Restricted accessResearch articleFirst published online 2024-12
Repetitive Transcranial Magnetic Stimulation on Individualized Spots Based on Task functional Magnetic Resonance Imaging Improves Swallowing Function in Poststroke Dysphagia
Functional magnetic resonance imaging (fMRI) has not previously been used to localize the swallowing functional area in repetitive transcranial magnetic stimulation (rTMS) treatment for poststroke dysphagia; Traditionally, the target area for rTMS is the hotspot, which is defined as the specific region of the brain identified as the optimal location for transcranial magnetic stimulation (TMS). This study aims to compare the network differences between the TMS hotspot and the saliva swallowing fMRI activation to determine the better rTMS treatment site and investigate changes in functional connectivity related to poststroke dysphagia using resting-state fMRI.
Methods:
Using an information-based approach, we conducted a single case study to explore neural functional connectivity in a patient with poststroke dysphagia before, immediately after rTMS, and 4 weeks after rTMS intervention. A total of 20 healthy participants underwent fMRI and TMS hotspot localization as a control group. Neural network alterations were assessed, and functional connections related to poststroke dysphagia were examined using resting-state fMRI.
Results:
Compared to the TMS-induced hotspots, the fMRI activation peaks were located significantly more posteriorly and exhibited stronger functional connectivity with bilateral postcentral gyri. Following rTMS treatment, this patient developed functional connection between the brainstem and the bilateral insula, caudate, anterior cingulate cortex, and cerebellum.
Conclusion:
The saliva swallowing fMRI activation peaks show more intense functional connectivity with bilateral postcentral gyri compared to the TMS hotspots. Activation peak-guided rTMS treatment improves swallowing function in poststroke dysphagia. This study proposes a novel and potentially more efficacious therapeutic target for rTMS, expanding its therapeutic options for treating poststroke dysphagia.
Impact Statement
Rehabilitation for poststroke dysphagia is often challenging, and many patients are significantly affected by this condition. Repetitive transcranial magnetic stimulation (rTMS) has shown varying degrees of effectiveness in treating poststroke dysphagia. Enhancing the precision of treatment targets could substantially improve clinical efficacy. From a mechanistic standpoint, this study introduces the concept of personalized precision treatment targets, which is more rational compared to traditional targets. Additionally, it generates new avenues for further research on the application of rTMS in treating other neurological disorders that present with dysphagia, such as Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis, and dysphagia prevalent in the aging population.
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