Neurogastroenterology, Manchester University Foundation Trust, Wythenshawe Hospital, Manchester, UK.
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.
Neurogastroenterol Motil. 2019 Jul;31(7):e13609. doi: 10.1111/nmo.13609. Epub 2019 Apr 26.
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.
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.
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.
Our results suggest that cerebellar rTMS has plausible therapeutic potential for post stroke dysphagia.
大量研究表明，小脑在吞咽过程中是活跃的。皮质靶向重复经颅磁刺激（rTMS）是一种技术，已被证明可导致健康参与者和中风后吞咽困难患者的有益的电生理和行为变化。小脑 rTMS 是这一新兴领域中相对未被研究的领域。在这里，我们将小脑靶向 rTMS 应用于一名中风后吞咽困难的患者，试图改善他们的吞咽能力。
一名 67 岁的中风后吞咽困难女性患者被招募进行交叉活性 rTMS 与假 rTMS 研究。结果测量是咽电机诱发反应（PMEP）幅度和累积渗透-吸入评分（cPAS）。该患者在两次就诊时参加了实验。在每次就诊期间，均采集基线 PMEP 和 cPAS 测量值，然后进行活性或假 rTMS。之后，在 30 分钟时重复 PMEP 和 cPAS 测量值。
活性小脑 rTMS 能够增加 PMEP 幅度（比基线高 55%）和改善吞咽安全性（比基线低 17%）。假 rTMS 没有导致任何有益的 PMEP 或 cPAS 变化。
我们的结果表明，小脑 rTMS 对中风后吞咽困难具有合理的治疗潜力。
