High frequency versus low frequency repetitive Transcranial Magnetic Stimulation in post stroke dysphagia

This research project investigates the comparative efficacy of high-frequency versus low-frequency repetitive transcranial magnetic stimulation (rTMS) in the management of post-stroke dysphagia. Post-stroke dysphagia is a common and potentially serious complication of stroke that may lead to aspiration, pneumonia, malnutrition, dehydration, prolonged hospitalization, and reduced quality of life. Although rTMS has been increasingly explored in stroke rehabilitation, particularly for motor and language recovery, its role in swallowing rehabilitation remains incompletely defined, and uncertainty persists regarding the most effective stimulation frequency and therapeutic approach. The main purpose of this study is to evaluate whether stimulation frequency influences swallowing recovery in patients with acute ischemic stroke and dysphagia during early rehabilitation. Specifically, the study compares high-frequency 5 Hz rTMS, low-frequency 1 Hz rTMS, and sham stimulation, all applied to the contralesional hemisphere, to determine which approach is associated with better clinical outcomes. The project is designed as a randomized, parallel, controlled comparative trial involving 60 adult patients with acute ischemic stroke and unilateral hemispheric lesions, who will be allocated equally into three study groups. Before intervention, all participants will undergo a structured clinical assessment, including case history, the Arabic Eating Assessment Tool (A-EAT-10), and Fiberoptic Endoscopic Evaluation of Swallowing (FEES). FEES findings will be scored using the Penetration-Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). The intervention will consist of daily rTMS sessions for five consecutive days, and swallowing outcomes will be reassessed immediately after treatment and again one month later. This design allows evaluation of both short-term and sustained treatment effects. The expected outcome of this work is to clarify whether one stimulation frequency is more beneficial than the other in improving swallowing function after stroke. By identifying the more effective rTMS protocol, the study aims to support evidence-based rehabilitation strategies for post-stroke dysphagia, improve patient safety and functional recovery, and contribute to the growing literature on noninvasive brain stimulation in neurorehabilitation. More broadly, the findings may help refine therapeutic protocols for dysphagic stroke patients and guide future clinical research in this field.