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Pharyngolaryngeal Sensory Deficits in Patients with Middle Cerebral Artery Infarction: Lateralization and Relation to Overall Dysphagia Severity

Published on Oct 3, 2017in Cerebrovascular Diseases Extra
· DOI :10.1159/000479483
Thomas Marian4
Estimated H-index: 4
,
Jens Burchard Schröder4
Estimated H-index: 4
+ 5 AuthorsRainer Dziewas34
Estimated H-index: 34
Abstract
Background: Dysphagia is a frequent and dangerous complication of acute stroke. Apart from a well-timed oropharyngeal muscular contraction pattern, sensory feedback is of utmost importance for safe and efficient swallowing. In the present study, we therefore analyzed the relation between pharyngolaryngeal sensory deficits and post-stroke dysphagia (PSD) severity in a cohort of acute stroke patients with middle cerebral artery (MCA) infarction. Methods: Eighty-four first-ever MCA stroke patients (41 left, 43 right) were included in this trial. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardized protocol within 96 h after stroke onset. PSD was classified according to the 6-point fiberoptic endoscopic dysphagia severity scale. Pharyngolaryngeal sensation was semi-quantitatively evaluated by a FEES-based touch technique. Results: PSD severity was closely related to the pharyngolaryngeal sensory deficit. With regards to lateralization of the sensory deficit, there was a slight but significant preponderance of sensory loss contralateral to the side of stroke. Apart from that, right hemispheric stroke patients were found to present with a more severe PSD. Conclusions: This study provides evidence that an intact sensory feedback is of utmost importance to perform nonimpaired swallowing and highlights the key role of disturbed pharyngeal and laryngeal afferents in the pathophysiology of PSD.
  • References (52)
  • Citations (8)
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References52
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#1Sonja Suntrup-Krueger (WWU: University of Münster)H-Index: 7
#2André KemmlingH-Index: 21
Last. Rainer Dziewas (WWU: University of Münster)H-Index: 34
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Background and purpose Dysphagia is a well-known complication of acute stroke. Given the complexity of cerebral swallowing control it is still difficult to predict which patients are likely to develop swallowing dysfunction based on their neuroimaging. In Part 2 of a comprehensive voxel-based imaging study, whether the location of a stroke lesion can be correlated with further dysfunctional swallowing patterns, pulmonary protective reflexes and pneumonia was evaluated. Methods In all, 200 acute ...
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#1Philip M.W. BathH-Index: 67
#2Polly ScuttH-Index: 11
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Background and Purpose— Dysphagia is common after stroke, associated with increased death and dependency, and treatment options are limited. Pharyngeal electric stimulation (PES) is a novel treatment for poststroke dysphagia that has shown promise in 3 pilot randomized controlled trials. Methods— We randomly assigned 162 patients with a recent ischemic or hemorrhagic stroke and dysphagia, defined as a penetration aspiration score (PAS) of ≥3 on video fluoroscopy, to PES or sham treatment given o...
27 CitationsSource
Background Substance P (SP) is a neuropeptide known to enhance the swallow response. It likely acts as a neurotransmitter in the pharyngeal mucosa in response to local stimuli. It has been proposed that dysphagia after stroke may be related to reduced levels of SP, which therefore constitutes a therapeutic target. In the present pilot study, we evaluated whether electrical pharyngeal stimulation (EPS), a neuromodulation device to enhance cortical reorganization for the restoration of swallowing ...
12 CitationsSource
#1David L Cohen (Northwick Park Hospital)H-Index: 5
#2Christine Roffe (Keele University)H-Index: 27
Last. Philip M.W. Bath (University of Nottingham)H-Index: 67
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Post-stroke dysphagia (a difficulty in swallowing after a stroke) is a common and expensive complication of acute stroke and is associated with increased mortality, morbidity, and institutionalization due in part to aspiration, pneumonia, and malnutrition. Although most patients recover swallowing spontaneously, a significant minority still have dysphagia at six months. Although multiple advances have been made in the hyperacute treatment of stroke and secondary prevention, the management of dys...
47 CitationsSource
#1Sonja SuntrupH-Index: 15
#2Thomas MarianH-Index: 4
Last. Rainer DziewasH-Index: 34
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Purpose Treatment of post-stroke dysphagia is notoriously difficult with different neurostimulation strategies having been employed with a variable degree of success. Recently, electrical pharyngeal stimulation (EPS) has been shown to improve swallowing function and in particular decrease airway aspiration in acute stroke. We performed a randomized controlled trial to assess EPS effectiveness on swallowing function in severely dysphagic tracheotomized patients.
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#2André Kemmling (WWU: University of Münster)H-Index: 21
Last. Rainer Dziewas (WWU: University of Münster)H-Index: 34
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Background and purpose Although early identification of patients at risk for dysphagia is crucial in acute stroke care, predicting whether a particular patient is likely to have swallowing problems based on the brain scan is difficult because a comprehensive model of swallowing control is missing. In this study whether stroke location is associated with dysphagia incidence, severity and the occurrence of penetration or aspiration was systematically evaluated relying on a voxel-based imaging anal...
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#1Asako Kaneoka (BU: Boston University)H-Index: 6
#2Gintas P. Krisciunas (BMC: Boston Medical Center)H-Index: 9
Last. Susan E. Langmore S E (BU: Boston University)H-Index: 33
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Objective:This study examined the association between laryngeal sensory deficits and penetration or aspiration. Two methods of testing laryngeal sensation were carried out to determine which was more highly correlated with Penetration-Aspiration Scale (PAS) scores.Methods:Healthy participants and patients with dysphagia received an endoscopic swallowing evaluation including 2 sequential laryngeal sensory tests—air pulse followed by touch method. Normal/impaired responses were correlated with PAS...
11 CitationsSource
#1Gitta RohwederH-Index: 7
#2Hanne EllekjærH-Index: 9
Last. Bent IndredavikH-Index: 29
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Background and Purpose— The aim of this study was to explore the associations of common medical complications with functional outcome at 90 days post stroke. Methods— Patients with unselected acute stroke were included and observed for 16 predefined complications during the first week. Fifty percent (244 patients) were allocated to follow-up of 13 complications until 90 days and then assessed with the modified Rankin Scale 90. Common complications were defined as complications with frequencies o...
32 CitationsSource
#1Suely Mayumi Motonaga Onofri (UNESP: Sao Paulo State University)H-Index: 1
#2Paula Cristina Cola (UNESP: Sao Paulo State University)H-Index: 8
Last. Roberto Oliveira Dantas (USP: University of São Paulo)H-Index: 28
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Stroke is the most common neurological disease in adults that is associated with deglutition disorders. The presence of laryngeal sensitivity is very important in developing safe swallowing without risk of pulmonary complications. The aim of this study was to correlate laryngeal sensitivity with laryngeal penetration and tracheal aspiration after swallows of three food consistencies (puree, thickened liquid, and liquid) in poststroke individuals in the late phase. A cross-sectional clinical stud...
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#1Laia Rofes (ISCIII: Carlos III Health Institute)H-Index: 16
#2Viridiana Arreola (Autonomous University of Barcelona)H-Index: 16
Last. Pere Clavé (Autonomous University of Barcelona)H-Index: 36
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Objective There is no pharmacological treatment for oropharyngeal dysphagia (OD). The aim of this study was to compare the therapeutic effect of stimulation of oropharyngeal transient receptor potential vanilloid type 1 (TRPV1) with that of thickeners in older patients with OD. Design A clinical videofluoroscopic non-randomised study was performed to assess the signs of safety and efficacy of swallow and the swallow response in (1) 33 patients with OD (75.94±1.88 years) while swallowing 5, 10 an...
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#1Tobias WarneckeH-Index: 24
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Removal of a tracheostomy tube in critically ill neurologic patients is a difficult issue, particularly due to the high incidence of oropharyngeal dysphagia. For an objective evaluation of decannulation readiness the “Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients” (SESETD) – a stepwise evaluation of ‘secretion management’, ‘spontaneous swallows’ and ‘laryngeal sensibility/cough’ – has been introduced. With the recent study deta...
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#1Christopher Cabib (Autonomous University of Barcelona)H-Index: 2
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Oropharyngeal dysphagia (OD) is a common post-stroke complication and is associated with respiratory infections. The aim was to assess the biomechanical impairments in swallow function and the afferent and efferent swallowing pathways impairing swallow safety in chronic post-stroke patients. We studied 30 patients with unilateral stroke and chronic OD (> 3 months from stroke onset) with impaired safety of swallow (Penetration–Aspiration Scale [PAS] ≥ 2). We evaluated the efficacy, safety, and ki...
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#1Miranda J. Cullins (UW: University of Wisconsin-Madison)H-Index: 2
#2Nadine P. Connor (UW: University of Wisconsin-Madison)H-Index: 2
Abstract Purpose Dysphagia is a common problem after stroke that is often associated with tongue weakness. However, the physiological mechanisms of post-stroke tongue muscle weakness and optimal treatments have not been established. To advance understanding of physiological mechanisms of post stroke dysphagia, we sought to validate the unilateral transient middle cerebral artery occlusion (MCAO) rat model of ischemic stroke as a translational model of post stroke dysphagia. Our goal was to estab...
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#1Bendix LabeitH-Index: 1
#2Paul MuhleH-Index: 7
Last. Rainer DziewasH-Index: 34
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#1Laura F. Santoso (UMMS: University of Massachusetts Medical School)H-Index: 1
#2Daniel Y. Kim (UMMS: University of Massachusetts Medical School)H-Index: 4
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#2Thomas MarianH-Index: 4
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#1Janina Wilmskoetter (MUSC: Medical University of South Carolina)H-Index: 4
#2Leonardo Bonilha (MUSC: Medical University of South Carolina)H-Index: 43
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Abstract Dysphagia is a common deficit after a stroke, and it is frequently associated with pneumonia, malnutrition, dehydration, and poor quality of life. It is not yet fully clear which brain regions are directly related to swallowing, and how lesions affect swallow physiology. This study aimed to assess the statistical relationship between acute stroke lesion locations and impairment of specific aspects of swallow physiology. We performed lesion symptom mapping with 68 retrospectively recruit...
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Purpose of Review This review gives an outline of the current state of knowledge on swallowing-related neurophysiology, neuroplasticity mechanisms following dysphagic stroke and neuromodulatory treatment approaches to enhance recovery processes for faster and better rehabilitation of post-stroke dysphagia.
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#1Paul MuhleH-Index: 7
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Background/Aims: Performing neurophysiological and functional imaging studies in severely affected patients to investigate novel neurostimulation techniques for the treatment of neurogenic dysphagia is difficult. Therefore, basic research needs to be conducted in healthy subjects. Swallowing is a motor function highly dependent on sensory afferent input. Here we propose a virtual peripheral sensory lesion model to mimic pharyngeal sensory impairment, which is known as a major contributor to dysp...
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