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Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brain stem infarction
  1. Eman Khedr*,
  2. Noha Abo-Elfetoh
  1. 1 Department of Neurology , Assiut University Hospital, Assiut, Egypt
  1. Correspondence to: Eman Khedr, neurology, Assiut University Hospital, Assiut Universty Hospital, Assiut, 11117, Egypt; emankhedr99{at}


Background and purpose: There is some evidence for a therapeutic effect of rTMS on dysphagia in hemispheric stroke.

Aim of the study: To compare the effect of real or sham rTMS applied to the motor area of both hemispheres in patients with acute Lateral medullay (LMI) or brain stem infarctions.

Material and method: The study included 22 patients with acute ischemic stroke who had severe bulbar manifestation. 11 patients had LMI and 11 had brain stem infarction. They were randomly allocated to receive real (n = 11) or sham (n = 11) rTMS of the esophageal motor cortex. Each patient received 300 rTMS pulses at 3 Hz and an intensity of 130% resting motor threshold to each hemisphere for five consecutive days. Clinical ratings of dysphagia and motor disability were assessed before and immediately after the last session and then again after 1 and 2 months.

Results: There were no significant differences in baseline clinical assessment of swallowing between real and sham groups. Real rTMS improved dysphagia compared with sham rTMS in both groups of patients,(P = 0.001 for both); the LMI group also improved the scores in the Barthel Index. All improvements were maintained over 2 months of follow-up (P = 0.001).

Conclusion: These findings suggest that rTMS could be a useful adjuvant strategy in neurorehabilitation of dysphagia due to LMI or brain stem infarction, although further assessment is necessary in multicentre clinical trials.

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