Intensive Rehabilitation With Adjunctive Bilateral Anodal
tDCS
in Post‐Stroke Dysphagia: A Multicenter Randomized Controlled Trial
Giuseppe Cosentino, Tommaso Bocci, Francesca Cecchi, Valeria Pingue, Carla Giudice, Nicole Pizzorni, Antonello Grippo, Simone Pierro, Ilaria Pellegrini, Emanuela Concas, Sara Rocca, Simone Mauramati, Giulia Bertino, Valentina Grillo, Shaheen Hamdy, Alberto Priori, Antonio Schindler, Antonio Nardone, Cristina Tassorelli, Enrico Alfonsi ABSTRACT
Background
Oropharyngeal dysphagia is a common and disabling consequence of stroke. Transcranial direct current stimulation (tDCS) has shown potential in promoting swallowing recovery, although evidence remains limited.
Objective
To determine whether bilateral anodal tDCS combined with intensive speech‐language therapy (SLT) improves swallowing outcomes compared with sham stimulation in patients with post‐stroke dysphagia. Exploratory analyses examined the influence of treatment phase, sex, lesion site, and baseline severity.
Methods
This multicenter, randomized, double‐blind, sham‐controlled trial enrolled patients with supratentorial or infratentorial ischemic stroke and oropharyngeal dysphagia. Participants received either bilateral anodal tDCS or sham stimulation (1.5 mA, 20 min/day, 5 days/week for 2 weeks) combined with intensive SLT over 6 weeks. Swallowing outcomes were assessed at baseline, 2 weeks, and 6 weeks using the Dysphagia Outcome and Severity Scale (DOSS, primary outcome), Penetration–Aspiration Scale (PAS), Mann Assessment of Swallowing Ability (MASA), and Swallowing Quality of Life questionnaire (SWAL‐QoL).
Results
Forty‐six patients (24 active, 22 sham) completed the protocol. Both groups showed significant improvement across all outcomes ( p < 0.001), with no significant difference between active and sham stimulation. The DOSS was the most sensitive measure, showing sustained improvement over time. Exploratory analyses indicated greater MASA gains with active tDCS in infratentorial strokes ( p = 0.04). Correlation analyses showed that greater baseline dysphagia severity was associated with larger functional gains.
Conclusions
Intensive SLT was associated with meaningful recovery in post‐stroke dysphagia, regardless of stimulation condition. Exploratory findings suggest that bilateral tDCS may confer additional benefit in selected lesion subgroups.