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Background <p>Combined central-peripheral magnetic stimulation shows promise for post-stroke dysphagia (PSD), but its neural mechanisms remain unclear. We evaluated the its efficacy and cortical mechanisms in PSD patients.</p> Methods <p>In this single-blind, parallel-controlled trial, 44 PSD patients were randomized to four groups: active-rTMS + active-rPMS, active-rTMS + sham-rPMS, sham-rTMS + active-rPMS, or sham-rTMS + sham-rPMS. Clinical scales, such as functional oral intake scale (FOIS) and Penetration-Aspiration Scale (PAS), and Videofluoroscopic Swallowing Study (VFSS) were accessed before, after intervention. Cortical activation during rest and swallowing task was measured by functional near-infrared spectroscopy (fNIRS).</p> Results <p>Significant interaction effects (time × intervention) were found for FOIS (Wald χ<sup>2</sup> = 39.816, p &lt; 0.001) and PAS scores (Wald χ<sup>2</sup> = 45.433, p &lt; 0.001), with the active-rTMS + active-rPMS group showing the most pronounced therapeutic gains. Concurrently, this group displayed significant improvements of laryngeal vestibular closure duration (LCD, MD = –3.598, 95% CI -4.177 to –3.019, adjusted p &lt; 0.001) and superior hyoid excursion (SHE, MD = –3.708, 95% CI -4.213 to –3.18, adjusted p &lt; 0.001). Neurophysiologically, increased functional connectivity (FC) within the ipsilesional prefrontal-sensorimotor network was observed and the changes of FC in ipsilesional M1 and S1 is significantly correlated with the change magnitude of LCD (r<sub>s</sub> = 0.78, p = 0.004) and SHE (r<sub>s</sub> = 0.67, P = 0.023).</p> Conclusions <p>The combined central-peripheral magnetic stimulation robustly improved swallowing function, temporal and kinematic sequence of swallowing, and sensori-motor connectivity in PSD patients, representing a promising neuromodulatory therapy for PSD.</p>

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Efficacy and Mechanisms of Combined Central-Peripheral Magnetic Stimulation on Prefrontal-Sensorimotor Cortex Connectivity in Post-Stroke Dysphagia after Supratentorial Stroke: A Randomized, Single-Blind, Parallel-Controlled Trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月24日

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  • Zirui Luo,
  • Zhiying Zhu,
  • Yujue Wang,
  • Na Su,
  • Yajing Xue,
  • Wanqi Zhang,
  • Wei Liao,
  • Yaoyao You,
  • Lin Ling,
  • Mei Li,
  • Junjie Liang,
  • Zulin Dou,
  • Haian Mao,
  • Nenggui Xu

摘要

Background

Combined central-peripheral magnetic stimulation shows promise for post-stroke dysphagia (PSD), but its neural mechanisms remain unclear. We evaluated the its efficacy and cortical mechanisms in PSD patients.

Methods

In this single-blind, parallel-controlled trial, 44 PSD patients were randomized to four groups: active-rTMS + active-rPMS, active-rTMS + sham-rPMS, sham-rTMS + active-rPMS, or sham-rTMS + sham-rPMS. Clinical scales, such as functional oral intake scale (FOIS) and Penetration-Aspiration Scale (PAS), and Videofluoroscopic Swallowing Study (VFSS) were accessed before, after intervention. Cortical activation during rest and swallowing task was measured by functional near-infrared spectroscopy (fNIRS).

Results

Significant interaction effects (time × intervention) were found for FOIS (Wald χ2 = 39.816, p < 0.001) and PAS scores (Wald χ2 = 45.433, p < 0.001), with the active-rTMS + active-rPMS group showing the most pronounced therapeutic gains. Concurrently, this group displayed significant improvements of laryngeal vestibular closure duration (LCD, MD = –3.598, 95% CI -4.177 to –3.019, adjusted p < 0.001) and superior hyoid excursion (SHE, MD = –3.708, 95% CI -4.213 to –3.18, adjusted p < 0.001). Neurophysiologically, increased functional connectivity (FC) within the ipsilesional prefrontal-sensorimotor network was observed and the changes of FC in ipsilesional M1 and S1 is significantly correlated with the change magnitude of LCD (rs = 0.78, p = 0.004) and SHE (rs = 0.67, P = 0.023).

Conclusions

The combined central-peripheral magnetic stimulation robustly improved swallowing function, temporal and kinematic sequence of swallowing, and sensori-motor connectivity in PSD patients, representing a promising neuromodulatory therapy for PSD.