Effects of cortical anodal transcranial direct current stimulation on swallowing biomechanics
Effects of cortical anodal transcranial direct current stimulation on swallowing biomechanics
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DOI：
10.1111/nmo.13434
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发表时间：
2018-11-01
影响因子：
3.5
通讯作者：
Omari, Taher
中科院分区：
文献类型：
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作者：
Doeltgen, Sebastian H.;Rigney, Lakkari;Omari, Taher
背景经颅阳极直流电刺激(TDC)在卒中队列中已证实对皮质球兴奋性和吞咽功能的影响，这是通过临床分级量表评估的。阳极型tDCs对吞咽的生物力学影响在很大程度上仍未被研究。我们研究了在初级运动皮质的口底(FOM)表示上施加阳极tDCs对健康受试者吞咽生物力学的影响。用运动诱发电位评估皮质球兴奋性，并通过经颅磁刺激评估治疗后0、15、30和45分钟。通过常规的临床评估(研究1)和咽部高分辨率阻抗测压(研究2)评估了治疗前后的吞咽功能。研究1(n=17)显示，在采用阳极湿法治疗后，在熟练的吞咽任务中，皮质球兴奋性和吞咽能力增强，而不是假的治疗。在研究2(n=10)中，阳极tDCs导致上食道括约肌的团注导纳增加，但咽部和上食道收缩活力降低。结论临床上饮食摄入量的改善可能是由于吞咽神经整形重组促进了上食道括约肌(UES)的团注导纳。
BackgroundAnodal transcranial direct current stimulation (tDCS) has demonstrated effects on corticobulbar excitability and swallowing function as assessed via clinical rating scales in stroke cohorts. Biomechanical effects of anodal tDCS on swallowing remain largely unexplored. We investigated how anodal tDCS applied over the floor of mouth (FOM) representation on the primary motor cortex affects swallowing biomechanics in healthy participants.MethodsKey ResultsAnodal and sham tDCS were applied for 20 minutes at 1.5mA. Corticobulbar excitability was assessed using motor evoked potentials at baseline and 0, 15, 30 and 45 minutes post-tDCS, as assessed by transcranial magnetic stimulation. Swallowing function was assessed pre- and post-tDCS using routine clinical assessments (Study 1) and pharyngeal high resolution impedance manometry (Study 2).Study 1 (n=17) showed increased corticobulbar excitability and performance on a skilled swallowing task following anodal wetDCS, but not sham tDCS. In Study 2 (n=10) anodal tDCS resulted in increased bolus admittance across the upper esophageal sphincter, but decreased pharyngeal and upper esophageal contractile vigor.ConclusionsInferencesClinical improvements of dietary intake are likely driven by swallowing neuroplastic reorganization which improves bolus admittance across the upper esophageal sphincter (UES).The documented changes make motor cortical application of anodal tDCS a promising adjunct to swallowing rehabilitation practice.