School of Translational Medicine-Gastrointestinal Sciences, Salford Royal Hospital, University of Manchester (Manchester Academic Health Sciences Centre), Salford, England.
Gastroenterology. 2010 May;138(5):1737-46. doi: 10.1053/j.gastro.2010.01.052. Epub 2010 Feb 2.
BACKGROUND & AIMS: Oropharyngeal dysphagia is an important disability that occurs after stroke; it contributes to aspiration pneumonia and death, and current modalities for rehabilitation of dysphagia have uncertain efficacy. We therefore examined the role of pharyngeal electrical stimulation (PES) in expediting human swallowing recovery after experimental (virtual) and actual (stroke) brain lesions.
First, healthy subjects (n = 13) were given 1-Hz repetitive transcranial magnetic stimulation to induce a unilateral virtual lesion in pharyngeal motor cortex followed by active or sham (control) PES. Motor-evoked potentials and swallow accuracy were recorded before and after the lesion to assess PES response. Thereafter, 50 acute dysphagic stroke patients underwent either a dose-response study, to determine optimal parameters for PES (n = 22), or were assigned randomly to groups given either active or sham (control) PES (n = 28). The primary end point was the reduction of airway aspiration at 2 weeks postintervention.
In contrast to sham PES, active PES reversed the cortical suppression induced by the virtual lesion (F(7,70) = 2.7; P = .015) and was associated with improvement in swallowing behavior (F(3,42) = 5; P = .02). After stroke, 1 PES treatment each day (U = 8.0; P = .043) for 3 days (U = 10.0) produced improved airway protection compared with controls (P = .038). Active PES also reduced aspiration (U = 54.0; P = .049), improved feeding status (U = 58.0; P = .040), and resulted in a shorter time to hospital discharge (Mantel-Cox log-rank test, P = 0.038).
This pilot study of PES confirms that it is a safe neurostimulation intervention that reverses swallowing disability after virtual lesion or stroke.
口咽吞咽障碍是中风后发生的一种重要残疾；它可导致吸入性肺炎和死亡，目前用于吞咽障碍康复的方法疗效不确定。因此，我们研究了电刺激咽部（PES）在加速实验性（虚拟）和实际（中风）脑损伤后人类吞咽恢复的作用。
首先，健康受试者（n=13）接受 1Hz 重复经颅磁刺激以诱导咽运动皮质单侧虚拟损伤，随后进行主动或假（对照）PES。在损伤前后记录运动诱发电位和吞咽准确性，以评估 PES 反应。此后，50 例急性吞咽障碍中风患者进行剂量反应研究，以确定 PES 的最佳参数（n=22），或随机分为接受主动或假（对照）PES 治疗的组（n=28）。主要终点是干预后 2 周时气道吸入的减少。
与假 PES 相比，主动 PES 逆转了虚拟损伤引起的皮质抑制（F（7,70）=2.7；P=0.015），并与吞咽行为改善相关（F（3,42）=5；P=0.02）。中风后，每天接受 1 次 PES 治疗（U=8.0；P=0.043），连续 3 天（U=10.0），与对照组相比，气道保护得到改善（P=0.038）。主动 PES 还减少了吸入（U=54.0；P=0.049），改善了喂养状况（U=58.0；P=0.040），并缩短了住院时间（Mantel-Cox 对数秩检验，P=0.038）。
这项 PES 的初步研究证实，它是一种安全的神经刺激干预措施，可逆转虚拟损伤或中风后的吞咽障碍。
