Objective: To systematically review randomized controlled trials that evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on rehabilitation aspects related to communication and swallowing functions. Methods: A search was conducted on PubMed, Clinical Trials, Cochrane Library, and ASHA electronic databases. Studies were judged according to the eligibility criteria and analyzed by 2 independent and blinded researchers. Results: We analyzed 9 studies: 4 about aphasia, 3 about dysphagia, 1 about dysarthria in Parkinson's disease and 1 about linguistic deficits in Alzheimer's disease. All aphasia studies used low-frequency rTMS to stimulate Broca's homologous area. High-frequency rTMS was applied over the pharyngoesophageal cortex from the left and/or right hemisphere in the dysphagia studies and over the left dorsolateral prefrontal cortex in the Parkinson's and Alzheimer's studies. Two aphasia and all dysphagia studies showed a significant improvement of the disorder, compared to the sham group. The other 2 studies related to aphasia found a benefit restricted to subgroups with a severe case or injury on the anterior portion of the language cortical area, respectively, whereas the Alzheimer's study demonstrated positive effects specific to auditory comprehension. There were no changes for vocal function in the Parkinson's study. Conclusion: The benefits of the technique and its applicability in neurogenic disorders related to communication and deglutition are still uncertain. Therefore, other randomized controlled trials are needed to clarify the optimal stimulation protocol for each disorder studied and its real effects.

Keywords:
Voice disorders, Deglutition disorders, Transcranial magnetic stimulation, Language disorders, Speech disorders
1.
Neurological Disorders: Public Health Challenges World Health Organization, 2006.
2.
Brewer L, Horgan F, Hickey a, Williams D: Stroke rehabilitation: recent advances and future therapies. QJM 2013;106:11-25.
3.
Von Campenhausen S, Winter Y, Rodrigues e Silva A, Sampaio C, Ruzicka E, Barone P, et al: Costs of illness and care in Parkinson's disease: an evaluation in six countries. Eur Neuropsychopharmacol 2011;21:180-191.
4.
Kobayashi M, Pascual-Leone A: Transcranial magnetic stimulation in neurology. Lancet Neurol 2003;2:145-156.
5.
Hamilton RH, Chrysikou EG, Coslett B: Mechanisms of aphasia recovery after stroke and the role of noninvasive brain stimulation. Brain Lang 2011;118:40-50.
6.
Rossi S, Hallett M, Rossini PM, Pascual-Leone A: Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clin Neurophysiol 2009;120:2008-2039.
7.
Dias AE, Barbosa ER, Coracini K, Maia F, Marcolin MA, Fregni F: Effects of repetitive transcranial magnetic stimulation on voice and speech in Parkinson's disease. Acta Neurol Scand 2006;113:92-99.
8.
Cotelli M, Calabria M, Manenti R, Rosini S, Zanetti O, Cappa SF, et al: Improved language performance in Alzheimer disease following brain stimulation. J Neurol Neurosurg Psychiatry 2011;82:794-797.
9.
Weiduschat N, Thiel A, Rubi-Fessen I, Hartmann A, Kessler J, Merl P, et al: Effects of repetitive transcranial magnetic stimulation in aphasic stroke: a randomized controlled pilot study. Stroke 2011;42:409-415.
10.
Park J-W, Oh J-C, Lee J-W, Yeo J-S, Ryu KH: The effect of 5Hz high-frequency rTMS over contralesional pharyngeal motor cortex in post-stroke oropharyngeal dysphagia: a randomized controlled study. Neurogastroenterol Motil 2013;25:324-e250.
11.
Seniów J, Waldowski K, Leśniak M, Iwański S, Czepiel W, Członkowska A: Transcranial magnetic stimulation combined with speech and language training in early aphasia rehabilitation: a randomized double-blind controlled pilot study. Top Stroke Rehabil 2013;20:250-261.
12.
Naeser MA, Martin PI, Nicholas M, Baker EH, Seekins H, Kobayashi M, et al: Improved picture naming in chronic aphasia after TMS to part of right Broca's area: an open-protocol study. Brain Lang 2005;93:95-105.
13.
Holland R, Leff AP, Josephs O, Galea JM, Desikan M, Price CJ, et al: Speech facilitation by left inferior frontal cortex stimulation. Curr Biol 2011;21:1403-1407.
14.
Khedr EM, Abo-Elfetoh N, Rothwell JC: Treatment of post-stroke dysphagia with repetitive transcranial magnetic stimulation. Acta Neurol Scand 2009;119:155-161.
15.
Khedr EM, Abo-Elfetoh N: Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brainstem infarction. J Neurol Neurosurg Psychiatry 2010;81:495-499.
16.
Hamdy S, Aziz Q, Rothwell JC, Crone R, Hughes D, Tallis RC, et al: Explaining oropharyngeal dysphagia after unilateral hemispheric stroke. Lancet 1997;350:686-692.
17.
Hamdy S, Aziz Q, Rothwell JC, et al: Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex. Gastroenterology 1998;115:1104-1112.
18.
Eliasova I, Mekyska J, Kostalova M, Marecek R, Smekal Z, Rektorova I: Acoustic evaluation of short-term effects of repetitive transcranial magnetic stimulation on motor aspects of speech in Parkinson's disease. J Neural Transm 2013;120:597-605.
19.
Cotelli M, Manenti R, Cappa SF, Zanetti O, Miniussi C: Transcranial magnetic stimulation improves naming in Alzheimer disease patients at different stages of cognitive decline. Eur J Neurol 2008;15:1286-1292.
20.
Ahmed MA, Darwish ES, Khedr EM, El Serogy YM, Ali AM: Effects of low versus high frequencies of repetitive transcranial magnetic stimulation on cognitive function and cortical excitability in Alzheimer's dementia. J Neurol 2012;259:83-92.
21.
Lefaucheur JP: Motor cortex dysfunction revealed by cortical excitability studies in Parkinson's disease: influence of antiparkinsonian treatment and cortical stimulation. Clin Neurophysiol 2005;116:244-253.
22.
Edwards MJ, Talelli P, Rothwell JC: Clinical applications of transcranial magnetic stimulation in patients with movement disorders. Lancet Neurol 2008;7:827-840.
23.
Araújo HA, Iglesio RF, Correia GS de C, Fernandes DTRM, Galhardoni R, Teixeira MJ, et al: Transcranial magnetic stimulation and clinical applicability: perspectives in neuropsychiatric therapeutics. Rev Med (São Paulo) 2011;90:3-14.
24.
Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-269, W64.
25.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al: Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1-12.
26.
Thiel A, Hartmann A, Rubi-Fessen I, Anglade C, Kracht L, Weiduschat N, et al: Effects of noninvasive brain stimulation on language networks and recovery in early poststroke aphasia. Stroke 2013;44:2240-2246.
27.
Waldowski K, Seniów J, Leśniak M, Iwański S, Członkowska A: Effect of low-frequency repetitive transcranial magnetic stimulation on naming abilities in early-stroke aphasic patients: a prospective, randomized, double-blind sham-controlled study. ScientificWorldJournal 2012;2012:518568.
28.
Kindler J, Schumacher R, Cazzoli D, Gutbrod K, Koenig M, Nyffeler T, et al: Theta burst stimulation over the right Broca's homologue induces improvement of naming in aphasic patients. Stroke 2012;43:2175-2179.
29.
Anderkova L, Rektorova I: Cognitive effects of repetitive transcranial magnetic stimulation in patients with neurodegenerative diseases - clinician's perspective. J Neurol Sci 2014;339:15-25.
30.
Gow D, Rothwell J, Hobson A, Thompson D, Hamdy S: Induction of long-term plasticity in human swallowing motor cortex following repetitive cortical stimulation. Clin Neurophysiol 2004;115:1044-1051.
31.
Naeser M, Martin P, Theoret H, et al: TMS suppression of right pars triangularis, but not pars opercularis, improves naming in aphasia. Brain Lang 2011;119:206-213.
32.
Atkins D, Eccles M, Flottorp S, Guyatt GH, Henry D, Hill S, et al: Systems for grading the quality of evidence and the strength of recommendations I: critical appraisal of existing approaches The GRADE Working Group. BMC Health Serv Res 2004;4:38.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.