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      The Effect of High-Frequency Repetitive Transcranial Magnetic Stimulation on Advancing Parkinson's Disease With Dysphagia: Double Blind Randomized Clinical Trial.

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          Abstract

          We investigate if rTMS has a therapeutic role in the treatment of dysphagia in patients with Parkinson's disease (PD). Material and Methods. Thirty-three patients with PD and dysphagia were randomly classified with ratio 1:2 to receive sham or real rTMS (2000 pulses; 20 Hz; 90% resting motor threshold; 10 trains of 10 seconds with 25 seconds between each train) over the hand area of each motor cortex (5 minutes between hemispheres) for 10 days (5 days per week) followed by 5 booster sessions every month for 3 months. Assessments included the Unified Parkinson's Disease Rating Scale part III (UPDRS), Instrumental Activities of Daily Living (IADL), and Arabic-Dysphagia Handicap Index (A-DHI) before, after the last session, and 3 months later. Video-fluoroscopy measures of pharyngeal transit time (PTT) and time to maximal hyoid elevation (H1-H2) were taken before and after the treatment sessions. Results. There were no significant differences between groups. There was a significant improvement on all rating scales (analysis of variance) after real rTMS with a significant time × group interaction. In particular, there was a significant and long-lasting (3 months) effect of time on all subitems of the A-DHI (functional, P = .0001; physical, P = .0001; emotional, P = .02) but not in the sham group. This was associated with significant improvement in H1-H2 (P = .03) and PTT (P = .01) during solid swallows in the real rTMS but not the sham group. Conclusion. Real rTMS improves dysphagia in PD as documented by A-DHI scores and by video-fluoroscopy.

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          Author and article information

          Journal
          Neurorehabil Neural Repair
          Neurorehabilitation and neural repair
          SAGE Publications
          1552-6844
          1545-9683
          June 2019
          : 33
          : 6
          Affiliations
          [1 ] 1 Assiut University Hospital, Assiut, Egypt.
          [2 ] 2 UCL Queen Square Institute of Neurology, London, UK.
          Article
          10.1177/1545968319847968
          31072214
          7ab5c7e4-5f32-4b13-bcbd-cdb3e79d4a2e
          History

          repetitive transcranial magnetic stimulation,dysphagia,clinical trial,Unified Parkinson’s Disease Rating part III,Parkinson’s disease,Instrumental Activities of Daily Living scale,Arabic Dysphagia Handicap Index,rehabilitation

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