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.
J Physiol. 2019 May;597(9):2533-2546. doi: 10.1113/JP277545. Epub 2019 Apr 3.
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.
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.
尽管有证据表明人类小脑在吞咽神经生理学中具有重要作用，但小脑刺激对大脑受损时吞咽的影响尚未得到探索。在这项研究中，首次在受损吞咽的人体模型（使用皮质虚拟病变）中对小脑神经刺激的应用进行了描述。结果表明，小脑刺激可以逆转皮质吞咽系统中被抑制的活动，并在具有挑战性的行为任务中恢复吞咽功能，这表明这些发现可能具有重要的治疗意义。
重复经颅磁刺激（rTMS）可以改变大脑内神经元的活动，具有治疗潜力。对“优势”皮质吞咽投射区进行低频刺激会导致“虚拟病变”，短暂抑制皮质兴奋性并破坏吞咽行为。在这里，我们比较了同侧、对侧和假小脑 rTMS 逆转健康人“虚拟病变”影响的能力。两组健康参与者（n=15/组）通过咽导管插管。测量基础咽运动诱发电位（PMEPs）和吞咽性能（反应任务）。参与者接受 10 分钟 1Hz rTMS 刺激咽运动皮质，以产生最大的 PMEPs 来抑制皮质活动并破坏吞咽行为。在六次就诊中，参与者随机接受同侧、对侧或假刺激的 250 个 10Hz 小脑 rTMS 脉冲，同时在之后一小时评估 PMEP 幅度或吞咽性能。与假刺激相比，同侧（P=0.011）或对侧（P=0.005）活性小脑 rTMS 均逆转了皮质“虚拟病变”对 PMEPs 和吞咽准确性的抑制作用（同侧，P<0.001，对侧，P<0.001）。小脑 rTMS 能够逆转“虚拟病变”的破坏性影响。这些发现为开发小脑 rTMS 治疗中风后吞咽困难提供了证据。
