Woo CG, Kim JH, Lee JH, Kim HJ. Effectiveness of antidepressant repetitive transcranial magnetic stimulation in a patient with refractory psychogenic dysphagia: A case report and review of literature. World J Clin Cases 2023; 11(28): 6850-6856 [PMID: 37901033 DOI: 10.12998/wjcc.v11.i28.6850]
Corresponding Author of This Article
Hyo Jong Kim, MD, PhD, Professor, Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju 28644, South Korea. hyojong80@gmail.com
Research Domain of This Article
Rehabilitation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Oct 6, 2023; 11(28): 6850-6856 Published online Oct 6, 2023. doi: 10.12998/wjcc.v11.i28.6850
Effectiveness of antidepressant repetitive transcranial magnetic stimulation in a patient with refractory psychogenic dysphagia: A case report and review of literature
Chang Gok Woo, Ji Hyoun Kim, Jeong Hwan Lee, Hyo Jong Kim
Chang Gok Woo, Department of Pathology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
Ji Hyoun Kim, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
Jeong Hwan Lee, Department of Psychiatry, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
Hyo Jong Kim, Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, South Korea
Author contributions: All the authors solely contributed to this paper; Woo CG, Kim JH, and Lee JH drafted the manuscript; Kim HJ is the supervisors of study; and all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this report and the accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hyo Jong Kim, MD, PhD, Professor, Department of Rehabilitation Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, 776, 1 Sunhwan-ro, Seowon-gu, Cheongju 28644, South Korea. hyojong80@gmail.com
Received: June 13, 2023 Peer-review started: June 13, 2023 First decision: August 24, 2023 Revised: August 28, 2023 Accepted: September 4, 2023 Article in press: September 4, 2023 Published online: October 6, 2023
Abstract
BACKGROUND
Dysphagia is a common condition in older as well as young patients, and a variety of treatments have been reported depending on the cause. However, clinicians are challenged when the cause is unclear. This is the case with psychogenic dysphagia, which has typically been treated with supportive psychotherapy, medication, swallowing exercise, and dysphagia rehabilitation therapy. Here, we aimed to relieve the symptoms of a patient with refractory psychogenic dysphagia, who was unresponsive to conventional swallowing therapy, with repetitive transcranial magnetic stimulation (rTMS).
CASE SUMMARY
A relatively calm-looking 35-year-old female patient presented with a 2-year history of dysphagia. She showed little improvement with conventional swallowing treatments over the past 2 years. She was relatively compliant with in-hospital dysphagia therapy, but uncooperative with home exercise and medication. In particular, since she was resistant to drug treatment, we had to take a different approach than the treatment she had been receiving for the past 2 years. After much deliberation, we decided to initiate antidepressant rTMS treatment with her consent (IRB No. 2023-05-021). Antidepressant rTMS treatment was performed twice weekly for a total of 20 sessions over 10 wk. The results showed improvement in subjective symptoms and video fluoroscopic swallowing study findings. To the best of our knowledge, this is the first report of symptomatic improvement using antidepressant rTMS protocol for refractory psychogenic dysphagia.
CONCLUSION
This case demonstrates that rTMS with antidepressant protocol can be used to improve swallowing in patients with refractory psychogenic dysphagia.
Core Tip: This case report describes the use of repetitive transcranial magnetic stimulation (rTMS) to improve swallowing in a patient with refractory psychogenic dysphagia. The patient had not responded to conventional swallowing therapy for the past two years. Interviews with her reveal that she appears calm but is very depressed. Therefore, rTMS with antidepressant protocol was deemed appropriate and applied for 10 wk. After the treatment, the patient’s swallowing symptoms improved, and the effect was maintained for 1 mo. This case shows that antidepressant rTMS treatment can be a good alternative for patients with psychogenic dysphagia who do not respond to conventional swallowing therapy.
