Targeting unlesioned pharyngeal motor cortex improves swallowing in healthy individuals and after dysphagic stroke.
Targeting unlesioned pharyngeal motor cortex improves swallowing in healthy individuals and after dysphagic stroke.
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DOI：
10.1053/j.gastro.2011.09.040
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发表时间：
2012-01
期刊：
影响因子：
29.4
通讯作者：
Hamdy S
中科院分区：
文献类型：
--
作者：
Michou E;Mistry S;Jefferson S;Singh S;Rothwell J;Hamdy S
中风患者出现吞咽问题(吞咽困难)；吸入性肺炎、营养不良和脱水的风险增加；并增加了死亡率。我们研究了一种新的神经刺激技术(配对联想刺激[PAS])应用于咽运动皮质对健康人和中风吞咽障碍患者吞咽功能的影响。我们研究了通过结合外周咽部电刺激和皮质刺激来促进可塑性的PAS的最佳参数。使用一个虚拟病变作为中风的实验模型，在12名健康人的咽部皮质上用1赫兹重复的经颅磁刺激造成中风。我们测试了6例卒中后重度慢性吞咽困难患者(平均卒中后38.8±24.4周)，在应用该技术之前，大脑半球靶向PAS是否改变了吞咽能力。与假PAS相比，对未损毁的咽皮质10分钟的PAS(双侧)翻转了由虚拟病变(损伤：F1，9=21.347，P=.001；对照：F1，9=9.648，P=.013；重复测量方差分析)引起的皮质抑制。它促进了通过吞咽反应时间任务测量的行为反应的变化(F1，7=21.02，P=0.003；重复测量方差分析)。在慢性吞咽困难的患者中，真正的PAS导致大脑中短期的双侧改变；未受影响的咽皮质兴奋性增加(P=.001；95%可信区间0.21-0.05；后配对t检验)，穿透-吸入评分降低，吞咽生物力学改变由视频透视确定。PAS有益的神经生理和行为特性应用于未损伤的大脑，为进一步研究神经刺激作为中风后吞咽困难患者的康复方法提供了基础。
Patients with stroke experience swallowing problems (dysphagia); increased risk of aspiration pneumonia, malnutrition, and dehydration; and have increased mortality. We investigated the behavioral and neurophysiological effects of a new neurostimulation technique (paired associative stimulation [PAS]), applied to the pharyngeal motor cortex, on swallowing function in healthy individuals and patients with dysphagia from stroke. We examined the optimal parameters of PAS to promote plasticity by combining peripheral pharyngeal (electrical) with cortical stimulation. A virtual lesion was used as an experimental model of stroke, created with 1-Hz repetitive transcranial magnetic stimulation over the pharyngeal cortex in 12 healthy individuals. We tested whether hemispheric targeting of PAS altered swallowing performance before applying the technique to 6 patients with severe, chronic dysphagia from stroke (mean of 38.8 ± 24.4 weeks poststroke). Ten minutes of PAS to the unlesioned pharyngeal cortex reversed (bilaterally) the cortical suppression induced by virtual lesion (lesioned: F1,9 = 21.347, P = .001; contralesional: F1,9 = 9.648, P = .013; repeated-measures analysis of variance) compared with sham PAS. It promoted changes in behavior responses measured with a swallowing reaction time task (F1,7 = 21.02, P = .003; repeated-measures analysis of variance). In patients with chronic dysphagia, real PAS induced short-term bilateral changes in the brain; the unaffected pharyngeal cortex had increased excitability (P = .001; 95% confidence interval, 0.21–0.05; post hoc paired t test) with reduced penetration-aspiration scores and changes in swallowing biomechanics determined by videofluoroscopy. The beneficial neurophysiological and behavioral properties of PAS, when applied to unlesioned brain, provide the foundation for further investigation into the use of neurostimulation as a rehabilitative approach for patients with dysphagia from stroke.
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DOI：
10.1097/moo.0b013e32832b255e
发表时间：
2009-06-01
影响因子：
1.6
作者：
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通讯作者：
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