Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Palmer 127 Boston, MA 02215, USA.
Stroke. 2011 Apr;42(4):1035-40. doi: 10.1161/STROKEAHA.110.602128. Epub 2011 Mar 24.
Treatment options for stroke-related dysphagia are currently limited. In this study, we investigated whether noninvasive brain stimulation in combination with swallowing maneuvers facilitates swallowing recovery in dysphagic stroke patients during early stroke convalescence.
Fourteen patients with subacute unilateral hemispheric infarction were randomized to anodal transcranial direct current stimulation (tDCS) versus sham stimulation to the sensorimotor cortical representation of swallowing in the unaffected hemisphere over the course of 5 consecutive days with concurrent standardized swallowing maneuvers. Severity of dysphagia was measured using a validated swallowing scale, Dysphagia Outcome and Severity scale, before the first and after the last session of tDCS or sham. The effect of tDCS was analyzed in a multivariate linear regression model using changes in Dysphagia Outcome and Severity Scale as the outcome variable after adjusting for the effects of other potential confounding variables such as the National Institutes of Health Stroke Scale and Dysphagia Outcome and Severity scale scores at baseline, acute ischemic lesion volumes, patient age, and time from stroke onset to stimulation.
Patients who received anodal tDCS gained 2.60 points of improvement in Dysphagia Outcome and Severity scale scores compared to patients in the sham stimulation group who showed an improvement of 1.25 points (P=0.019) after controlling for the effects of other aforementioned variables. Six out 7 (86%) patients in tDCS stimulation group gained at least 2 points of improvement compared with 3 out 7 (43%) patients in the sham group (P=0.107).
Because brain stem swallowing centers have bilateral cortical innervations, measures that enhance cortical input and sensorimotor control of brain stem swallowing may be beneficial for dysphagia recovery.
目前，针对与中风相关的吞咽困难的治疗选择有限。本研究旨在探究在中风后早期康复期间，联合吞咽训练的无创性脑刺激是否能促进吞咽功能恢复。
14 例亚急性单侧大脑半球梗死患者随机分为经颅直流电刺激（tDCS）组和假刺激组，在 5 天内每天进行双侧感觉运动皮质吞咽区的经颅直流电刺激（tDCS），同时进行标准化吞咽训练。在 tDCS 或假刺激的第 1 次和最后 1 次治疗前和后，使用经过验证的吞咽量表——吞咽障碍结局和严重程度量表（Dysphagia Outcome and Severity Scale）评估吞咽困难的严重程度。在调整其他潜在混杂变量（如美国国立卫生研究院中风量表和基线时的吞咽障碍结局和严重程度量表评分、急性缺血性病变体积、患者年龄和中风发病至刺激时间）的影响后，采用多元线性回归模型分析 tDCS 的效果，将 Dysphagia Outcome and Severity Scale 的变化作为结果变量。
与假刺激组相比，接受阳极 tDCS 的患者吞咽障碍结局和严重程度量表评分改善了 2.60 分，而假刺激组仅改善了 1.25 分（P=0.019）。在调整其他上述变量的影响后，tDCS 刺激组的 6 名患者中有 7 名（86%）至少改善了 2 分，而假刺激组的 7 名患者中有 3 名（43%）（P=0.107）。
由于脑干吞咽中枢具有双侧皮质神经支配，因此增强皮质输入和脑干吞咽的感觉运动控制的措施可能有益于吞咽功能的恢复。
