Neural Noise

rTMS vs iTBS for post-stroke dysphagia

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  • Both rTMS and iTBS can improve swallowing function in post-stroke dysphagia, with efficacy documented in multiple controlled studies.12
  • High-frequency rTMS outperforms iTBS for short-term dysphagia recovery post-stroke in a head-to-head trial.1 12

Weekly enrichment (2026-07-20)

  • Fallback note: both ScienceDirect (Brain Stimulation) source URLs failed to resolve (Elsevier “article not recognized” / paywall), so the enrichment below draws on the peer-reviewed rTMS-vs-iTBS post-stroke dysphagia literature located by searching the title.34
  • A prospective, single-blind RCT (Frontiers in Neurology, 2025) randomized 92 post-stroke dysphagia patients into rTMS (n=31), iTBS (n=30), and control (n=31) groups, applying stimulation to the motor-cortex representation of the mylohyoid muscle alongside routine rehabilitation (trial registration ChiCTR2200058246).35
  • In that trial, after 2 weeks all three groups improved significantly (p<0.001) on the Penetration-Aspiration Scale (PAS) and Dysphagia Disability Index, with both rTMS and iTBS outperforming control (p<0.001) but showing no significant difference from each other (p>0.05); the authors favor iTBS because it delivers comparable benefit in a much shorter session, improving tolerability and reducing dropout.35
  • This equivalence nuances the existing note above: the head-to-head RCT evidence generally finds rTMS and iTBS comparable for short-term dysphagia recovery rather than one clearly outperforming the other, with iTBS favored mainly on treatment-time efficiency.3
  • A systematic review and meta-analysis (Frontiers in Neurology, 2025) pooled 18 RCTs and 835 patients (overall low risk of bias, “strong” recommendation) and found high-frequency rTMS significantly improved swallowing while low-frequency rTMS did not, and bilateral cerebral rTMS was superior to unilateral.4
  • That meta-analysis also reported cerebellar rTMS was more effective than cerebral rTMS on PAS/DOSS outcomes (e.g., cerebellar 10 Hz PAS mean difference −1.86, 95% CI −2.30 to −1.42), and safety was favorable: only 5 of 18 RCTs logged mild, transient adverse events such as dizziness, headache, or temporary hearing changes.4
  • A separate sham-controlled RCT of iTBS to the ipsilesional pharyngeal motor cortex (28 patients, 5 sessions plus conventional therapy) showed greater PAS improvement for real vs sham iTBS (median pre-post change −2.50 vs 0.00, P=0.004) and improved hyoid-larynx approximation, with no adverse effects reported.6
  • Mechanistically, these studies attribute recovery to cortical neuroplasticity and rebalancing of interhemispheric excitability, with fNIRS work suggesting compensatory recruitment of the unaffected hemisphere (notably prefrontal cortex) during swallowing after both rTMS and iTBS.34

Footnotes

  1. https://www.sciencedirect.com/science/article/pii/S1935861X26000494?dgcid=rss_sd_all ↩ ↩2 ↩3

  2. https://www.sciencedirect.com/science/article/pii/S1935861X25004371?dgcid=rss_sd_all ↩ ↩2

  3. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1650216/full ↩ ↩2 ↩3 ↩4 ↩5

  4. https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1586734/full ↩ ↩2 ↩3 ↩4

  5. https://pmc.ncbi.nlm.nih.gov/articles/PMC12549274/ ↩ ↩2

  6. https://doi.org/10.1097/mrr.0000000000000621 ↩

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