Lasting modulation of human cortical swallowing motor pathways following thermal tongue stimulation
Lasting modulation of human cortical swallowing motor pathways following thermal tongue stimulation
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DOI：
10.1111/nmo.13938
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发表时间：
2020-07-12
影响因子：
3.5
通讯作者：
Inoue, Makoto
中科院分区：
文献类型：
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作者：
Magara, Jin;Watanabe, Masahiro;Inoue, Makoto
热触觉口咽刺激已在临床上用于促进吞咽困难患者的吞咽启动。我们以前证明，热刺激施加到口腔引起立即兴奋性咽运动皮层。本研究的目的是研究热刺激是否能对皮质咽神经通路产生更持久的影响。方法12例健康志愿者（n = 8/12）接受经颅磁刺激诱发的咽运动诱发电位（PMEP）测试。在第一个实验中，受试者接受15和36摄氏度的交替30秒的热刺激，施加到舌头表面10分钟、5分钟或假手术。在第二个实验中，提供了三种间歇性热刺激模式之一：冷（15和36摄氏度交替30秒），暖（连续36摄氏度），或热（45和36摄氏度交替30秒）10分钟。在这两个实验中，在热刺激后每15分钟重新测量PMEP直到60分钟。在第一个实验中，每个刺激时间的重复测量ANOVA显示，与假手术相比，仅10分钟刺激后30分钟的PMEP振幅变化显著增加（P <0.05）。在第二个实验中，我们发现冷刺激在增加PMEP幅度方面比其他刺激更有效（P <0.05）。结论和推论10分钟的冷刺激舌头可以诱导延迟（30分钟）增加咽皮质兴奋性，提供了一个临床上有用的治疗窗口，其应用于吞咽困难的患者。
Background Thermal tactile oropharyngeal stimulation has been clinically used to facilitate swallowing initiation in dysphagic patients. We previously demonstrated that thermal stimulation applied to the oral cavity provokes an immediate excitability in pharyngeal motor cortex. The aim of the current study was to investigate whether thermal stimulation can produce longer lasting effects on the corticopharyngeal neural pathway. Methods Healthy volunteers (n = 8/12) underwent baseline pharyngeal motor evoked potential (PMEP) measurements evoked by transcranial magnetic stimulation. In the first experiment, subjects received thermal stimulation alternating 30 seconds of 15 and 36 degrees C applied to the tongue surface for either 10 minutes, 5 minutes, or sham. In the second experiment, one of three intermittent thermal stimulus patterns was delivered: cold (alternating 30 seconds of 15 and 36 degrees C), warm (continuous 36 degrees C), or hot (alternating 30 seconds of 45 and 36 degrees C) for 10 minutes. In both experiments, PMEP were remeasured every 15 minutes up to 60 minutes following thermal stimulation. Key Results Repeated measures ANOVA for each stimulus time in the first experiment showed a significant increased change in PMEP amplitude at 30 minutes following only 10-minute stimulation compared with sham (P < .05). In the second experiment, we found that cold stimulation was more effective than the other stimulation (P < .05) at increasing PMEP amplitudes. Conclusions and Inferences Ten-minute cold stimulation on the tongue can induce a delayed (30 minutes) increase in pharyngeal cortical excitability, providing a clinically useful therapeutic window for its application in dysphagic patients.