Recent advances and mechanistic insights of non-invasive brain stimulation in post-stroke dysphagia rehabilitation.

BACKGROUND

Post-stroke dysphagia (PSD) affects nearly half of stroke survivors and is associated with aspiration pneumonia, malnutrition, and increased mortality. Conventional swallowing rehabilitation often yields limited functional recovery. In recent years, non-invasive brain stimulation (NIBS), particularly repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), has emerged as a promising adjunctive therapy for promoting neuroplasticity and improving swallowing function in patients with PSD.

METHODS

This structured narrative review summarizes current clinical evidence on the application of rTMS and tDCS in PSD rehabilitation. A literature search was conducted in PubMed, Web of Science, CNKI, and the Cochrane Library from database inception to August 31, 2025. Randomized controlled trials evaluating the effects of rTMS or tDCS on swallowing-related outcomes in patients with PSD were included and narratively synthesized according to stimulation modality, target site, and clinical efficacy.

RESULTS

Across the included studies, both rTMS and tDCS significantly improved swallowing function compared with sham stimulation or conventional therapy alone, with good safety and tolerability. Therapeutic benefits were observed using various stimulation protocols, including high-frequency rTMS applied to the affected hemisphere, low-frequency rTMS applied to the unaffected hemisphere, and anodal tDCS delivered to the affected, unaffected, or bilateral hemispheres. However, stimulation parameters and target selection varied widely across studies, and no direct comparisons between rTMS and tDCS or combined-stimulation trials were identified.

CONCLUSIONS

Current evidence supports rTMS and tDCS as effective, safe, and feasible adjuncts to conventional rehabilitation for post-stroke dysphagia. Nevertheless, heterogeneity in study design and outcome measures limits protocol standardization. Future large-scale, multimodal studies incorporating neuroimaging and guided by the bimodal balance-recovery model are warranted to optimize stimulation strategies and further elucidate the mechanisms underlying cortical reorganization in PSD recovery.