Noninvasive brain stimulation may improve stroke-related dysphagia: a pilot study.
Noninvasive brain stimulation may improve stroke-related dysphagia: a pilot study.
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DOI：
10.1161/strokeaha.110.602128
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发表时间：
2011-04
期刊：
影响因子：
8.3
通讯作者：
Schlaug G
中科院分区：
文献类型：
--
作者：
Kumar S;Wagner CW;Frayne C;Zhu L;Selim M;Feng W;Schlaug G
目前，卒中相关吞咽困难的治疗选择有限。在这项研究中，我们调查了无创脑刺激结合吞咽动作是否有助于吞咽困难的中风患者在早期中风恢复期的吞咽恢复。14例亚急性单侧大脑半球梗死患者被随机分为阳极经颅直流电刺激（tDCS）组和假刺激组，连续5天在未受影响的大脑半球进行吞咽感觉运动皮质表征，同时进行标准化吞咽动作。在tDCS或假手术的第一次治疗之前和最后一次治疗之后，使用经过验证的吞咽量表、吞咽困难结局和严重程度量表（DOSS）来测量吞咽困难的严重程度。在调整其他潜在混杂变量（如基线时的NIH卒中量表（NIHSS）和DOSS评分、急性缺血性病变体积、患者年龄和卒中发作至刺激的时间）的影响后，使用DOSS变化作为结局变量，在多变量线性回归模型中分析tDCS的影响。与假刺激组相比，接受阳极tDCS的患者的DOSS评分改善了2.60分，在控制其他上述变量的影响后，假刺激组的患者改善了1.25分（P=0.019）。tDCS刺激组7例患者中有6例（86%）与假手术组7例患者中的3例（43%）相比获得至少2分的改善（P=0.107）。由于脑干吞咽中枢具有双侧皮质神经支配，因此增强脑干吞咽的皮质输入和感觉运动控制的措施可能有利于吞咽障碍的恢复。
Treatment options for stroke related dysphagia are currently limited. In this study we investigated whether non-invasive brain stimulation in combination with swallowing maneuvers facilitates swallowing recovery in dysphagic stroke patients during early stroke convalescence. Fourteen patients with subacute unilateral hemispheric infarction were randomized to anodal transcranial direct current stimulation (tDCS) versus sham stimulation to the sensorimotor cortical representation of swallowing in the unaffected hemisphere over 5 consecutive days with concurrent standardized swallowing maneuvers. Severity of dysphagia was measured using a validated swallowing scale, Dysphagia Outcome and Severity Scale (DOSS), before the first and after the last session of tDCS or sham. The effect of tDCS was analyzed in a multivariate linear regression model using changes in DOSS as the outcome variable, after adjusting for the effects of other potential confounding variables such as the NIH Stroke Scale (NIHSS) and DOSS scores at baseline, acute ischemic lesion volumes, patient’s age and time from stroke onset to stimulation. Patients who received anodal tDCS gained 2.60 points improvement in DOSS scores compared to patients in the sham stimulation group who showed an improvement of 1.25 points (P=0.019) after controlling for the effects of other aforementioned variables. 6 out 7 (86%) patients in tDCS stimulation group gained at least 2 points improvement compared with 3 out 7 (43%) patients in sham group (P=0.107). Since brainstem swallowing centers have bilateral cortical innervations, measures that enhance cortical input and sensorimotor control of brainstem swallowing may be beneficial for dysphagia recovery.