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辅助经颅直流电刺激改善帕金森病吞咽功能

Adjunctive transcranial direct current stimulation to improve swallowing functions in Parkinson's disease.

作者信息

Dashtelei Ali Akbar, Nitsche Michael A, Salehinejad Mohammad Ali, Habibi Amir Hassan, Bakhtyiari Jalal, Khatoonabadi Ahmad R

机构信息

Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.

Department Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, IfADo, Dortmund, Germany.

出版信息

EXCLI J. 2024 Jan 18;23:95-107. doi: 10.17179/excli2023-6496. eCollection 2024.

Abstract

Swallowing problems are frequent in Parkinson's disease (PD). The aim of this study was to determine the effectiveness of combined transcranial Direct Current Stimulation (tDCS) and Conventional Dysphagia Therapy (CDT) on dysphagia in PD patients. Twenty PD patients with dysphagia were randomized into two groups: combination therapy (anodal tDCS plus CDT) and sham tDCS combined with CDT. Anodal or sham tDCS, bilaterally over the pharyngeal motor cortex, was applied with one mA during the first 20 min (real) or 30 s (sham) of CDT, which was delivered for 30 min. Both groups received twice-daily treatment sessions within two weeks. Swallowing functions were evaluated before, immediately, and one month after the intervention via the Penetration-Aspiration Scale (PAS), and the Swallowing Disorder Questionnaire (SDQ) as the primary outcome measures, and the Dysphagia Handicap Index (DHI) as the secondary outcome measure. The results showed a significant improvement of PAS scores from baseline to post-intervention and baseline to follow-up in both groups without significant differences between groups (t=0.03, p=0.973, and t=1.27, p=0.22 for post-intervention and follow-up time points, respectively). The results showed a significant reduction of SDQ and DHI scores in both groups after the intervention, but the magnitude of the change was significantly larger in the anodal tDCS group at the post-intervention (ta=2.58, pa=0.019 and tb=2.96, pb=0.008) and follow-up (ta=2.65, pa=0.016 and tb=2.97, pb=0.008) time points. This study provides preliminary evidence that bi-hemispheric anodal tDCS combined with CDT enhances swallowing functions in patients with Parkinson's disease more than CDT alone.

摘要

吞咽问题在帕金森病(PD)中很常见。本研究的目的是确定经颅直流电刺激(tDCS)联合传统吞咽障碍治疗(CDT)对帕金森病患者吞咽困难的疗效。20例患有吞咽困难的帕金森病患者被随机分为两组:联合治疗组(阳极tDCS加CDT)和假tDCS联合CDT组。在CDT的前20分钟(真实)或30秒(假刺激)内,以1毫安的电流强度在双侧咽运动皮层施加阳极或假tDCS,CDT持续30分钟。两组在两周内每天接受两次治疗。在干预前、干预后即刻和干预后一个月,通过渗透-误吸量表(PAS)、吞咽障碍问卷(SDQ)作为主要结局指标,吞咽障碍 handicap指数(DHI)作为次要结局指标评估吞咽功能。结果显示,两组从基线到干预后以及从基线到随访时,PAS评分均有显著改善,组间无显著差异(干预后和随访时间点的t值分别为0.03,p = 0.973和1.27,p = 0.22)。结果显示,两组干预后SDQ和DHI评分均显著降低,但在干预后(阳极tDCS组ta = 2.58,pa = 0.019;假tDCS组tb = 2.96,pb = 0.008)和随访(阳极tDCS组ta = 2.65,pa = 0.016;假tDCS组tb = 2.97,pb = 0.008)时间点,阳极tDCS组的变化幅度显著更大。本研究提供了初步证据,表明双半球阳极tDCS联合CDT比单独使用CDT更能增强帕金森病患者的吞咽功能。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f822/10938234/da63d00b9d4f/EXCLI-23-95-t-001.jpg

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