Navigated fMRI-guided rTMS in rehabilitation of swallowing: A case demonstration

Abstract

Introduction.- Restoration of swallowing years after brain damage is challenging due to low neuroplasticity. Methods influencing brain plasticity may increase the efficacy of rehabilitation. Observation.- A 25 y.o. female patient with consciences of autoimmune encephalitis was attended for rehabilitation 1 year 6 month after the insult with swallowing dysfunction: difficulties in swallowing liquids and crumbly food, leading to a need in tracheostomic tube and special meal preparation, prolonged meal time. Functional outcome swallowing scale (FOSS) at admission-II. The patient received long-term rehabilitation including trainings with speech therapists and electrostimulation of bulbar musculature, last 3 months - without significant effects. Cortical representation of bulbar musculature was mapped bilaterally in M1 by functional MRI with saline swallowing paradigm. Then, 10 sessions of rTMS (10 Hz, intensity 100% motor threshold, 800 pulses at each side) were performed by Magstim Rapid 2 stimulator. Coil was positioned over the fMRI activation area with the use of eXimia Nexstim neuronavigation system. After the treatment, an improvement was observed: patient was able to swallow any food without difficulties, FOSS grade I. Discussion.- rTMS is a feasible option in rehabilitation of swallowing. More research is needed to access its efficacy.