2008","DOI":"10.1016\/j.clinph.2009.08.016","article-title":"Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research","volume":"120","author":"Rossi","year":"2009","journal-title":"Clin Neurophysiol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1159\/000228711","article-title":"Fiberoptic endoscopic Dysphagia severity scale predicts outcome after acute stroke","volume":"28","author":"Warnecke","year":"2009","journal-title":"Cerebrovasc Dis."},{"key":"B27","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1046\/j.1365-2702.2001.00501.x","article-title":"Screening swallowing function of patients with acute stroke. Part one: identification, implementation and initial evaluation of a screening tool for use by nurses","volume":"10","author":"Perry","year":"2001","journal-title":"J Clin Nurs."},{"key":"B28","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1046\/j.1365-2702.2001.00502.x","article-title":"Screening swallowing function of patients with acute stroke. Part two: detailed evaluation of the tool used by nurses","volume":"10","author":"Perry","year":"2001","journal-title":"J Clin Nurs."},{"key":"B29","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/BF00417897","article-title":"A penetration-aspiration scale","volume":"11","author":"Rosenbek","year":"1996","journal-title":"Dysphagia."},{"key":"B30","doi-asserted-by":"publisher","first-page":"2948","DOI":"10.1161\/STROKEAHA.107.483933","article-title":"Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen","volume":"38","author":"Trapl","year":"2007","journal-title":"Stroke."},{"key":"B31","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1007\/s00455-018-09965-6","article-title":"Effects of low-frequency repetitive transcranial magnetic stimulation on swallowing function and quality of life of post-stroke patients","volume":"34","author":"\u00dcnl\u00fcer","year":"2019","journal-title":"Dysphagia."},{"key":"B32","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/s00221-012-3069-9","article-title":"Functional connectivity and laterality of the motor and sensory components in the volitional swallowing network","volume":"219","author":"Lowell","year":"2012","journal-title":"Exp Brain Res."},{"key":"B33","doi-asserted-by":"publisher","first-page":"3209","DOI":"10.1002\/hbm.20743","article-title":"Neural activation of swallowing and swallowing-related tasks in healthy young adults: an attempt to separate the components of deglutition","volume":"30","author":"Malandraki","year":"2009","journal-title":"Hum Brain Mapp."},{"key":"B34","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1007\/s11894-015-0483-8","article-title":"Repetitive transcranial magnetic stimulation: a novel approach for treating oropharyngeal dysphagia","volume":"18","author":"Michou","year":"2016","journal-title":"Curr Gastroenterol Rep."},{"key":"B35","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1016\/j.ncl.2014.07.013","article-title":"The human cerebellum: a review of physiologic neuroanatomy","volume":"32","author":"Roostaei","year":"2014","journal-title":"Neurol Clin."},{"key":"B36","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1111\/j.1365-2982.2011.01747.x","article-title":"Non-invasive magnetic stimulation of the human cerebellum facilitates cortico-bulbar projections in the swallowing motor system","volume":"23","author":"Jayasekeran","year":"2011","journal-title":"Neurogastroenterol Motil."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1719","DOI":"10.1007\/s00221-020-05787-x","article-title":"The effects of unilateral and bilateral cerebellar rTMS on human pharyngeal motor cortical activity and swallowing behavior","volume":"238","author":"Sasegbon","year":"2020","journal-title":"Exp Brain Res."},{"key":"B38","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.brs.2016.08.005","article-title":"Effects of bilateral repetitive transcranial magnetic stimulation on post-stroke dysphagia","volume":"10","author":"Park","year":"2017","journal-title":"Brain Stimul."},{"key":"B39","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1177\/0300060518807340","article-title":"Repetitive transcranial magnetic stimulation in combination with neuromuscular electrical stimulation for treatment of post-stroke dysphagia","volume":"47","author":"Zhang","year":"2019","journal-title":"J Int Med Res."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2021.625683\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,26]],"date-time":"2021-05-26T01:25:47Z","timestamp":1621992347000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2021.625683\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,26]]},"references-count":39,"alternative-id":["10.3389\/fneur.2021.625683"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2021.625683","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,26]]},"article-number":"625683"}}