1 IRCCS ICS Maugeri, Pavia, Italy.
2 "Aldo Ravelli" Center for Neurotechnology & Experimental Brain Therapeutics, University of Milan, Department of Health Sciences, ASST Santi Paolo e Carlo, Milan, Italy.
Neurorehabil Neural Repair. 2018 Jun;32(6-7):635-644. doi: 10.1177/1545968318782743. Epub 2018 Jun 21.
Poststroke dysphagia is associated with considerable morbidity and has high health care cost implications.
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.
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).
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).
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.
脑卒中后吞咽障碍与较高的发病率相关，且对医疗保健成本有较大影响。
评估卒中后早期康复阶段对病灶侧施以阳极经颅直流电刺激（tDCS），对健侧施以阴极 tDCS 是否能改善卒中后吞咽障碍。
共 40 例患者被随机分配至接受治疗组（阳极 tDCS 联合阴极 tDCS）或假刺激组（ sham 刺激），在 10 次治疗过程中进行吞咽运动。在刺激前后使用吞咽障碍结局和严重程度量表（DOSS）评估吞咽功能。
tDCS 组达到不同改善阈值的患者比例高于 sham 组，但差异无统计学意义（例如，DOSS 评分较基线增加≥20%：tDCS 组 55%， sham 组 40%；P =.53）。在基线记录的所有变量中，仅无鼻饲管的亚组患者接受 tDCS 治疗与 sham 治疗相比显示出明显更高的改善（DOSS 评分较基线增加≥10%和≥20%：64.29% vs 0%，P =.01）。
对于卒中后吞咽障碍患者，在康复早期阶段接受双 tDCS 治疗与 sham 刺激相比，并没有显著增加恢复的可能性。
