A pilot study on the efficacy of transcranial direct current stimulation applied to the pharyngeal motor cortex for dysphagia associated with brainstem involvement in multiple sclerosis. Issue 6 (June 2019)

• Record Type: Journal Article
• Authors: Restivo, Domenico A.; Alfonsi, Enrico; Casabona, Antonino; Hamdy, Shaheen; Tassorelli, Cristina; Panebianco, Mariangela; Marchese-Ragona, Rosario; Quartarone, Angelo; Centonze, Diego; Pavone, Antonino; Stampanoni Bassi, Mario
• Is Part Of: Clinical neurophysiology. Volume 130:Issue 6(2019:Jun.)
• Page Start: 1017
• Page End: 1024
• Publication Date: 2019-06
• Subjects: Multiple sclerosis-associated dysphagia -- Transcranial direct current stimulation (tDCS) -- Cortico-pharyngeal excitability -- Swallowing motor cortex -- Cricopharyngeal muscle -- Pharyngeal MEPs; Neurophysiology -- Periodicals; Electroencephalography -- Periodicals; Electromyography -- Periodicals; Neurology -- Periodicals; 612.8
• DOI: 10.1016/j.clinph.2019.04.003
• Languages: English
• ISSNs: 1388-2457

Abstract

Highlights: Dysphagia can complicate Multiple Sclerosis (MS), causing considerable morbidity, due to respiratory sequaelae. Anodal tDCS over the pharyngeal motor cortex may improve swallowing in dysphagic MS patients. Our findings suggest a potential benefit of pharyngeal motor cortex tDCS in MS-associated dysphagia. Abstract: Objective: we investigated the effect of anodal transcranial direct current stimulation (tDCS) applied over the pharyngeal motor area in dysphagia associated with multiple sclerosis (MS). Methods : Eighteen MS patients with dysphagia associated with brainstem involvement were randomized to receive either "real" or "sham" tDCS. Primary outcome: The Penetration/Aspiration Scale (PAS). Secondary outcomes: changes in electromyographic (EMG) parameters and pharyngeal cortical motor evoked potentials (MEPs). Patients were evaluated at baseline (T0 ), at the end of 5-session cycle of tDCS stimulations (T1 ), after two (T2 ), and four (T3 ) weeks. Results: the PAS values were significantly lower in the active group than in "sham" group at T1, and at T3 . Over the post-stimulation periods, PAS significantly improved only in the "real" group. As regards the secondary outcomes, we observed a statistically significant difference between the 2 groups only in the MEPs amplitude at T1 . The comparison between baseline and each of the post-stimulation times showed significant differences only of the "real" group across all the secondary parameters. Conclusions: Our findings support a beneficial effect of anodal tDCS applied to the pharyngeal motor cortex in MS-associated dysphagia. Significance: Considering its safety and efficacy, tDCS may represent an important resource in MS-associated dysphagia.