1
|
Sasegbon A, Cheng I, Labeit B, Lapa S, Rommel N, Hamdy S. New and Evolving Treatments for Neurologic Dysphagia. Drugs 2024:10.1007/s40265-024-02064-x. [PMID: 38954267 DOI: 10.1007/s40265-024-02064-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
Despite swallowing being a frequently performed daily function, it is highly complex. For a safe swallow to occur, muscles within the head, neck, and thorax need to contract in a concerted pattern, controlled by several swallowing centers at multiple levels of the central nervous system, including the midbrain, cerebral cortex, and cerebellum in addition to five cranial nerves. Dysphagia, or difficulty swallowing, is caused by a long list of pathologic processes and diseases, which can interfere with various stages along the swallowing sensorimotor pathway. When present, dysphagia leads to increased mortality, morbidity, hospital length of stay, and reduced quality of life. Current dysphagia management approaches, such as altering the texture and consistency of foods and fluids and teaching patients rehabilitative exercises, have been broadly unchanged for many years and, in the case of texture modification, are of uncertain effectiveness. However, evidence is emerging in support of new medication-based and neuromodulatory treatment approaches. Regarding medication-based therapies, most research has focused on capsaicinoids, which studies have shown are able to improve swallowing in patients with post-stroke dysphagia. Separately, albeit convergently, in the field of neuromodulation, there is a growing and positive evidential base behind three non-invasive brain stimulation techniques: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (TDCS), and pharyngeal electrical stimulation (PES). Should some or all of these emerging therapies fulfill their promise, dysphagia-related patient outcomes may be improved. This paper describes the current state of our understanding regarding new medication and neuromodulation-based neurogenic oropharyngeal dysphagia treatments.
Collapse
Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignal Analysis, University of Münster, Münster, Germany
- Universitätsklinikum Münster, Münster, Germany
| | - Bendix Labeit
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sriramya Lapa
- Department of Neurology, Goethe University and University Hospital, Frankfurt, Germany
| | - Nathalie Rommel
- Deglutology, Experimental Otorhinolaryngology, Department of Neurosciences, University of Leuven, Leuven, Belgium
- Department of Gastroenterology, Neurogastroenterology and Motility, University Hospitals Leuven, Leuven, Belgium
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, Centre for Gastrointestinal Sciences, University of Manchester, Manchester, UK.
- Centre for Gastrointestinal Sciences, Salford Royal Foundation Trust, University of Manchester, Clinical Sciences Building, Manchester, Eccles Old Road, Salford, M6 8HD, UK.
| |
Collapse
|
2
|
Georgiou AM. Perspective on the clinical management of post-stroke aphasia and dysphagia using repetitive transcranial magnetic stimulation (rTMS). Front Neurol 2024; 15:1417641. [PMID: 38994490 PMCID: PMC11236691 DOI: 10.3389/fneur.2024.1417641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 06/13/2024] [Indexed: 07/13/2024] Open
Affiliation(s)
- Anastasios M Georgiou
- The Cyprus Rehabilitating Aphasia and Dysphagia (C-RAD) Lab, Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
- The Brain and Neurorehabilitation Lab, Department of Rehabilitation Sciences, Cyprus University of Technology, Limassol, Cyprus
| |
Collapse
|
3
|
Guanyabens N, Tomsen N, Palomeras E, Mundet L, Clavé P, Ortega O. Neurophysiological characterization of oropharyngeal dysphagia in older patients. Clin Neurophysiol 2024; 162:129-140. [PMID: 38615499 DOI: 10.1016/j.clinph.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/09/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To characterize swallowing biomechanics and neurophysiology in older patients with oropharyngeal dysphagia (OD). METHODS Observational study in 12 young healthy volunteers (HV), 9 older HV (OHV) and 12 older patients with OD with no previous diseases causing OD (OOD). Swallowing biomechanics were measured by videofluoroscopy, neurophysiology with pharyngeal sensory (pSEP) and motor evoked-potentials (pMEP) to intrapharyngeal electrical and transcranial magnetic stimulation (TMS), respectively, and salivary neuropeptides with enzyme-linked immunosorbent assay (ELISA). RESULTS 83.3% of OOD patients had unsafe swallows (Penetration-Aspiration scale = 4.3 ± 2.1; p < 0.0001) with delayed time to laryngeal vestibule closure (362.5 ± 73.3 ms; p < 0.0001) compared to both HV groups. OOD patients had: (a) higher pharyngeal sensory threshold (p = 0.009) and delayed pSEP P1 and N2 latencies (p < 0.05 vs HV) to electrical stimulus; and (b) higher pharyngeal motor thresholds to TMS in both hemispheres (p < 0.05) and delayed pMEPs latencies (right, p < 0.0001 HV vs OHV/OOD; left, p < 0.0001 HV vs OHV/OOD). CONCLUSIONS OOD patients have unsafe swallow and delayed swallowing biomechanics, pharyngeal hypoesthesia with disrupted conduction of pharyngeal sensory inputs, and reduced excitability and delayed cortical motor response. SIGNIFICANCE These findings suggest new elements in the pathophysiology of aging-associated OD and herald new and more specific neurorehabilitation treatments for these patients.
Collapse
Affiliation(s)
- Nicolau Guanyabens
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Neurology Department, Hospital de Mataró, Barcelona, Spain
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Lluís Mundet
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
4
|
Wei KC, Wang TG, Hsiao MY. The Cortical and Subcortical Neural Control of Swallowing: A Narrative Review. Dysphagia 2024; 39:177-197. [PMID: 37603047 DOI: 10.1007/s00455-023-10613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
Swallowing is a sophisticated process involving the precise and timely coordination of the central and peripheral nervous systems, along with the musculatures of the oral cavity, pharynx, and airway. The role of the infratentorial neural structure, including the swallowing central pattern generator and cranial nerve nuclei, has been described in greater detail compared with both the cortical and subcortical neural structures. Nonetheless, accumulated data from analysis of swallowing performance in patients with different neurological diseases and conditions, along with results from neurophysiological studies of normal swallowing have gradually enhanced understanding of the role of cortical and subcortical neural structures in swallowing, potentially leading to the development of treatment modalities for patients suffering from dysphagia. This review article summarizes findings about the role of both cortical and subcortical neural structures in swallowing based on results from neurophysiological studies and studies of various neurological diseases. In sum, cortical regions are mainly in charge of initiation and coordination of swallowing after receiving afferent information, while subcortical structures including basal ganglia and thalamus are responsible for movement control and regulation during swallowing through the cortico-basal ganglia-thalamo-cortical loop. This article also presents how cortical and subcortical neural structures interact with each other to generate the swallowing response. In addition, we provided the updated evidence about the clinical applications and efficacy of neuromodulation techniques, including both non-invasive brain stimulation and deep brain stimulation on dysphagia.
Collapse
Affiliation(s)
- Kuo-Chang Wei
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan.
| |
Collapse
|
5
|
Sasegbon A, Cheng I, Hamdy S. The neurorehabilitation of post-stroke dysphagia: Physiology and pathophysiology. J Physiol 2024. [PMID: 38517302 DOI: 10.1113/jp285564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
Swallowing is a complex process involving the precise contractions of numerous muscles of the head and neck, which act to process and shepherd ingested material from the oral cavity to its eventual destination, the stomach. Over the past five decades, information from animal and human studies has laid bare the complex network of neurones in the brainstem, cortex and cerebellum that are responsible for orchestrating each normal swallow. Amidst this complexity, problems can and often do occur that result in dysphagia, defined as impaired or disordered swallowing. Dysphagia is common, arising from multiple varied disease processes that can affect any of the neuromuscular structures involved in swallowing. Post-stroke dysphagia (PSD) remains the most prevalent and most commonly studied form of dysphagia and, as such, provides an important disease model to assess dysphagia physiology and pathophysiology. In this review, we explore the complex neuroanatomical processes that occur during normal swallowing and PSD. This includes how strokes cause dysphagia, the mechanisms through which natural neuroplastic recovery occurs, current treatments for patients with persistent dysphagia and emerging neuromodulatory treatments.
Collapse
Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
- Academic Unit of Human Communication, Learning, and Development, Faculty of Education, The University of Hong Kong, Hong Kong, China
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
| |
Collapse
|
6
|
Xu F, Bai L, Dai Z, Cheng H. Research hotspots and trends in post-stroke dysphagia: a bibliometric analysis. Front Neurosci 2023; 17:1275748. [PMID: 37942140 PMCID: PMC10628302 DOI: 10.3389/fnins.2023.1275748] [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: 08/10/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Background Dysphagia represents one of the common complications following a stroke, and post-stroke dysphagia (PSD) can lead to aspiration, pneumonia, and malnutrition, thus prolonging hospital stay, escalating medical expenditures, and imposing a substantial economic strain on both patients and society. The utilization of bibliometric analysis offers a quantitative approach for investigating the existing literature and recognizes the current status of the research. However, bibliometric analysis on the subject of PSD remains absent. Consequently, we carried out this study to provide researchers with insights, facilitating their further exploration of PSD. Methods Conducting a bibliometric analysis of articles pertaining to PSD retrieved over the past two decades enables us to acquire the research hotspots and trends in this area. The publications concerning PSD were searched from the Core Collection of Web of Science, spanning the period ranging from 2003 to 2023. Articles or reviews published in English were included in this study. Subsequently, we employed CiteSpace and VOSviewer software to visualize the retrieved articles, thereby identifying the cooperative relationships of authors, institutions, and countries, as well as relevant information about journals and references. Results This study comprised 866 papers in total, and the number of articles published each year shows an overall growth trend. As for the analysis of the authors, Dziewas R. was the most prolific author with 21 articles. The most frequently published institutions, countries, and journals were the University of Manchester, China, and Dysphagia, with 28, 254, and 75 publications, respectively. And the co-cited authors and journals with the highest counts were Martino R and Stroke. According to the analysis of keywords and references, dysphagia screening and assessment, prevention of pneumonia, rehabilitation approaches, and nutritional management of PSD are considered research hotpots. Additionally, future research may focus on the topics of systematic review and meta-analysis, noninvasive brain stimulation, and lesion location. Conclusion Through the bibliometrics analysis of PSD, we can capture the research hotspots and frontiers of PSD, thereby providing inspiration and reference for subsequent studies in this field.
Collapse
Affiliation(s)
- Fangyuan Xu
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Lin Bai
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Ziliang Dai
- Department of Rehabilitation Medicine, Wuhan Iron and Steel (Group) Second Staff Hospital, Wuhan, China
| | - Hongliang Cheng
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| |
Collapse
|
7
|
Tai J, Hu R, Fan S, Wu Y, Wang T, Wu J. Theta-burst transcranial magnetic stimulation for dysphagia patients during recovery stage of stroke: a randomized controlled trial. Eur J Phys Rehabil Med 2023; 59:543-553. [PMID: 37737051 PMCID: PMC10664766 DOI: 10.23736/s1973-9087.23.08023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/17/2023] [Accepted: 09/04/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The Theta-burst Transcranial Magnetic Stimulation (TBS) is an emerging modality of Repetitive Transcranial Magnetic Stimulation (rTMS). However, the efficacy of TBS on post-stroke recovery-stage patients with dysphagia remains unclear. AIM To investigate the effect of intermittent theta burst stimulation (iTBS) and continuous theta burst stimulation (cTBS) in post-stroke dysphagia patients within the recovery stage. DESIGN Randomized controlled double blinded trial. SETTING Inpatient. POPULATION Ninety patients with dysphagia after stroke within 1 to 6 months. METHODS Patients were divided into the supratentorial group and the brainstem group, and both of groups were further divided into three subgroups, including the sham subgroups, the iTBS subgroups, and the cTBS subgroups. Each of subgroups received 30 min of traditional swallowing rehabilitation treatment every day for 4 weeks. In addition, the iTBS subgroups received iTBS over the cortex of the suprahyoid muscles on the affected hemisphere, the cTBS subgroups received cTBS on the unaffected hemisphere, and the sham subgroups received sham stimulation on unilateral hemisphere. Standardized swallowing assessment (SSA), Oral Motor Function Scale (OMFS) and fiberoptic endoscopic examination of swallowing (FEES) were assessed before and after treatments. RESULTS In the supratentorial group, compared with the sham and cTBS subgroups, the iTBS subgroups showed significant improvement in SSA, OMFS, vocal folds movement, laryngeal sensation, and Rosenbek Penetration-Aspiration Scale (PAS) (P<0.05). In the brainstem group, compared with the sham subgroup, the iTBS subgroup significantly improved SSA, OMFS, Yale Pharyngeal Residue Severity Rating Scale (YPR-SRS) and PAS (P<0.05), and the cTBS subgroup significantly improved SSA, YPR-SRS and PAS (P<0.05). CONCLUSIONS This study demonstrated that iTBS might be an effective stimulation pattern to improve the overall swallowing function whether in supratentorial stroke patients or brainstem stroke patients. CLINICAL REHABILITATION IMPACT iTBS seems to be a promising approach for rehabilitation of overall swallowing function in post-stroke patients.
Collapse
Affiliation(s)
- Jiahui Tai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Ruiping Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Shunjuan Fan
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Yi Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Tingwei Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Junfa Wu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China -
- National Center for Neurological Disorders, Shanghai, China
| |
Collapse
|
8
|
Cheng I, Sasegbon A, Hamdy S. Evaluating the Therapeutic Application of Neuromodulation in the Human Swallowing System. Dysphagia 2023; 38:1005-1024. [PMID: 36239821 PMCID: PMC10326109 DOI: 10.1007/s00455-022-10528-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/30/2022] [Indexed: 11/03/2022]
Abstract
In the last two decades, the focus of neurogenic dysphagia management has moved from passive compensatory strategies to evidence-based rehabilitative approaches. Advances in technology have enabled the development of novel treatment approaches such as neuromodulation techniques, which target the promotion of neurological reorganization for functional recovery of swallowing. Given the rapid pace of development in the field, this review aims to summarize the current findings on the effects of neuromodulation techniques on the human swallowing system and evaluate their therapeutic potential for neurogenic dysphagia. Implications for future clinical research and practical considerations for using neuromodulation in clinical practice will also be discussed.
Collapse
Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ayodele Sasegbon
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
- Centre for Gastrointestinal Sciences, University of Manchester, Clinical Sciences Building, Salford Royal Foundation Trust, Eccles Old Road, Salford, M6 8HD, UK.
| |
Collapse
|
9
|
Yao L, Ye Q, Liu Y, Yao S, Yuan S, Xu Q, Deng B, Tang X, Shi J, Luo J, Wu J, Wu Z, Liu J, Tang C, Wang L, Xu N. Electroacupuncture improves swallowing function in a post-stroke dysphagia mouse model by activating the motor cortex inputs to the nucleus tractus solitarii through the parabrachial nuclei. Nat Commun 2023; 14:810. [PMID: 36781899 PMCID: PMC9925820 DOI: 10.1038/s41467-023-36448-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/01/2023] [Indexed: 02/15/2023] Open
Abstract
As a traditional medical therapy, stimulation at the Lianquan (CV23) acupoint, located at the depression superior to the hyoid bone, has been shown to be beneficial in dysphagia. However, little is known about the neurological mechanism by which this peripheral stimulation approach treats for dysphagia. Here, we first identified a cluster of excitatory neurons in layer 5 (L5) of the primary motor cortex (M1) that can regulate swallowing function in male mice by modulating mylohyoid activity. Moreover, we found that focal ischemia in the M1 mimicked the post-stroke dysphagia (PSD) pathology, as indicated by impaired water consumption and electromyographic responses in the mylohyoid. This dysfunction could be rescued by electroacupuncture (EA) stimulation at the CV23 acupoint (EA-CV23) in a manner dependent on the excitatory neurons in the contralateral M1 L5. Furthermore, neuronal activation in both the parabrachial nuclei (PBN) and nucleus tractus solitarii (NTS), which was modulated by the M1, was required for the ability of EA-CV23 treatment to improve swallowing function in male PSD model mice. Together, these results uncover the importance of the M1-PBN-NTS neural circuit in driving the protective effect of EA-CV23 against swallowing dysfunction and thus reveal a potential strategy for dysphagia intervention.
Collapse
Affiliation(s)
- Lulu Yao
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Qiuping Ye
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.,Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China
| | - Yun Liu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.,Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Shuqi Yao
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Si Yuan
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Qin Xu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Bing Deng
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Xiaorong Tang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Jiahui Shi
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Jianyu Luo
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Junshang Wu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Zhennan Wu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Jianhua Liu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.,Acupuncture Research Team, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Chunzhi Tang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Lin Wang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
| | - Nenggui Xu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China.
| |
Collapse
|
10
|
Borders JC, Grande AA, Troche MS. Statistical Power and Swallowing Rehabilitation Research: Current Landscape and Next Steps. Dysphagia 2022; 37:1673-1688. [PMID: 35226185 DOI: 10.1007/s00455-022-10428-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Despite rapid growth in the number of treatments to rehabilitate dysphagia, studies often demonstrate mixed results with non-significant changes to functional outcomes. Given that power analyses are infrequently reported in dysphagia research, it remains unclear whether studies are adequately powered to detect a range of treatment effects. Therefore, this review sought to examine the current landscape of statistical power in swallowing rehabilitation research. Databases were searched for swallowing treatments using instrumental evaluations of swallowing and the penetration-aspiration scale as an outcome. Sensitivity power analyses based on each study's statistical test and sample size were performed to determine the minimum effect size detectable with 80% power. Eighty-nine studies with 94 treatment comparisons were included. Sixty-seven percent of treatment comparisons were unable to detect effects smaller than d = 0.80. The smallest detectable effect size was d = 0.29 for electrical stimulation, d = 0.49 for postural maneuvers, d = 0.52 for non-invasive brain stimulation, d = 0.61 for combined treatments, d = 0.63 for respiratory-based interventions, d = 0.70 for lingual strengthening, and d = 0.79 for oral sensory stimulation. Dysphagia treatments examining changes in penetration-aspiration scale scores were generally powered to reliably detect larger effect sizes and not smaller (but potentially clinically meaningful) effects. These findings suggest that non-significant results may be related to low statistical power, highlighting the need for collaborative, well-powered intervention studies that can detect smaller, clinically meaningful changes in swallowing function. To facilitate implementation, a tutorial on simulation-based power analyses for ordinal outcomes is provided ( https://osf.io/e6usd/ ).
Collapse
Affiliation(s)
- James C Borders
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
| | | | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| |
Collapse
|
11
|
Xu C, He Z, Shen Z, Huang F. Potential Benefits of Music Therapy on Stroke Rehabilitation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:9386095. [PMID: 35757506 PMCID: PMC9217607 DOI: 10.1155/2022/9386095] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Abstract
Stroke is associated with a high rate of disability and mortality, and survivors are usually accompanied with dysphagia, aphasia, motor dysfunction, cognitive impairment, depression, and other complications. In the past decades, many studies have been conducted to reveal the pathogenesis and pathological mechanisms of stroke. Furthermore, treatment methods have been developed that contribute to the elevated survival rate of stroke patients. Early rehabilitation poststroke is starting to be recognized as important and has been receiving increasing attention in order to further improve the quality of life of the patients. As an emerging method of poststroke rehabilitation, music therapy can help attenuate dysphagia and aphasia, improve cognition and motor function, alleviate negative moods, and accelerate neurological recovery in stroke patients. This review helps summarize the recent progress that has been made using music therapy in stroke rehabilitation and is aimed at providing clinical evidence for the treatment of stroke patients.
Collapse
Affiliation(s)
- Chengyan Xu
- Department of Neurosurgery, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zixia He
- Department of Outpatient, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhipeng Shen
- Department of Neurosurgery, The Children's Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fei Huang
- Department of Science and Education, Hangzhou Women's Hospital, Hangzhou Maternity and Child Health Care Hospital, Hangzhou, China
| |
Collapse
|
12
|
Michou E, Hamdy S. Reversal of the effects of focal suppression on pharyngeal corticobulbar tracts by chemesthesis coupled with repeated swallowing. Neurogastroenterol Motil 2022; 34:e14286. [PMID: 34729879 DOI: 10.1111/nmo.14286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous reports suggested the potential benefit of chemesthesis in the form of carbonated water (CW) integrated within dysphagia rehabilitation protocols. Here, we examined the effects of CW within a repeated swallowing protocol following focal suppression to pharyngeal cortical representation as a prelude to its application in dysphagic patients. METHODS Fourteen healthy volunteers participated in a 3-arm study. Each participant underwent baseline corticobulbar pharyngeal and thenar motor-evoked potential (MEP) measurements with Transcranial Magnetic Stimulation (TMS). Subjects were then conditioned with 1Hz repetitive (r)TMS to induce focal unilateral suppression of the corticopharyngeal hotspot before randomization to each of three arms with 40 swallows of CW, non-CW and saliva swallowing on separate days. Corticobulbar and thenar MEPs were collected for up to 1 h and analyzed using repeated measures (rm)ANOVA. RESULTS A 2-way rmANOVA for Intervention x Time showed a significant effect of Intervention (F(1,13) = 7.519, p = 0.017) in both ipsi- and contra-lesional corticopharyngeal projections. Carbonation showed superiority in facilitating change by increasing pharyngeal cortical MEPs compared to non-CW (z = -3.05, p = 0.002) and saliva swallowing (z = -2.6, p = 0.008). No change in thenar representation (control) was observed nor in MEP latencies from both pharyngeal and thenar musculature. CONCLUSIONS We conclude that interventional paradigms with CW have the capacity to reverse the effects of a focal suppression with 1Hz rTMS more strongly than non-CW or saliva swallowing alone, producing site specific bi-hemispheric changes in corticopharyngeal excitability. Our data suggest that carbonation produces the effects through a mainly cortical mechanism.
Collapse
Affiliation(s)
- Emilia Michou
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Clinical Sciences Building, Salford Royal Hospital, University of Manchester, Salford, UK.,Department of Speech and Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Clinical Sciences Building, Salford Royal Hospital, University of Manchester, Salford, UK
| |
Collapse
|
13
|
Sasegbon A, Hammerbeck U, Michou E, Cheng I, Zhang M, James C, Hamdy S. A feasibility pilot study of the effects of neurostimulation on swallowing function in Parkinson’s Disease. AMRC OPEN RESEARCH 2022; 3:19. [PMID: 35726231 PMCID: PMC7612876 DOI: 10.12688/amrcopenres.13007.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introduction Dysphagia often occurs during Parkinson’s disease (PD) and can have severe consequences. Recently, neuromodulatory techniques have been used to treat neurogenic dysphagia. Here we aimed to compare the neurophysiological and swallowing effects of three different types of neurostimulation, 5 Hertz (Hz) repetitive transcranial magnetic stimulation (rTMS), 1 Hz rTMS and pharyngeal electrical stimulation (PES) in patients with PD. Method 12 PD patients with dysphagia were randomised to receive either 5 Hz rTMS, 1 Hz rTMS, or PES. In a cross-over design, patients were assigned to one intervention and received both real and sham stimulation. Patients received a baseline videofluoroscopic (VFS) assessment of their swallowing, enabling penetration aspiration scores (PAS) to be calculated for: thin fluids, paste, solids and cup drinking. Swallowing timing measurements were also performed on thin fluid swallows only. They then had baseline recordings of motor evoked potentials (MEPs) from both pharyngeal and (as a control) abductor pollicis brevis (APB) cortical areas using single-pulse TMS. Subsequently, the intervention was administered and post interventional TMS recordings were taken at 0 and 30 minutes followed by a repeat VFS within 60 minutes of intervention. Results All interventions were well tolerated. Due to lower than expected recruitment, statistical analysis of the data was not undertaken. However, with respect to PAS swallowing timings and MEP amplitudes, there was small but visible difference in the outcomes between active and sham. Conclusion PES, 5 Hz rTMS and 1 Hz rTMS are tolerable interventions in PD related dysphagia. Due to small patient numbers no definitive conclusions could be drawn from the data with respect to individual interventions improving swallowing function and comparative effectiveness between interventions. Larger future studies are needed to further explore the efficacy of these neuromodulatory treatments in Parkinson’s Disease associated dysphagia.
Collapse
Affiliation(s)
- Ayodele Sasegbon
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| | - Ulrike Hammerbeck
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| | - Emilia Michou
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
- Department of Speech and Language Therapy, University of Patras, Patras, Greece
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| | - Mengqing Zhang
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| | - Charlotte James
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, Greater Manchester, Stott Lane, Salford M6 8HD, UK
| |
Collapse
|
14
|
Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analysis of Randomised Controlled Trials-Part II: Brain Neurostimulation. J Clin Med 2022; 11:jcm11040993. [PMID: 35207265 PMCID: PMC8878820 DOI: 10.3390/jcm11040993] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/05/2023] Open
Abstract
Objective. To assess the effects of brain neurostimulation (i.e., repetitive transcranial magnetic stimulation [rTMS] and transcranial direct current stimulation [tDCS]) in people with oropharyngeal dysphagia (OD). Methods. Systematic literature searches were conducted in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed) to retrieve randomised controlled trials (RCTs) only. Using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2), the methodological quality of included studies was evaluated, after which meta-analysis was conducted using a random-effects model. Results. In total, 24 studies reporting on brain neurostimulation were included: 11 studies on rTMS, 9 studies on tDCS, and 4 studies on combined neurostimulation interventions. Overall, within-group meta-analysis and between-group analysis for rTMS identified significant large and small effects in favour of stimulation, respectively. For tDCS, overall within-group analysis and between-group analysis identified significant large and moderate effects in favour of stimulation, respectively. Conclusion. Both rTMS and tDCS show promising effects in people with oropharyngeal dysphagia. However, comparisons between studies were challenging due to high heterogeneity in stimulation protocols and experimental parameters, potential moderators, and inconsistent methodological reporting. Generalisations of meta-analyses need to be interpreted with care. Future research should include large RCTs using standard protocols and reporting guidelines as achieved by international consensus.
Collapse
|
15
|
Speyer R, Sutt AL, Bergström L, Hamdy S, Heijnen BJ, Remijn L, Wilkes-Gillan S, Cordier R. Neurostimulation in People with Oropharyngeal Dysphagia: A Systematic Review and Meta-Analyses of Randomised Controlled Trials-Part I: Pharyngeal and Neuromuscular Electrical Stimulation. J Clin Med 2022; 11:jcm11030776. [PMID: 35160228 PMCID: PMC8836998 DOI: 10.3390/jcm11030776] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 12/22/2022] Open
Abstract
Objective. To assess the effects of neurostimulation (i.e., neuromuscular electrical stimulation (NMES) and pharyngeal electrical stimulation (PES)) in people with oropharyngeal dysphagia (OD). Methods. Systematic literature searches were conducted to retrieve randomised controlled trials in four electronic databases (CINAHL, Embase, PsycINFO, and PubMed). The methodological quality of included studies was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Results. In total, 42 studies reporting on peripheral neurostimulation were included: 30 studies on NMES, eight studies on PES, and four studies on combined neurostimulation interventions. When conducting meta analyses, significant, large and significant, moderate pre-post treatment effects were found for NMES (11 studies) and PES (five studies), respectively. Between-group analyses showed small effect sizes in favour of NMES, but no significant effects for PES. Conclusions. NMES may have more promising effects compared to PES. However, NMES studies showed high heterogeneity in protocols and experimental variables, the presence of potential moderators, and inconsistent reporting of methodology. Therefore, only conservative generalisations and interpretation of meta-analyses could be made. To facilitate comparisons of studies and determine intervention effects, there is a need for more randomised controlled trials with larger population sizes, and greater standardisation of protocols and guidelines for reporting.
Collapse
Affiliation(s)
- Renée Speyer
- Department Special Needs Education, Faculty of Educational Sciences, University of Oslo, 0318 Oslo, Norway
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 1233 ZA Leiden, The Netherlands;
- Correspondence:
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD 4032, Australia;
- School of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Liza Bergström
- Remeo Stockholm, 128 64 Stockholm, Sweden;
- Speech Therapy Clinic, Danderyd University Hospital, 182 88 Stockholm, Sweden
| | - Shaheen Hamdy
- GI Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Bas Joris Heijnen
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, 1233 ZA Leiden, The Netherlands;
| | - Lianne Remijn
- School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands;
| | - Sarah Wilkes-Gillan
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Reinie Cordier
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Department of Social Work, Education and Community Wellbeing, Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE7 7XA, UK;
| |
Collapse
|
16
|
Ebihara S, Naito T. A Systematic Review of Reported Methods of Stimulating Swallowing Function and their Classification. TOHOKU J EXP MED 2022; 256:1-17. [DOI: 10.1620/tjem.256.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Satoru Ebihara
- Department of Rehabilitation Medicine, Toho University Graduate School of Medicine
| | - Toru Naito
- Section of Geriatric Dentistry, Department of General Dentistry, Fukuoka Dental College
| |
Collapse
|
17
|
Koganemaru S, Mizuno F, Takahashi T, Takemura Y, Irisawa H, Matsuhashi M, Mima T, Mizushima T, Kansaku K. Event-Related Desynchronization and Corticomuscular Coherence Observed During Volitional Swallow by Electroencephalography Recordings in Humans. Front Hum Neurosci 2021; 15:643454. [PMID: 34899209 PMCID: PMC8664381 DOI: 10.3389/fnhum.2021.643454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 10/29/2021] [Indexed: 11/20/2022] Open
Abstract
Swallowing in humans involves many cortical areas although it is partly mediated by a series of brainstem reflexes. Cortical motor commands are sent to muscles during swallow. Previous works using magnetoencephalography showed event-related desynchronization (ERD) during swallow and corticomuscular coherence (CMC) during tongue movements in the bilateral sensorimotor and motor-related areas. However, there have been few analogous works that use electroencephalography (EEG). We investigated the ERD and CMC in the bilateral sensorimotor, premotor, and inferior prefrontal areas during volitional swallow by EEG recordings in 18 healthy human subjects. As a result, we found a significant ERD in the beta frequency band and CMC in the theta, alpha, and beta frequency bands during swallow in those cortical areas. These results suggest that EEG can detect the desynchronized activity and oscillatory interaction between the cortex and pharyngeal muscles in the bilateral sensorimotor, premotor, and inferior prefrontal areas during volitional swallow in humans.
Collapse
Affiliation(s)
- Satoko Koganemaru
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Physiology, Dokkyo Medical University, Mibu, Japan
| | - Fumiya Mizuno
- Division of Rehabilitation Medicine, Dokkyo Medical University Hospital, Mibu, Japan
| | | | - Yuu Takemura
- Department of Rehabilitation Medicine, Dokkyo Medical University, Mibu, Japan
| | - Hiroshi Irisawa
- Department of Rehabilitation Medicine, Dokkyo Medical University, Mibu, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Takashi Mizushima
- Department of Rehabilitation Medicine, Dokkyo Medical University, Mibu, Japan
| | - Kenji Kansaku
- Department of Physiology, Dokkyo Medical University, Mibu, Japan
| |
Collapse
|
18
|
Yang W, Cao X, Zhang X, Wang X, Li X, Huai Y. The Effect of Repetitive Transcranial Magnetic Stimulation on Dysphagia After Stroke: A Systematic Review and Meta-Analysis. Front Neurosci 2021; 15:769848. [PMID: 34867171 PMCID: PMC8634594 DOI: 10.3389/fnins.2021.769848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/07/2021] [Indexed: 12/12/2022] Open
Abstract
Objective: The primary purpose of our study is to systemically evaluate the effect of repetitive transcranial magnetic stimulation (rTMS) on recovery of dysphagia after stroke. Search Methods: We searched randomized controlled trials (RCTs) and non-RCTs published by PubMed, the Cochrane Library, ScienceDirect, MEDLINE, and Web of Science from inception until April 24, 2021. Language is limited to English. After screening and extracting the data, and evaluating the quality of the selected literature, we carried out the meta-analysis with software RevMan 5.3 and summarized available evidence from non-RCTs. Results: Among 205 potentially relevant articles, 189 participants (from 10 RCTs) were recruited in the meta-analysis, and six non-RCTs were qualitatively described. The random-effects model analysis revealed a pooled effect size of SMD = 0.65 (95% CI = 0.04–1.26, p = 0.04), which indicated that rTMS therapy has a better effect than conventional therapy. However, the subgroup analysis showed that there was no significant difference between low-frequency and high-frequency groups. Even more surprisingly, there were no statistically significant differences between the two groups and the conventional training group in the subgroup analysis, but the combined effect was positive. Conclusion: Our study suggests that rTMS might be effective in treating patients with dysphagia after stroke.
Collapse
Affiliation(s)
- Weiwei Yang
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Xiongbin Cao
- Neurology Department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Xiaoyun Zhang
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Xuebing Wang
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Xiaowen Li
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Yaping Huai
- Rehabilitation Department, Shenzhen Longhua District Central Hospital, Shenzhen, China
| |
Collapse
|
19
|
Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke. Neural Plast 2021; 2021:3831472. [PMID: 34777497 PMCID: PMC8580697 DOI: 10.1155/2021/3831472] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia. Objective To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS. Methods Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Results Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference (SMD) = 1.44, 95% CI 0.80 to 2.08, P < 0.05) and the water swallow test score (SMD = 6.23, 95% CI 5.44 to 7.03, P < 0.05). NIBS could reduce the standardized swallowing assessment (SSA) score (SMD = −1.04, 95% CI -1.50 to -0.58, P < 0.05), the penetration-aspiration scale (PAS) score (SMD = −0.85, 95% CI -1.33 to -0.36, P < 0.05), and the functional dysphagia scale score (SMD = −1.05, 95% CI -1.48 to -0.62, P < 0.05). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS (P = 0.52) > tDCS (P = 0.48), the best probabilistic ranking of the SSA score is rTMS (P = 0.72) > tDCS (P = 0.28), and the best probabilistic ranking of the PAS score is rTMS (P = 0.68) > tDCS (P = 0.32). Conclusion Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.
Collapse
|
20
|
Dziewas R, Michou E, Trapl-Grundschober M, Lal A, Arsava EM, Bath PM, Clavé P, Glahn J, Hamdy S, Pownall S, Schindler A, Walshe M, Wirth R, Wright D, Verin E. European Stroke Organisation and European Society for Swallowing Disorders guideline for the diagnosis and treatment of post-stroke dysphagia. Eur Stroke J 2021; 6:LXXXIX-CXV. [PMID: 34746431 DOI: 10.1177/23969873211039721] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022] Open
Abstract
Post-stroke dysphagia (PSD) is present in more than 50% of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke patients to prevent post-stroke pneumonia and to early mortality and low quality of evidence to suggest dysphagia assessment in stroke patients having been identified at being at risk of PSD. We found low to moderate quality of evidence for a variety of treatment options to improve swallowing physiology and swallowing safety. These options include dietary interventions, behavioural swallowing treatment including acupuncture, nutritional interventions, oral health care, different pharmacological agents and different types of neurostimulation treatment. Some of the studied interventions also had an impact on other clinical endpoints such as feedings status or pneumonia. Overall, further randomized trials are needed to improve the quality of evidence for the treatment of PSD.
Collapse
Affiliation(s)
- Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany.,Department of Neurology and Neurorehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Emilia Michou
- Department of Speech Language Therapy, School of Health Rehabilitation Sciences, University of Patras, Greece.,Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | | | - Avtar Lal
- Guidelines Methodologist, European Stroke Organisation, Basel, Switzerland
| | - Ethem Murat Arsava
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Pere Clavé
- Centro de Investigación Biomédica en Red de Enfermedades, Hepáticas y Digestivas (CIBERehd), Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
| | - Jörg Glahn
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, University Hospital Ruhr-University Bochum, Germany
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, University of Manchester and the Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Sue Pownall
- Department of Speech & Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences, Phoniatric Unit, Sacco Hospital Milano, University of Milano, Milan, Italy
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, University Hospital Ruhr-University Bochum, Germany
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Eric Verin
- Department of Physical and Rehabilitation Medicine, Rouen University Hospital, Rouen, France
| |
Collapse
|
21
|
Metaplasticity in the human swallowing system: clinical implications for dysphagia rehabilitation. Neurol Sci 2021; 43:199-209. [PMID: 34654983 PMCID: PMC8724108 DOI: 10.1007/s10072-021-05654-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
Dysphagia is a common and devastating complication following brain damage. Over the last 2 decades, dysphagia treatments have shifted from compensatory to rehabilitative strategies that facilitate neuroplasticity, which is the reorganization of neural networks that is essential for functional recovery. Moreover, there is growing interest in the application of cortical and peripheral neurostimulation to promote such neuroplasticity. Despite some preliminary positive findings, the variability in responsiveness toward these treatments remains substantial. The purpose of this review is to summarize findings on the effects of neurostimulation in promoting neuroplasticity for dysphagia rehabilitation and highlight the need to develop more effective treatment strategies. We then discuss the role of metaplasticity, a homeostatic mechanism of the brain to regulate plasticity changes, in helping to drive neurorehabilitation. Finally, a hypothesis on how metaplasticity could be applied in dysphagia rehabilitation to enhance treatment outcomes is proposed.
Collapse
|
22
|
Cheng I, Hamdy S. Current perspectives on the benefits, risks, and limitations of noninvasive brain stimulation (NIBS) for post-stroke dysphagia. Expert Rev Neurother 2021; 21:1135-1146. [PMID: 34530656 DOI: 10.1080/14737175.2021.1974841] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Studies have shown that noninvasive brain stimulation (NIBS), including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), can promote neuroplasticity, which is considered important for functional recovery of swallowing after stroke. Despite extensive studies on NIBS, there remains a gap between research and clinical practice. AREAS COVERED In this article, we update the current knowledge on the benefits and challenges of rTMS and tDCS for post-stroke dysphagia. We identify some key limitations of these techniques that hinder the translation from clinical trials to routine practice. Finally, we discuss the future of NIBS as a treatment for post-stroke dysphagia in real-world settings. EXPERT OPINION Current evidence suggests that rTMS and tDCS show promise as a treatment for post-stroke dysphagia. However, these techniques are limited by the response variability, uncertainty on the safety in patients with comorbidities and difficulties in clinical study designs. Such limitations call for further work to enhance their utility through individualized approaches. Despite this, the last decade has seen a growing acceptance toward these techniques among clinical personnel. As such, we advocate caution but support optimism that NIBS will gradually be recognized as a mainstream treatment approach for post-stroke dysphagia in the future.
Collapse
Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
23
|
Effects of Pharyngeal Electrical Stimulation on Swallow Timings, Clearance and Safety in Post-Stroke Dysphagia: Analysis from the Swallowing Treatment Using Electrical Pharyngeal Stimulation (STEPS) Trial. Stroke Res Treat 2021; 2021:5520657. [PMID: 34211688 PMCID: PMC8205591 DOI: 10.1155/2021/5520657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 01/25/2023] Open
Abstract
Swallowing impairment (dysphagia) post-stroke results in poorer outcomes. Pharyngeal electrical stimulation (PES) is a potential treatment for post-stroke dysphagia. In a post hoc analysis, we investigated PES using videofluoroscopy swallow studies (VFSS) from the STEPS trial incorporating multiple measures of safety (penetration aspiration scale-PAS), speed and duration (timing), and efficiency (clearance), as opposed to the original trial which only measured PAS scores. 81 randomised participants (PES (N = 43) versus sham (N = 38)) were analysed at baseline and 2 weeks. Participants swallowed up to 6 × 5 ml and 1 × 50 ml of thin liquid barium at 40% w/v, images at ≥25 fps. Based on PAS, the 5 ml mode bolus (most frequently occurring PAS from 6 × 5 ml) and the worst 50 ml bolus were chosen for further analysis. Eight timing measures were performed, including stage transition duration (STD) and pharyngeal transit time (PTT). Clearance measures comprised oral and pharyngeal residue and swallows to clear. Comparisons of change of scoring outcomes between PES and sham were done at 2 weeks. Wilcoxon Signed Ranks Test was also used to evaluate longitudinal changes from both groups' combined results at two weeks. Between-group analysis showed no statistically significant differences. Issues with suboptimal image quality and frame rate acquisition affected final numbers. At two weeks, both groups demonstrated a significant improvement in most safety scores (PAS) and STD, possibly due to spontaneous recovery or a combination of spontaneous recovery and swallowing treatment and usual care. A nonsignificant trend for improvement was seen in other timing measures, including PTT. This study, which conducted additional measurements of kinematic and residue analysis on the STEPS data did not detect “missed” improvements in swallowing function that the PAS is not designed to measure. However, more studies with greater numbers are required.
Collapse
|
24
|
Zhong L, Rao J, Wang J, Li F, Peng Y, Liu H, Zhang Y, Wang P. Repetitive Transcranial Magnetic Stimulation at Different Sites for Dysphagia After Stroke: A Randomized, Observer-Blind Clinical Trial. Front Neurol 2021; 12:625683. [PMID: 34122294 PMCID: PMC8187758 DOI: 10.3389/fneur.2021.625683] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background: The clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) protocols on patients with poststroke dysphagia is still unclear. Objective: This trial aimed to explore and analyze the effectiveness of 5 Hz rTMS on the unaffected hemisphere, affected hemisphere, and cerebellum in stroke patients with dysphagia. Methods: This observer-blind and randomized controlled trial included a total of 147 patients with stroke. Patients were divided into four treatment groups: the unaffected hemispheric group, the affected hemispheric group, the cerebellum group and the control group. Each group received traditional dysphagia treatment 5 days a week for 2 weeks. All recruited patients except for those in the control group underwent 10 consecutive rTMS sessions for 2 weeks. For the affected hemispheric group and unaffected hemispheric group, 5 Hz rTMS was applied to the affected mylohyoid cortical region or to the unaffected mylohyoid cortical region. For the cerebellum group, 5 Hz rTMS was applied to the mylohyoid cortical representation of the cerebellum (4.3 cm lateral and 2.4 cm below the inion). The Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), Penetration/Aspiration Scale (PAS), Gugging Swallowing Screen (GUSS), and Standardized Swallowing Assessment (SSA) were used to evaluate clinical swallowing function before the intervention (baseline), immediately after the intervention and 2 weeks after the intervention. Results: There were significant time and intervention interaction effects on the FEDSS, PAS, SSA, and GUSS scores (p < 0.05). In a direct comparison of the swallowing parameters of the four groups, the changes in FEDSS, PAS, SSA, and GUSS scores showed a significantly greater improvement in the unaffected hemispheric group, the affected hemispheric group and cerebellum group than in the control group (p < 0.05). Conclusions: Whether stimulating the unaffected hemisphere or the affected hemisphere, 5 Hz high-frequency rTMS on mylohyoid cortical tissue might have a positive effect on poststroke patients with dysphagia. In addition, cerebellar rTMS is a safe method that represents a potential treatment for poststroke dysphagia, and more clinical trials are needed to develop this technique further. Clinical Trial Registration:chictr.org.cn, identifier: ChiCTR2000032255.
Collapse
Affiliation(s)
- Lida Zhong
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Jinzhu Rao
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Jing Wang
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Fang Li
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Yang Peng
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Huiyu Liu
- Department of Rehabilitation Medicine, Yue Bei People's Hospital, Shaoguan, China
| | - Yan Zhang
- School of Educational Science, Huazhong University of Science and Technology, Wuhan, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, China
| |
Collapse
|
25
|
Zhang Q, Wu S. Effects of Synchronized Neuromuscular Electrical Stimulation (NMES) on the Submental Muscles During Ingestion of a Specified Volume of Soft Food in Patients with Mild-to-Moderate Dysphagia Following Stroke. Med Sci Monit 2021; 27:e928988. [PMID: 33780432 PMCID: PMC8018178 DOI: 10.12659/msm.928988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Neuromuscular electrical stimulation (NMES) is a method for producing regular contractions of muscles that have been paralyzed. This study aimed to evaluate the effects of synchronized NMES on the submental muscles during ingestion of a specified volume of soft food in patients with mild-to-moderate dysphagia following stroke. Material/Methods Eighty-three patients with mild-to-moderate dysphagia following stroke were enrolled and randomly divided into 3 groups: conventional training (CT) (n=28), eating training (ET) (n=28), and intensive swallowing training (IST) (n=27). The CT group received conventional swallow training, the ET group was given additional individual feedings with a specified volume of soft food, and the IST group received intensive swallowing training with synchronized NEMS. All of the patients were evaluated before and after the treatment with a modified barium swallow, and the Dysphagia Outcome and Severity Scale (DOSS); the numbers of patients with Stroke-Associated Pneumonia (SAP) and wet voice also were assessed. Results After 6 weeks, DOSS scores improved in patients in all 3 groups, and there were significant differences among the groups in their scores (P<0.001 for both measures). In the CT and ET groups, there was a statistically significant difference in the number of patients with SAP before and after treatment (P=0.010 and P<0.001, respectively). There also were fewer cases in the IST group than in the CT (P=0.042) and ET groups (P=0.011). After completion of treatment, compared with the first treatment, there were significantly fewer patients with wet voices in the CT (P<0.001) and IST groups (P<0.001). Conclusions Feeding a specified volume of soft food plus synchronized NMES of the submental muscles can improve the swallowing function of patients with mild-to-moderate dysphagia following stroke and it reduces their risk of food aspiration.
Collapse
Affiliation(s)
- Qian Zhang
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China (mainland).,Guizhou Medical University, Guiyang, Guizhou, China (mainland)
| | - Shuang Wu
- Department of Rehabilitation, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China (mainland).,Guizhou Medical University, Guiyang, Guizhou, China (mainland)
| |
Collapse
|
26
|
Cheng I, Sasegbon A, Hamdy S. Effects of Neurostimulation on Poststroke Dysphagia: A Synthesis of Current Evidence From Randomized Controlled Trials. Neuromodulation 2020; 24:1388-1401. [PMID: 33301231 PMCID: PMC9292042 DOI: 10.1111/ner.13327] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/27/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate the effects of neurostimulation, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS) and pharyngeal electrical stimulation (PES), for poststroke dysphagia based on evidence from randomized controlled trials (RCTs). Materials and Methods Electronic databases were systematically searched between January 1985 and June 2020 and studies were included based on prespecified selection criteria. The quality of studies was evaluated and data were extracted and synthesized by two independent reviewers. The primary outcome measure was change in (any) relevant clinical swallowing‐related characteristic. Subgroup analysis were conducted based on follow‐up period and stimulation parameters. Results Data from 852 stroke patients were collected from 26 RCTs studies. Active neurostimulation treatments demonstrated a significant and moderate effect size compared to control treatment (0.69 [95% CI = 0.50, 0.89]; p < 0.001). The effect size of rTMS was the largest (0.73 [95% CI = 0.49, 0.98]; p < 0.001), followed by PES (0.68 [95% CI = 0.22, 1.14]; p = 0.004) and tDCS (0.65 [95% CI = 0.25, 1.04]; p = 0.001). All treatments showed comparable effect sizes within the first two weeks. Between three weeks and two months, tDCS demonstrated the largest effects (1.02 [95% CI = 0.45, 1.59]; p < 0.001) among the three treatments. No significant treatment effects were reported beyond three months. The combined effect size was large when applied in acute (<14 days) stroke (0.8 [95% CI = 0.34, 1.26]; p < 0.001). For noninvasive brain stimulation (NIBS), bihemispheric stimulation demonstrated the strongest effect size (0.93 [95% CI = 0.53, 1.33]; p < 0.001). In contrast, unilateral rTMS using ipsilesional high‐frequency stimulation had a combined effect size of 0.83 (95% CI = 0.14, 1.52; p = 0.02). For tDCS, a significant effect size was found only with anodal stimulation applied over the contralesional hemisphere (1.04 [95% CI = 0.54, 1.53]; p < 0.001). Conclusions The results show that neurostimulation can benefit patients with poststroke dysphagia. The treatment effects were the strongest in acute stroke patients and within the first two months of application. For NIBS, bihemispheric stimulation appeared to be most effective. The most beneficial hemisphere for unilateral stimulation differed between rTMS and tDCS. These findings provide a platform for future studies and clinical practice.
Collapse
Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester Manchester UK
| | - Ayodele Sasegbon
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester Manchester UK
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester Manchester UK
| |
Collapse
|
27
|
Cabib C, Nascimento W, Rofes L, Arreola V, Tomsen N, Mundet L, Palomeras E, Michou E, Clavé P, Ortega O. Short-term neurophysiological effects of sensory pathway neurorehabilitation strategies on chronic poststroke oropharyngeal dysphagia. Neurogastroenterol Motil 2020; 32:e13887. [PMID: 32449296 DOI: 10.1111/nmo.13887] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neurorehabilitation strategies for chronic poststroke (PS) oropharyngeal dysphagia (OD) have been mainly focused on the neurostimulation of the pharyngeal motor cortex with only marginal effects. In contrast, treatments targeting the PS oropharyngeal sensory pathway dysfunction offer very promising results, but there is little knowledge on the underlying mechanisms. We aimed to explore the neurophysiological mechanisms behind the effect of three sensory neurostimulation strategies. METHODS We carried out a randomized two-blinded parallel group's crossover sham-controlled clinical trial in 36 patients with unilateral stroke and chronic unsafe swallow to investigate the effect of repetitive transcranial magnetic stimulation (rTMS) of the primary sensory cortex (A), oral capsaicin (B) and intra-pharyngeal electrical stimulation (IPES; C). The effect was evaluated immediately after the interventions with videofluoroscopy (VFS) and motor/sensory evoked potentials (MEP/SEP). KEY RESULTS Interventions induced no changes in the biomechanics of the swallow response during VFS. However, an enhancement of motor cortex excitability (latency shortening and increased size of thenar MEP) was found with active interventions (A + B + C, and B/C alone; P < .05 for all) but not with sham. Active but not sham interventions shortened pharyngeal SEP latency in the ipsilesional hemisphere (A + B + C: P2-peak, P = .039; A: N2-peak, P = .034) and antagonized the physiological habituation in pharyngeal MEP (A + B + C and A alone, P < .05 for both). CONCLUSIONS AND INFERENCES Sensory pathway neurostimulation strategies caused immediate enhancement of motor cortex excitability with peripheral strategies (capsaicin and IPES) and of pharyngeal sensory conduction with rTMS. These changes support the use of sensory neurorehabilitation strategies in promoting swallow recovery in chronic PS-OD.
Collapse
Affiliation(s)
- Christopher Cabib
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Weslania Nascimento
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Viridiana Arreola
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Lluis Mundet
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Ernest Palomeras
- Neurology Department, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain
| | - Emilia Michou
- Technological Educational Institute Western Greece, Patras, Greece
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró (Universitat Autónoma de Barcelona), Mataró, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
28
|
Hossain MZ, Ando H, Unno S, Kitagawa J. Targeting Chemosensory Ion Channels in Peripheral Swallowing-Related Regions for the Management of Oropharyngeal Dysphagia. Int J Mol Sci 2020; 21:E6214. [PMID: 32867366 PMCID: PMC7503421 DOI: 10.3390/ijms21176214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022] Open
Abstract
Oropharyngeal dysphagia, or difficulty in swallowing, is a major health problem that can lead to serious complications, such as pulmonary aspiration, malnutrition, dehydration, and pneumonia. The current clinical management of oropharyngeal dysphagia mainly focuses on compensatory strategies and swallowing exercises/maneuvers; however, studies have suggested their limited effectiveness for recovering swallowing physiology and for promoting neuroplasticity in swallowing-related neuronal networks. Several new and innovative strategies based on neurostimulation in peripheral and cortical swallowing-related regions have been investigated, and appear promising for the management of oropharyngeal dysphagia. The peripheral chemical neurostimulation strategy is one of the innovative strategies, and targets chemosensory ion channels expressed in peripheral swallowing-related regions. A considerable number of animal and human studies, including randomized clinical trials in patients with oropharyngeal dysphagia, have reported improvements in the efficacy, safety, and physiology of swallowing using this strategy. There is also evidence that neuroplasticity is promoted in swallowing-related neuronal networks with this strategy. The targeting of chemosensory ion channels in peripheral swallowing-related regions may therefore be a promising pharmacological treatment strategy for the management of oropharyngeal dysphagia. In this review, we focus on this strategy, including its possible neurophysiological and molecular mechanisms.
Collapse
Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Hiroshi Ando
- Department of Biology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Shumpei Unno
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan;
| |
Collapse
|
29
|
Sasegbon A, Cheng I, Zhang M, Hamdy S. Advances in the Use of Neuromodulation for Neurogenic Dysphagia: Mechanisms and Therapeutic Application of Pharyngeal Electrical Stimulation, Transcranial Magnetic Stimulation, and Transcranial Direct Current Stimulation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1044-1064. [PMID: 32650660 DOI: 10.1044/2020_ajslp-19-00073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The swallowing motor system and, specifically, its cortical substrates appear to have certain unique properties that make it highly susceptible to brain plasticity, both driven and following injury. Furthermore, neurogenic dysphagia is a common complication of brain disease, associated with poor outcomes, and yet treatment options remain limited. Therefore, translating the physiology of neurostimulation into clinical populations becomes imperative. In this review, we describe therapeutic application of neuroplasticity in the human swallowing motor system by initially examining the role of pharyngeal electrical stimulation from a mechanistic perspective and then reporting on clinical studies using this approach. Thereafter, we explore the application of noninvasive brain stimulation, which has previously been used to treat nervous system disorders such as depression, pain modulation, and cognitive impairment. Transcranial brain stimulations, in particular, transcranial magnetic stimulation and transcranial direct current stimulation, have been utilized by a number of investigators for rehabilitation in early-stage clinical trials, including dysphagia after neurological disease. In this review, we assess its usefulness in neurogenic dysphagia. Conclusion Early studies indicate these emerging neurostimulatory techniques hold future therapeutic promise. However, both a greater number of and larger clinical trials are required to provide evidence delineating their efficacy and scope of application.
Collapse
Affiliation(s)
- Ayodele Sasegbon
- Faculty of Biology, Medicine, and Health, University of Manchester, Salford, United Kingdom
| | - Ivy Cheng
- Faculty of Biology, Medicine, and Health, University of Manchester, Salford, United Kingdom
| | - Mengqing Zhang
- Faculty of Biology, Medicine, and Health, University of Manchester, Salford, United Kingdom
| | - Shaheen Hamdy
- Faculty of Biology, Medicine, and Health, University of Manchester, Salford, United Kingdom
| |
Collapse
|
30
|
Sasegbon A, Smith CJ, Bath P, Rothwell J, Hamdy S. The effects of unilateral and bilateral cerebellar rTMS on human pharyngeal motor cortical activity and swallowing behavior. Exp Brain Res 2020; 238:1719-1733. [PMID: 32232540 PMCID: PMC7413876 DOI: 10.1007/s00221-020-05787-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
Abstract
The cerebellum is recognised to bilaterally modulate sensorimotor function and has recently been shown to play a role in swallowing. Unilateral cerebellar repetitive trans-cranial magnetic stimulation (rTMS) excites corticobulbar motor pathways to the pharynx but the effects of bilateral versus unilateral cerebellar rTMS on these pathways are unknown. In this three-part cross-over study, healthy participants (n = 13) were randomly allocated to receive unilateral or bilateral 10 Hz cerebellar rTMS. Participants were intubated with pharyngeal electromyography and/or manometry catheters for motor evoked potentials (MEPs) and pressure recordings. In part 1 of the study, single pulse TMS was used to measure baseline motor cortical pharyngeal MEP (PMEP) and hemispheric cerebellar MEP (CMEP) amplitudes, before cerebellar rTMS was administered. Repeat measures of PMEP amplitude were performed at 15-min intervals for an hour post unilateral and bilateral rTMS. Thereafter, in two further studies, a cortical ‘virtual lesion’ (V/L) was applied prior to cerebellar rTMS with pre and post PMEPs (part 2) and measurements of swallowing accuracy (part 3) using a behavioural task. Compared to baseline, unilateral and bilateral cerebellar rTMS provoked increases in pharyngeal cortical excitation (P = 0.028, 0.0005, respectively). Bilateral rTMS was significantly more effective than unilateral in causing cortical excitation (P = 0.0005) and in reversing the suppressive neurological (P = 0.0005) and behavioural (P = 0.0005) effects of a cortical V/L. Our findings suggest bilateral cerebellar rTMS has greater facilitatory effects on corticobulbar motor pathways to the pharynx than unilateral stimulation with the potential to be a more effective clinical therapy if its effects are reproduced in populations with neurogenic dysphagia.
Collapse
Affiliation(s)
- Ayodele Sasegbon
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Clinical Sciences Building, Eccles Old Road, Salford, M6 8HD, UK
| | - Craig J Smith
- Division of Cardiovascular Sciences, Manchester Centre for Clinical Neurosciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Salford Royal Hospital, Manchester Academic Health Sciences Centre (MAHSC), Salford, UK
| | - Philip Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Shaheen Hamdy
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Clinical Sciences Building, Eccles Old Road, Salford, M6 8HD, UK.
| |
Collapse
|
31
|
Enhancing Stroke Recovery Across the Life Span With Noninvasive Neurostimulation. J Clin Neurophysiol 2020; 37:150-163. [DOI: 10.1097/wnp.0000000000000543] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
32
|
Borders JC, Brates D. Use of the Penetration-Aspiration Scale in Dysphagia Research: A Systematic Review. Dysphagia 2019; 35:583-597. [PMID: 31538220 DOI: 10.1007/s00455-019-10064-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/04/2019] [Indexed: 12/12/2022]
Abstract
The penetration-aspiration scale (PAS) is an 8-point scale used to characterize the depth and response to airway invasion during videofluoroscopy. Though widely used in the field of deglutition, there is a lack of consensus regarding the statistical properties of the scale. In order to better understand the state of the literature and the statistical use of the PAS, a systematic review was undertaken to descriptively examine trends in statistical and reporting practices of the PAS since its inception. Online databases were searched for studies citing the original PAS article, which yielded 754 unique articles. Of these, 183 studies were included in the review. Results showed inconsistencies in the statistical use of the scale; 79 studies treated the PAS as ordinal, 71 as categorical, and 49 as interval. Ten types of categorizations were identified. Reporting of power analyses (9%), as well as inter- (26%) and intra-rater (17%) reliability, was uncommon. Among studies that administered multiple bolus volumes or consistencies, 55% reported PAS analyses at the participant/group level only. This review confirms the existence of discrepancies in the statistical treatment of the PAS. A lack of consensus among researchers limits comparisons between studies. The approach to handling this scale dictates the statistical tests used, potentially affecting results and interpretations. Consistent application of statistically sound approaches to PAS analyses is vital for the future of deglutition research.
Collapse
Affiliation(s)
- James C Borders
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA.
| | - Danielle Brates
- Department of Communication Sciences and Disorders, New York University, New York, NY, USA
| |
Collapse
|
33
|
Papadopoulou SL, Ploumis A, Exarchakos G, Theodorou SJ, Beris A, Fotopoulos AD. Versatility of Repetitive Transcranial Magnetic Stimulation in the Treatment of Poststroke Dysphagia. J Neurosci Rural Pract 2019; 9:391-396. [PMID: 30069097 PMCID: PMC6050778 DOI: 10.4103/jnrp.jnrp_68_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Various techniques and courses of treatment have been researched, proposed, and implemented to evaluate and treat poststroke dysphagia (PSD) which is one of the main medical conditions affecting not only elderly people, as previously assumed, but also in recent years younger populations as well. The effectiveness of therapeutic methods depends mainly on the expertise of an interdisciplinary team of therapists, as well as on the timely application of the treatment. The present review discusses the therapeutic benefits of repetitive transcranial magnetic stimulation (rTMS) in patients suffering from PSD regardless of the location of the lesion. The use of rTMS directly manipulates cortical brain stimulation to restore neuroplasticity in the affected brain areas. This review presents a synopsis of the available literature on the patient along with a discussion on the effectiveness of rTMS as a safe and easy to use promising technique in the rehabilitation of dysphagic patients. Although the results from the studies so far have been largely positive in that direction, the question still remains whether larger scale and longitudinal studies will be able to corroborate the aspiring future of rTMS. Therefore, research questions to advance further investigation on the application and future of this technique are much in need.
Collapse
Affiliation(s)
- Soultana L Papadopoulou
- Department of Orthopedic Surgery, University of Ioannina Medical School, University Hospital of Ioannina, Greece
| | - Avraam Ploumis
- Department of Physical Medicine and Rehabilitation, University of Ioannina Medical School, University Hospital of Ioannina, Greece
| | - G Exarchakos
- Department of Otorhinolaryngology, University of Ioannina Medical School, University Hospital of Ioannina, Greece
| | - S J Theodorou
- Department of Radiology, University of Ioannina Medical School, University Hospital of Ioannina, Greece
| | - A Beris
- Department of Orthopedic Surgery, University of Ioannina Medical School, University Hospital of Ioannina, Greece
| | - A D Fotopoulos
- Department of Nuclear Medicine, University of Ioannina Medical School, University Hospital of Ioannina, Greece
| |
Collapse
|
34
|
Raginis-Zborowska A, Cheng I, Pendleton N, Payton A, Ollier W, Michou E, Hamdy S. Genetic influences on the variability of response to repetitive transcranial magnetic stimulation in human pharyngeal motor cortex. Neurogastroenterol Motil 2019; 31:e13612. [PMID: 31033149 DOI: 10.1111/nmo.13612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent studies have reported substantial variability in response to repetitive transcranial magnetic stimulation (rTMS). We hypothesized that an individual's genetic predisposition may contribute to such variability in the pharyngeal motor cortex. This study aimed to investigate the response to 1 and 5 Hz rTMS paradigms on pharyngeal motor cortex in healthy participants and its relationship with genetic predisposition. METHODS Forty-one healthy participants (25.4 ± 4.6 years old) received either or both 1 Hz (n = 39) and 5 Hz rTMS (n = 40) over pharyngeal motor cortex. Pharyngeal and thenar motor-evoked potentials were recorded at baseline and for 1 hour post-rTMS. The participants were then classified according to their response. The associations between rTMS response and gender, time of day of the stimulation, and eight prespecified single nucleotide polymorphisms (SNPs) were analyzed. KEY RESULTS There was no direction-specific response to either paradigm (1 Hz: F[3.69, 129.21] = 0.78, P = 0.56; 5 Hz: F[4.08, 146.85] = 1.38, P = 0.25). Only 13% of participants showed the expected bidirectional response (inhibition for 1 Hz and excitation for 5 Hz). Significant associations were found between response and COMT (1 Hz: P = 0.03) and DRD2 (1 Hz: P = 0.02; 5 Hz: P = 0.04) polymorphisms. Carriers of minor allele G from SNP rs6269 (COMT) were more likely to show inhibitory or excitatory outcomes after 1 Hz rTMS. By contrast, carriers of minor allele A from SNP rs1800497 (DRD2) were more likely to show no response to 1 Hz rTMS and inhibition after 5 Hz rTMS. CONCLUSIONS & INFERENCES Two SNPs from COMT and DRD2 genes may partially explain the response variability to rTMS in the pharyngeal motor system. Further research should focus on stratified approaches for neurostimulatory dysphagia treatment using rTMS.
Collapse
Affiliation(s)
- Alicja Raginis-Zborowska
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Centre for Gastrointestinal Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Ivy Cheng
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Centre for Gastrointestinal Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Antony Payton
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester, UK
| | - William Ollier
- School of Health Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Emilia Michou
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Centre for Gastrointestinal Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK.,Department of Speech and Language Therapy, Western Greece University of Applied Sciences, Patras, Greece
| | - Shaheen Hamdy
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Centre for Gastrointestinal Sciences, School of Medical Sciences, The University of Manchester, Manchester, UK
| |
Collapse
|
35
|
Vasant DH, Sasegbon A, Michou E, Smith C, Hamdy S. Rapid improvement in brain and swallowing behavior induced by cerebellar repetitive transcranial magnetic stimulation in poststroke dysphagia: A single patient case-controlled study. Neurogastroenterol Motil 2019; 31:e13609. [PMID: 31025451 DOI: 10.1111/nmo.13609] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/13/2019] [Accepted: 04/09/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The cerebellum has been showed by numerous studies to be active during the process of swallowing. Cortically targeted repetitive transcranial magnetic stimulation (rTMS) is a technique which has been shown to result in beneficial electrophysiological and behavioral changes in healthy participants and patients with post stroke dysphagia. Cerebellar rTMS is a relatively unstudied area of this emerging field. Here we apply cerebellar targeted rTMS to a patient with post stroke dysphagia in an attempt to improve their swallowing. METHODS A 67-year-old woman with post stroke dysphagia was recruited to undergo a crossover active rTMS vs sham rTMS study. Outcome measures were pharyngeal motor evoked potential (PMEP) amplitude and cumulative penetration-aspiration score (cPAS). The patient attended the laboratory on two occasions. During each attendance, baseline PMEP and cPAS measurements were acquired followed by either active or sham rTMS. Following this, PMEP and cPAS measurements were repeated at 30 minutes. RESULTS Active cerebellar rTMS was able to increase both PMEP amplitude (55% over baseline) and improve swallowing safety (17% below baseline). Sham rTMS did not result in any beneficial PMEP or cPAS changes. CONCLUSION Our results suggest that cerebellar rTMS has plausible therapeutic potential for post stroke dysphagia.
Collapse
Affiliation(s)
- Dipesh H Vasant
- Neurogastroenterology, Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Ayodele Sasegbon
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), University of Manchester, Salford, UK
| | - Emilia Michou
- Department of Speech and Language Therapy, Technological Educational Institute of Western Greece, Patras, Greece
| | - Craig Smith
- Manchester Centre for Clinical Neurosciences, Division of Cardiovascular Sciences, University of Manchester, Salford Royal Hospital, Manchester Academic Health Sciences Centre (MAHSC), Salford, UK
| | - Shaheen Hamdy
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), University of Manchester, Salford, UK
| |
Collapse
|
36
|
Sasegbon A, Watanabe M, Simons A, Michou E, Vasant DH, Magara J, Bath PM, Rothwell J, Inoue M, Hamdy S. Cerebellar repetitive transcranial magnetic stimulation restores pharyngeal brain activity and swallowing behaviour after disruption by a cortical virtual lesion. J Physiol 2019; 597:2533-2546. [PMID: 30907429 PMCID: PMC6487931 DOI: 10.1113/jp277545] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/21/2019] [Indexed: 01/14/2023] Open
Abstract
Key points Despite evidence that the human cerebellum has an important role in swallowing neurophysiology, the effects of cerebellar stimulation on swallowing in the disrupted brain have not been explored. In this study, for the first time, the application of cerebellar neurostimulation is characterized in a human model of disrupted swallowing (using a cortical virtual lesion). It is demonstrated that cerebellar stimulation can reverse the suppressed activity in the cortical swallowing system and restore swallowing function in a challenging behavioural task, suggesting the findings may have important therapeutic implications.
Abstract Repetitive transcranial magnetic stimulation (rTMS) can alter neuronal activity within the brain with therapeutic potential. Low frequency stimulation to the ‘dominant’ cortical swallowing projection induces a ‘virtual‐lesion’ transiently suppressing cortical excitability and disrupting swallowing behaviour. Here, we compared the ability of ipsi‐lesional, contra‐lesional and sham cerebellar rTMS to reverse the effects of a ‘virtual‐lesion’ in health. Two groups of healthy participants (n = 15/group) were intubated with pharyngeal catheters. Baseline pharyngeal motor evoked potentials (PMEPs) and swallowing performance (reaction task) were measured. Participants received 10 min of 1 Hz rTMS to the pharyngeal motor cortex which elicited the largest PMEPs to suppress cortical activity and disrupt swallowing behaviour. Over six visits, participants were randomized to receive 250 pulses of 10 Hz cerebellar rTMS to the ipsi‐lesional side, contra‐lesional side or sham while assessing PMEP amplitude or swallowing performance for an hour afterwards. Compared to sham, active cerebellar rTMS, whether administered ipsi‐lesionally (P = 0.011) or contra‐lesionally (P = 0.005), reversed the inhibitory effects of the cortical ‘virtual‐lesion’ on PMEPs and swallowing accuracy (ipsi‐lesional, P < 0.001, contra‐lesional, P < 0.001). Cerebellar rTMS was able to reverse the disruptive effects of a ‘virtual lesion’. These findings provide evidence for developing cerebellar rTMS into a treatment for post‐stroke dysphagia. Despite evidence that the human cerebellum has an important role in swallowing neurophysiology, the effects of cerebellar stimulation on swallowing in the disrupted brain have not been explored. In this study, for the first time, the application of cerebellar neurostimulation is characterized in a human model of disrupted swallowing (using a cortical virtual lesion). It is demonstrated that cerebellar stimulation can reverse the suppressed activity in the cortical swallowing system and restore swallowing function in a challenging behavioural task, suggesting the findings may have important therapeutic implications.
Collapse
Affiliation(s)
- Ayodele Sasegbon
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Salford, UK
| | - Masahiro Watanabe
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Salford, UK.,Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Andre Simons
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Salford, UK
| | - Emilia Michou
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Salford, UK.,Department of Speech and Language Therapy, Technological Educational Institute of Western Greece, Patras, Greece
| | - Dipesh H Vasant
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Salford, UK.,Manchester University Foundation Trust, Neurogastroenterology, Wythenshawe Hospital, Manchester, UK
| | - Jin Magara
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Philip M Bath
- Stroke, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - John Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Makoto Inoue
- Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shaheen Hamdy
- Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Salford, UK
| |
Collapse
|
37
|
Neurophysiological and Biomechanical Evaluation of the Mechanisms Which Impair Safety of Swallow in Chronic Post-stroke Patients. Transl Stroke Res 2019; 11:16-28. [DOI: 10.1007/s12975-019-00701-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/06/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
|
38
|
Chiang CF, Lin MT, Hsiao MY, Yeh YC, Liang YC, Wang TG. Comparative Efficacy of Noninvasive Neurostimulation Therapies for Acute and Subacute Poststroke Dysphagia: A Systematic Review and Network Meta-analysis. Arch Phys Med Rehabil 2019; 100:739-750.e4. [DOI: 10.1016/j.apmr.2018.09.117] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/29/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
|
39
|
Neurophysiological Adaptation and Neuromodulatory Treatment Approaches in Patients Suffering from Post-stroke Dysphagia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0201-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Zhang C, Zheng X, Lu R, Yun W, Yun H, Zhou X. Repetitive transcranial magnetic stimulation in combination with neuromuscular electrical stimulation for treatment of post-stroke dysphagia. J Int Med Res 2018; 47:662-672. [PMID: 30354918 PMCID: PMC6381516 DOI: 10.1177/0300060518807340] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study was performed to determine whether repetitive transcranial magnetic stimulation (rTMS) combined with neuromuscular electrical stimulation (NMES) effectively ameliorates dysphagia and how rTMS protocols (bilateral vs. unilateral) combined with NMES can be optimized. Methods Sixty-four patients were randomly divided into four groups using a random distribution table: the sham rTMS plus NMES (Sham-rTMS/NMES), ipsilesional 10-Hz rTMS plus NMES (Ipsi-rTMS/NMES), contralesional 1-Hz rTMS plus NMES (Contra-rTMS/NMES), and bilateral rTMS plus NMES (Bi-rTMS/NMES) groups. Cortical excitability as measured by the amplitude of the motor evoked potential at the mylohyoid muscle cortical representative area, swallowing function as measured by the Standardized Swallowing Assessment, and the degree of dysphagia were evaluated at baseline, after the stimulation course, and at the 1-month follow-up. Results Bi-rTMS/NMES produced higher cortical excitability and better swallowing function recovery. Compared with NMES alone, unilateral rTMS plus NMES had additional effects on cortical excitability and rehabilitation of dysphagia, but there were no differences between the Contra-rTMS/NMES and Ipsi-rTMS/NMES groups. No adverse events occurred. Conclusion The combination of rTMS with NMES was superior to NMES alone in improving the recovery of post-stroke dysphagia, and the combination of bilateral rTMS with NMES was more effective than unilateral rTMS combined with NMES.
Collapse
Affiliation(s)
- Chengliang Zhang
- 1 Laboratory of Neurological Diseases, Department of Neurology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Xiuqin Zheng
- 2 Department of Neurology, Changzhou Peace Hospital, 102nd Hospital of PLA, Changzhou, Jiangsu, China
| | - Rulan Lu
- 1 Laboratory of Neurological Diseases, Department of Neurology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Wenwei Yun
- 1 Laboratory of Neurological Diseases, Department of Neurology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Huifang Yun
- 3 Department of Anesthesiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| | - Xianju Zhou
- 1 Laboratory of Neurological Diseases, Department of Neurology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China
| |
Collapse
|
41
|
Effect of Paired Associative Stimulation on Motor Cortex Excitability in Rats. Curr Med Sci 2018; 38:903-909. [PMID: 30341527 DOI: 10.1007/s11596-018-1960-8] [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: 06/07/2018] [Revised: 09/10/2018] [Indexed: 10/28/2022]
Abstract
Paired associative stimulation (PAS), combining transcranial magnetic stimulation (TMS) with electrical peripheral nerve stimulation (PNS) in pairs with an optimal interstimulus interval (ISI) in between, has been shown to influence the excitability of the motor cortex (MC) in humans. However, the underlying mechanisms remain unclear. This study was designed to explore an optimal protocol of PAS, which can modulate the excitability of MC in rats, and to investigate the underlying mechanisms. The resting motor thresholds (RMTs) of TMS-elicited motor evoked potentials (MEPs) recorded from the gastrocnemius muscle and the latency of P1 component of somatosensory evoked potentials (SEPs) induced by electrical tibial nerve stimulation were determined in male Sprague-Dawley rats (n=10). Sixty rats were then randomly divided into 3 groups: a PAS group (further divided into 10 subgroups at various ISIs calculated by using the latency of P1, n=5, respectively), a TMS (only) group (n=5) and a PNS (only) group (n=5). Ninety repetitions of PAS, TMS and PNS were administered to the rats in the 3 groups, respectively, at the frequency of 0.05 Hz and the intensity of TMS at 120% RMT and that of PNS at 6 mA. RMTs and motor evoked potentials' amplitude (MEPamp) were recorded before and immediately after the interventions. It was found that the MEPamp significantly decreased after PAS at ISI of 5 ms (P<0.05), while the MEPamp significantly increased after PAS at ISI of 15 ms, as compared with those before the intervention (P<0.05). However, the RMT did not change significantly after PAS at ISI of 5 ms or 15 ms (P>0.05). PAS at other ISIs as well as the sole use of TMS and PNS induced no remarkable changes in MEPamp and RMT. In conclusion, PAS can influence motor cortex excitability in rats. Neither TMS alone nor PNS alone shows significant effect.
Collapse
|
42
|
Pingue V, Priori A, Malovini A, Pistarini C. Dual Transcranial Direct Current Stimulation for Poststroke Dysphagia: A Randomized Controlled Trial. Neurorehabil Neural Repair 2018; 32:635-644. [PMID: 29926772 DOI: 10.1177/1545968318782743] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poststroke dysphagia is associated with considerable morbidity and has high health care cost implications. OBJECTIVE To evaluate whether anodal transcranial direct current stimulation (tDCS) over the lesioned hemisphere and cathodal tDCS to the contralateral one during the early stage of rehabilitation can improve poststroke dysphagia. METHODS A total of 40 patients referred to our neurorehabilitation department were randomized to receive anodal tDCS over the damaged hemisphere plus cathodal stimulation over the contralateral one versus sham stimulation during swallowing maneuvers over the course of 10 sessions of treatment. Swallowing function was evaluated before and after stimulation using the Dysphagia Outcome and Severity Scale (DOSS). RESULTS The percentage of patients who reached various thresholds of improvement was higher in the tDCS group than in the sham group, but the differences were not significant (eg, DOSS score ≥ 20% increase from baseline: 55% in the tDCS group vs 40% in the sham group; P = .53). Among all variables recorded at baseline, only a subgroup of patients without nasogastric tube showed a significantly higher improvement with tDCS treatment versus sham (DOSS score ≥10% and ≥20% from baseline: 64.29% vs 0%, P = .01). CONCLUSIONS In patients with poststroke dysphagia, treatment with dual tDCS in the early phase of rehabilitation does not significantly increase the probability of recovery compared with sham stimulation.
Collapse
Affiliation(s)
| | - Alberto Priori
- 2 "Aldo Ravelli" Center for Neurotechnology & Experimental Brain Therapeutics, University of Milan, Department of Health Sciences, ASST Santi Paolo e Carlo, Milan, Italy
| | | | | |
Collapse
|
43
|
Direct and Indirect Therapy: Neurostimulation for the Treatment of Dysphagia After Stroke. Dysphagia 2018. [DOI: 10.1007/174_2017_147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
44
|
Lin WS, Chou CL, Chang MH, Chung YM, Lin FG, Tsai PY. Vagus nerve magnetic modulation facilitates dysphagia recovery in patients with stroke involving the brainstem - A proof of concept study. Brain Stimul 2017; 11:264-270. [PMID: 29162502 DOI: 10.1016/j.brs.2017.10.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND & AIMS Stroke involving the brainstem (SBS) causes severe oropharyngeal dysphagia (OD). Research on the therapeutic efficacy of vagus nerve modulation (VNM) by using repetitive transcranial magnetic stimulation (rTMS) in SBS patients with OD has been limited thus far. We aimed to assess the effect of VNM by using rTMS in improving swallowing function after SBS. METHOD We conducted a sham-controlled, double-blinded, parallel pilot study in 28 SBS patients with OD randomly allocated to a real rTMS group (n = 13; TMSreal) or a sham group (n = 15; TMSsham). For VNM, 5-Hz rTMS was applied to the left mastoid in 10 sessions. We evaluated all patients for swallowing function before and after rTMS conditioning, assessed on the 8-point Penetration-Aspiration Scale (PAS) through videofluoroscopy and the Australian Therapy Outcome Measures-Swallowing scale (AusTOMs). We measured the amplitude and latency of cricopharyngeal motor evoked potentials (CP-MEPs) as the neurophysiological parameters. RESULTS TMSreal exhibited significant improvement in all swallowing outcomes-neurophysiological, radiological, and functional-compared with TMSsham: We noted higher CP-MEP amplitude (p = 0.004), shorter CP-MEP latency (p = 0.004), a lower PAS score (p = 0.001), and a higher AusTOMs score (p < 0.001) following rTMS in TMSreal. Moreover, the neurophysiological improvements were significantly correlated with the functional outcomes (p < 0.05). CONCLUSIONS Our results encourage the application of VNM by using rTMS for improving swallowing function after SBS. The immediate therapeutic effects suggest that this novel intervention can be an effective complementary therapy to traditional oropharyngeal rehabilitation. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02893033.
Collapse
Affiliation(s)
- Wang-Sheng Lin
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Miao-Hsiang Chang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Mei Chung
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fu-Gong Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Po-Yi Tsai
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
| |
Collapse
|
45
|
Suppa A, Quartarone A, Siebner H, Chen R, Di Lazzaro V, Del Giudice P, Paulus W, Rothwell J, Ziemann U, Classen J. The associative brain at work: Evidence from paired associative stimulation studies in humans. Clin Neurophysiol 2017; 128:2140-2164. [DOI: 10.1016/j.clinph.2017.08.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/20/2017] [Accepted: 08/03/2017] [Indexed: 12/25/2022]
|
46
|
Wei X, Yu F, Dai M, Xie C, Wan G, Wang Y, Dou Z. Change in Excitability of Cortical Projection After Modified Catheter Balloon Dilatation Therapy in Brainstem Stroke Patients with Dysphagia: A Prospective Controlled Study. Dysphagia 2017; 32:645-656. [PMID: 28550485 PMCID: PMC5608794 DOI: 10.1007/s00455-017-9810-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 05/11/2017] [Indexed: 12/30/2022]
Abstract
Although the modified balloon dilatation therapy has been demonstrated to improve pharyngeal swallowing function post stroke, the underlying neural mechanisms of improvement are unknown. Our aims are (1) to investigate the effect of modified balloon dilatation on the excitability of corticobulbar projections to the submental muscle in dysphagic patients with brainstem stroke and (2) the relation between changes in excitability and pharyngeal kinematic modifications. Thirty patients with upper esophageal sphincter (UES) dysfunction due to unilateral brainstem stroke were recruited into two groups. The patients in dilatation group received modified balloon dilatation and conventional therapies, and those in control were only treated by conventional therapies (twice per day). The amplitudes of bilateral submental motor evoked potentials (MEPs) induced by transcranial magnetic stimulations over bilateral motor cortex, diameters of UES opening (UOD) and maximal displacement of hyoid (HD) were all assessed at baseline and the endpoint of treatments. Repeated ANOVA analysis revealed significant main effect of group, time and MEP laterality on MEP amplitudes (p = 0.02). There were no differences in the pretreatment measures between groups (all p > 0.05). After treatment, the amplitudes of affected submental MEP evoked by ipsilateral cortical pulse as well as UOD and HD were significantly different in dilatation group compared to control (amplitude: p = 0.02, UOD: p < 0.001, HD: p = 0.03). The differences of pre- and post-treatment amplitudes of the affected MEP evoked by ipsilateral stimulation showed a positive correlation with the improvement of HD (dilatation: R 2 = 0.51, p = 0.03; control: R 2 = 0.39, p = 0.01), rather than UOD in both groups (all p > 0.05). In conclusion, modified balloon dilatation therapy can increase the excitability of affected projection in patients with unilateral brainstem stroke.
Collapse
Affiliation(s)
- Xiaomei Wei
- 0000 0001 2360 039Xgrid.12981.33Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630 Guangdong China
| | - Fan Yu
- 0000 0001 2360 039Xgrid.12981.33Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630 Guangdong China
- 0000 0004 1760 4628grid.412478.cDepartment of Rehabilitation Medicine, Shanghai General Hospital, No. 100 Haining Road, Hongkou District, Shanghai, 200080 China
| | - Meng Dai
- 0000 0001 2360 039Xgrid.12981.33Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630 Guangdong China
| | - Chunqing Xie
- 0000 0001 2360 039Xgrid.12981.33Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630 Guangdong China
| | - Guifang Wan
- 0000 0001 2360 039Xgrid.12981.33Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630 Guangdong China
| | - Yujue Wang
- 0000 0001 2360 039Xgrid.12981.33Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630 Guangdong China
| | - Zulin Dou
- 0000 0001 2360 039Xgrid.12981.33Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630 Guangdong China
| |
Collapse
|
47
|
Essa H, Vasant DH, Raginis-Zborowska A, Payton A, Michou E, Hamdy S. The BDNF polymorphism Val66Met may be predictive of swallowing improvement post pharyngeal electrical stimulation in dysphagic stroke patients. Neurogastroenterol Motil 2017; 29. [PMID: 28317287 DOI: 10.1111/nmo.13062] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 02/14/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to explore the effect of brain-derived neurotrophic factor (BDNF) polymorphism rs6265 (Val66Met) in both "natural" and treatment induced recovery of swallowing after dysphagic stroke. METHODS Sixteen dysphagic stroke patients that completed a single-blind randomized sham controlled trial of pharyngeal electrical stimulation (PES) within 6 weeks of their stroke (N=38), were genotyped for the BDNF SNP Val66Met (rs6265) from saliva samples. These patients received active or sham PES according to randomized allocation. PES was delivered at a set frequency (5 Hz), intensity (75% of maximal tolerated), and duration (10 minutes) once a day for three consecutive days. Clinical measurements were taken from patients at baseline, 2 weeks and 3 months post entering the study. Changes in swallowing ability based on the dysphagia severity rating scale (DSRS) were compared between active and sham groups and associated with BDNF SNP status. KEY RESULTS In the active stimulation group, patients with the Met BDNF allele demonstrated significantly greater improvements in DSRS at 3 months compared to patients homozygous for the Val allele (P=.009). By comparison, there were no significant associations at the 2 week stage in either the active or sham group, or at 3 month in the sham group. Functional scores including the Barthel Index and modified Rankin scale were also unaffected by BDNF status. CONCLUSIONS & INFERENCES Our findings suggest an association between BDNF and stimulation induced swallowing recovery. Further work will be required to validate these observations and demonstrate clinical utility in patients.
Collapse
Affiliation(s)
- H Essa
- University of Manchester, Division of Diabetes, Endocrinology and Gastroenterology, Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - D H Vasant
- University of Manchester, Division of Diabetes, Endocrinology and Gastroenterology, Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - A Raginis-Zborowska
- University of Manchester, Division of Diabetes, Endocrinology and Gastroenterology, Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - A Payton
- University of Manchester, Division of Diabetes, Endocrinology and Gastroenterology, Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,School of Health Sciences, Division of Human Communication, Development & Hearing, The University of Manchester, Manchester, UK
| | - E Michou
- University of Manchester, Division of Diabetes, Endocrinology and Gastroenterology, Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - S Hamdy
- University of Manchester, Division of Diabetes, Endocrinology and Gastroenterology, Gastrointestinal Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| |
Collapse
|
48
|
Pontes ÉS, Amaral AKDFJD, Rêgo FLCD, Azevedo EHM, Silva POC. Quality of life in swallowing of the elderly patients affected by stroke. ARQUIVOS DE GASTROENTEROLOGIA 2017; 54:27-32. [PMID: 28079235 DOI: 10.1590/s0004-2803.2017v54n1-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/12/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND - The elderly population faces many difficulties as a result of the aging process. Conceptualize and evaluate their life quality is a challenge, being hard to characterize the impact on daily activities and on functional capacity. The stroke is one of the most disabling neurological diseases, becoming a public health problem. As an aggravating result, there is dysphagia, a disorder that compromises the progression of the food from the mouth to the stomach, causing clinical complications to the individual. OBJECTIVE - Characterize the life quality of the elderly swallowing affected by stroke. METHODS - Cross-sectional study conducted at the University Hospital, attended by 35 elderly with stroke, being 19 women and 16 men, with age between 60 and 90 years old, that self-reported satisfactory overall clinical picture. It was applied the Quality of Life Swallowing protocol. The data were statistically analyzed, by means of ANOVA tests, Spearman correlation, t test, with significance level of 5%. RESULTS - The mean age was 69.5 years; as for the scores obtained by the 35 participants in the 11 domains of the protocol, it was observed a change in score indicating severe to moderate impact in quality of life related to self-reported swallowing (31.8% to 59.5%); the domain that most interfered was the feeding time (31.8%). CONCLUSION - Elderly affected by stroke that present dysphagia has low scores in quality of life related to swallowing.
Collapse
|
49
|
Application of noninvasive brain stimulation for post-stroke dysphagia rehabilitation. Kaohsiung J Med Sci 2017; 33:55-61. [DOI: 10.1016/j.kjms.2016.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/20/2016] [Accepted: 11/09/2016] [Indexed: 11/15/2022] Open
|
50
|
Animal Models for Dysphagia Studies: What Have We Learnt So Far. Dysphagia 2017; 32:73-77. [PMID: 28132098 DOI: 10.1007/s00455-016-9778-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/30/2016] [Indexed: 10/20/2022]
Abstract
Research using animal models has contributed significantly to realizing the goal of understanding dysfunction and improving the care of patients who suffer from dysphagia. But why should other researchers and the clinicians who see patients day in and day out care about this work? Results from studies of animal models have the potential to change and grow how we think about dysphagia research and practice in general, well beyond applying specific results to human studies. Animal research provides two key contributions to our understanding of dysphagia. The first is a more complete characterization of the physiology of both normal and pathological swallow than is possible in human subjects. The second is suggesting of specific, physiological, targets for development and testing of treatment interventions to improve dysphagia outcomes.
Collapse
|