Dysphagia, or difficulty swallowing, is a common and potentially life-threatening complication after stroke, affecting up to 76% of patients in the acute phase. It increases the risk of malnutrition, dehydration, and aspiration pneumonia, significantly affecting recovery and quality of life. Traditional rehabilitation approaches such as dietary modification and swallowing therapy have limitations, especially in severe or persistent cases. However, Repetitive Transcranial Magnetic Stimulation (rTMS) has emerged as a promising, non-invasive neuromodulation technique to enhance swallowing recovery.

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive procedure that uses magnetic pulses to stimulate specific areas of the brain. For post-stroke dysphagia, rTMS is typically applied to the swallowing motor cortex, which controls the complex neural circuits responsible for safe swallowing.

The rationale for using rTMS lies in correcting the interhemispheric imbalance that occurs after stroke. When one hemisphere is damaged, the unaffected side may exert excessive inhibition on the affected side, limiting recovery. Repetitive Transcranial Magnetic Stimulation (rTMS) helps rebalance cortical excitability, either by:

•    Using low-frequency stimulation (1 Hz) on the unaffected hemisphere to reduce overactivity, or

•    Applying high-frequency stimulation (≥3 Hz) to the affected hemisphere to enhance underactive areas.

This approach promotes neuroplasticity, encouraging the brain to reorganize and form new neural connections, which is essential for functional recovery of swallowing.

Multiple randomized controlled trials and meta-analyses support the effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) in treating dysphagia after stroke:

•    A 2016 double-blind, randomized controlled trial demonstrated that both 1 Hz and 3 Hz rTMS significantly improved swallowing function compared to sham treatment. The benefits lasted for at least three months, showing the long-term potential of rTMS as a therapeutic tool.

•    Patients who received Repetitive Transcranial Magnetic Stimulation (rTMS) showed greater improvements in swallowing coordination and functional recovery, with some showing restored motor-evoked potentials (MEPs) in previously silent areas of the brain.

•    Another study demonstrated that rTMS increased cortical excitability and improved coordination between the oral and pharyngeal stages of swallowing, with reduced aspiration and pharyngeal residue, leading to safer and more effective swallowing.

Repetitive Transcranial Magnetic Stimulation (rTMS) is well-tolerated, with only mild side effects such as temporary scalp discomfort or light headaches. No serious adverse events have been reported in controlled studies. The treatment is non-invasive and outpatient-based, with sessions lasting 20–30 minutes over 5–10 days, followed by maintenance if needed.

Repetitive Transcranial Magnetic Stimulation (rTMS) may be especially helpful for:

•    Patients with acute or subacute stroke experiencing dysphagia

•    Individuals with incomplete recovery from standard swallowing therapy

•    Those seeking non-pharmacological and targeted treatments to improve function

•    Patients with a high risk of aspiration or complications from swallowing dysfunction

Repetitive Transcranial Magnetic Stimulation (rTMS) represents a safe, innovative, and effective treatment for post-stroke dysphagia. By enhancing brain plasticity and rebalancing neural activity, it offers stroke patients renewed hope for regaining safe swallowing function and improving overall quality of life.