Effectiveness of intermittent theta burst stimulation (iTBS) for managing post-stroke dysphagia: systematic review and meta-analysis

Background: Post-Stroke Dysphagia (PSD) is a common complication that significantly affects the quality of life and health outcomes of stroke survivors. Traditional treatments often have limitations, necessitating the exploration of new therapeutic approaches. This systematic review and meta-analysis aimed to evaluate the efficacy of intermittent Theta Burst Stimulation (iTBS) as an innovative treatment for PSD.

Methods: Following the PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library up to July 2024. Studies included were randomized controlled trials (RCTs) involving stroke patients with confirmed dysphagia, comparing iTBS to control treatments. Data extraction and quality assessment were performed independently by two reviewers using the Cochrane RoB 2 tool. Primary outcomes were changes in the Penetration-Aspiration Scale (PAS) and Swallowing Severity Scale (SSA). Meta-analyses were conducted using Review Manager (RevMan) 5.4.

Results: Four RCTs with a total of 199 participants were included. iTBS significantly improved SSA (MD = -3.26, 95% CI [-4.66, -1.86], p < 0.001) and PAS (MD = -1.67, 95% CI [-2.49, -0.86], p < 0.001) immediately after treatment compared to sham stimulation. No significant adverse events were reported.

Conclusion: iTBS appears to have a positive immediate effect on improving swallowing function and reducing aspiration risk in PSD patients compared to sham stimulation. However, these effects may not persist in the long term, and further large-scale RCTs are needed to confirm these findings and establish standardized treatment protocols.