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Qin Y, Tang Y, Liu X, Qiu S. Neural basis of dysphagia in stroke: A systematic review and meta-analysis. Front Hum Neurosci 2023; 17:1077234. [PMID: 36742358 PMCID: PMC9896523 DOI: 10.3389/fnhum.2023.1077234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023] Open
Abstract
Objectives Dysphagia is a major cause of stroke infection and death, and identification of structural and functional brain area changes associated with post-stroke dysphagia (PSD) can help in early screening and clinical intervention. Studies on PSD have reported numerous structural lesions and functional abnormalities in brain regions, and a systematic review is lacking. We aimed to integrate several neuroimaging studies to summarize the empirical evidence of neurological changes leading to PSD. Methods We conducted a systematic review of studies that used structural neuroimaging and functional neuroimaging approaches to explore structural and functional brain regions associated with swallowing after stroke, with additional evidence using a live activation likelihood estimation (ALE) approach. Results A total of 35 studies were included, including 20 studies with structural neuroimaging analysis, 14 studies with functional neuroimaging analysis and one study reporting results for both. The overall results suggest that structural lesions and functional abnormalities in the sensorimotor cortex, insula, cerebellum, cingulate gyrus, thalamus, basal ganglia, and associated white matter connections in individuals with stroke may contribute to dysphagia, and the ALE analysis provides additional evidence for structural lesions in the right lentiform nucleus and right thalamus and functional abnormalities in the left thalamus. Conclusion Our findings suggest that PSD is associated with neurological changes in brain regions such as sensorimotor cortex, insula, cerebellum, cingulate gyrus, thalamus, basal ganglia, and associated white matter connections. Adequate understanding of the mechanisms of neural changes in the post-stroke swallowing network may assist in clinical diagnosis and provide ideas for the development of new interventions in clinical practice.
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Affiliation(s)
- Yin Qin
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China,*Correspondence: Yin Qin,
| | - Yuting Tang
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaoying Liu
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China
| | - Shuting Qiu
- Department of Rehabilitation Medicine, The 900th Hospital of Joint Logistic Support Force, People’s Liberation Army (PLA), Fuzhou, China,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Rehabilitation of Post-Stroke Swallowing Dysfunction with Repeated Transcranial Magnetic Stimulation RTMS Based on Tomographic Images. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1118745. [PMID: 36159169 PMCID: PMC9489420 DOI: 10.1155/2022/1118745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022]
Abstract
In order to study the rehabilitation of dysphagia after stroke, this paper uses tomographic imaging technology and repeated transcranial magnetic stimulation rTMS therapy to verify the effect of this treatment method on the rehabilitation of dysphagia after stroke. In this study, the method of systematic review and meta-analysis are used to comprehensively collect the current published literature on the application of repeated transcranial magnetic stimulation in post-stroke dysphagia, and to quantitatively synthesize and qualitatively analyze the data and opinions. This article aims to explore the therapeutic effect and mechanism of repeated transcranial magnetic stimulation in the treatment of dysphagia after stroke, and to evaluate its effectiveness, so as to better guide the application of repetitive transcranial magnetic stimulation in the rehabilitation of dysphagia after stroke. The evaluation methods of rTMS for the clinical efficacy of PAS, FDS, VDS, DOSS, DD, and BI in patients with dysphagia after stroke are consistent. The influencing factors of rTMS on the swallowing function impairment of stroke include the choice of stimulation frequency, stimulation site, and stimulation time. Low-frequency stimulation of the contralateral hemisphere and high-frequency stimulation of the affected brain can reduce the excitability of the contralateral brain and enhance the excitability of the affected brain. The stimulation site is mainly in the pharyngeal cortex. Experiments show that rTMS can improve swallowing dysfunction after stroke within 2 weeks, and rTMS has no obvious side effects on swallowing dysfunction in patients with cerebral infarction.
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Chang MC, Seo Y, Kwak S. Deterioration of the Corticobulbar Tract in Older Dysphagic Patients Without Neurologic Diseases. Am J Phys Med Rehabil 2022; 101:353-357. [PMID: 35302528 DOI: 10.1097/phm.0000000000001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Less is known how dysphagia affects older patients without neurologic diseases and whether the symptoms of dysphagia have any association with impaired central control of swallowing. This study investigated the state of the corticobulbar tract, the surrogate marker for the central control of swallowing, in older dysphagic patients without any neurologic diseases, using diffusion tensor tractography. DESIGN This retrospective observational study was conducted at a tertiary university hospital including 10 patients 60 yrs or older with oropharyngeal dysphagia without neurological disease and 11 age- and sex-matched control participants. The corticobulbar tract was reconstructed, and the fractional anisotropy and tract volume were measured using diffusion tensor tractography. RESULTS The corticobulbar tracts of the dysphagia group were narrowed and not reconstructed by their configurations and had lower fractional anisotropy and tract volume values when compared with those of control group. Significant asymmetry between the left and the right corticobulbar tract hemispheres was found in the dysphagia group, whereas no asymmetry was found in the control group. CONCLUSIONS A deteriorated corticobulbar tract could be associated with the development of dysphagia in older adults without neurological diseases. Our findings might help establish more appropriate treatment strategies, such as targeted neuromodulation therapies in the future.
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Affiliation(s)
- Min Cheol Chang
- From the Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Kim Y, Han YJ, Park HY, Park GY, Jung M, Lee S, Im S. Neural correlates in the development of and recovery from dysphagia after supratentorial stroke: A prospective tractography study. NEUROIMAGE: CLINICAL 2022; 35:103103. [PMID: 35779464 PMCID: PMC9251599 DOI: 10.1016/j.nicl.2022.103103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Stroke may lead to unilateral or bilateral CBT changes regardless of dysphagia. Poor fractional anisotropy of the unaffected sides relates to limited recovery. Swallowing recovery may depend on the integrity of the unaffected CBT. Bi-hemispheric reorganization of the CBT is associated with swallowing recovery.
Background Methods Results Conclusions
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Affiliation(s)
- Youngkook Kim
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Jae Han
- Department of Rehabilitation Medicine, Hankook-hyo Convalescent Hospital, Republic of Korea
| | - Hae-Yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Moa Jung
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soohwan Lee
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Im S, Han YJ, Kim SH, Yoon MJ, Oh J, Kim Y. Role of bilateral corticobulbar tracts in dysphagia after middle cerebral artery stroke. Eur J Neurol 2020; 27:2158-2167. [PMID: 32524719 DOI: 10.1111/ene.14387] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE The corticobulbar tract is a potential neural pathway involved in swallowing. The frontal operculum, insular cortex, corona radiata and internal capsule, which are frequently involved in middle cerebral artery (MCA) strokes, are locations in which lesions cause dysphagia. However, it is unclear whether the locations are linked to the corticobulbar tract or whether corticobulbar tract integrity is associated with dysphagia severity. This study aimed to assess the association between corticobulbar tract integrity and dysphagia severity after MCA stroke. METHODS Thirty dysphagic patients after MCA stroke and 27 healthy controls were examined. Diffusion tensor imaging (DTI)-derived parameters of the corticobulbar tract were compared between patient and control groups. Next, patients were divided into mild and moderate-to-severe dysphagia groups, and DTI-derived parameters of the corticobulbar tract were compared between the subgroups. Logistic regression analysis was used to determine the association between corticobulbar tract integrity and dysphagia severity. RESULTS The tract volume (TV) of the affected corticobulbar tract was lower in dysphagic patients than in healthy controls (P < 0.001). According to dysphagia severity, TV of the unaffected corticobulbar tract was higher in the mild dysphagia group than in the moderate-to-severe dysphagia group (P = 0.012). TV of the unaffected corticobulbar tract was independently associated with dysphagia severity according to the logistic regression model (adjusted odds ratio 0.817, 95% confidence interval 0.683-0.976). CONCLUSIONS The corticobulbar tract was affected after MCA stroke and may be associated with dysphagia. A higher corticobulbar TV in the unaffected hemisphere was indicative of better swallowing function in dysphagic patients after MCA stroke.
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Affiliation(s)
- S Im
- Department of Rehabilitation Medicine, College of Medicine, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Korea
| | - Y J Han
- Department of Rehabilitation Medicine, College of Medicine, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Korea
| | - S-H Kim
- Department of Family Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - M-J Yoon
- Department of Rehabilitation Medicine, College of Medicine, Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - J Oh
- Rehabilitation Medicine, Independent Scholar, Seoul, Korea
| | - Y Kim
- Department of Rehabilitation Medicine, College of Medicine, Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
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Liew BS, Takagi K, Kato Y, Duvuru S, Thanapal S, Mangaleswaran B. Current Updates on Idiopathic Normal Pressure Hydrocephalus. Asian J Neurosurg 2019; 14:648-656. [PMID: 31497081 PMCID: PMC6703007 DOI: 10.4103/ajns.ajns_14_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is one of the neurodegenerative diseases which can be treated surgically with favorable outcome. The gait disturbance, cognitive, and urinary symptoms are known as the clinical triad of iNPH. In this review, we have addressed the comorbidities, differential diagnoses, clinical presentations, and pathology of iNPH. We have also summarized the imaging studies and clinical procedures used for the diagnosis of iNPH. The treatment modality, outcomes, and prognosis were also discussed.
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Affiliation(s)
- Boon Seng Liew
- Department of Neurosurgery, Hospital Sungai Buloh, Selangor, Malaysia
| | - Kiyoshi Takagi
- Normal Pressure Hydrocephalus Center, Tokyo Neurological Center Hospital, Tokyo, Japan
| | - Yoko Kato
- Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Shyam Duvuru
- Department of Neurosurgery, Velammal Hospitals, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Sengottuvel Thanapal
- Department of Neurosurgery, Government Mohan Kumaramangalam Medical College, Salem, Tamil Nadu, India
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Moon HI, Kim GS, Lee E. Is the Location of White Matter Lesions Important in the Swallowing Function of Older Patients with Mild Stroke? Dysphagia 2018; 34:407-414. [PMID: 30382381 DOI: 10.1007/s00455-018-9955-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
Older patients with stroke have poor functional prognosis compared to younger patients. Patients with stroke who have severe white matter (WM) lesions have been reported to have swallowing problems. The aim of this study was to determine whether the location of WM lesions affects swallowing function in older patients with mild stroke. We conducted a retrospective analysis of 88 patients aged > 65 years who had a National Institutes of Health Stroke Scale score of ≤ 5 and who underwent videofluoroscopic swallowing examination after their first stroke. Participants were divided into three groups according to the involvement of corticobulbar tract (CBT) as follows: group I, no involvement of CBT; group II, involvement of CBT in one hemisphere; and group III, involvement of CBT in both hemispheres. Linear regression analysis showed that pharyngeal transit time tended to increase according to the involvement of CBT in WM lesion (p = 0.043). In addition, inadequate laryngeal elevation was related to the involvement of CBT (p = 0.016). Early spillage, inadequate laryngeal elevation, and penetration could also be predicted by Fazekas grade. Accordingly, the location of WM lesions can be regarded as a potential predictive factor for dysphagia. Moreover, in patients with WM lesions involving CBT, detailed evaluation of dysphagia is required.
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Affiliation(s)
- Hyun Im Moon
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13590, Republic of Korea.
| | - Gyu Seong Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13590, Republic of Korea
| | - Eunchae Lee
- Department of Rehabilitation Medicine, Bundang Jesaeng General Hospital, 20, Seohyeon-ro 180 beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13590, Republic of Korea
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