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Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment

Published on Jan 1, 2018in Neurosignals
· DOI :10.1159/000487037
Paul Muhle7
Estimated H-index: 7
,
Inga Claus3
Estimated H-index: 3
+ 6 AuthorsSonja Suntrup-Krueger7
Estimated H-index: 7
Abstract
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 dysphagia in neurological disease. Methods: In this randomized crossover study on 11 healthy volunteers, cortical activation during pneumatic pharyngeal stimulation was measured applying magnetoencephalography in two separate sessions, with and without pharyngeal surface anesthesia. Results: Stimulation evoked bilateral event-related desynchronization (ERD) mainly in the caudolateral pericentral cortex. In comparison to the no-anesthesia condition, topical anesthesia led to a reduction of ERD in beta (13-30 Hz) and low gamma (30-60 Hz) frequency ranges (p<0.05) in sensory but also motor cortical areas. Conclusions: Withdrawal of sensory afferent information by topical anesthesia leads to reduced response to pneumatic pharyngeal stimulation in a distributed cortical sensorimotor network in healthy subjects. The proposed paradigm may serve to investigate the effect of neuromodulatory treatments specifically on pharyngeal sensory impairment as relevant cause of neurogenic dysphagia.
  • References (49)
  • Citations (3)
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References49
Newest
#1Thomas MarianH-Index: 4
Last. Rainer DziewasH-Index: 34
view all 8 authors...
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 ...
8 CitationsSource
#1Paul MuhleH-Index: 7
Last. Rainer DziewasH-Index: 34
view all 11 authors...
Background/Aims: Substance P (SP) is a neuropeptide, likely acting as a neurotransmitter in the pharyngeal mucosa enhancing the swallow and cough reflex. Pharyngeal Electrical Stimulation (PES) induces a temporary increase of salivary SP levels in healthy adults. Previous evidence suggests that post-stroke dysphagia is related to reduced SP levels. Here, we investigated the effects of PES on SP levels in severely dysphagic stroke patients and a possible link between increase of SP and treatment ...
4 CitationsSource
#1Omar Ortega (ISCIII: Carlos III Health Institute)H-Index: 10
#2Laia Rofes (ISCIII: Carlos III Health Institute)H-Index: 16
Last. Pere Clavé (ISCIII: Carlos III Health Institute)H-Index: 36
view all 6 authors...
Oropharyngeal dysphagia (OD) is a prevalent geriatric syndrome. Treatment is based on compensatory strategies to avoid complications. New treatments based on sensory stimulation to promote the recovery of the swallowing function have proved effective in acute studies but prolonged treatment needs further research. Our aim was to evaluate and compare the effect of two, longer-term sensory treatment strategies on older patients with OD. 38 older patients (≥70 years) were studied with videofluorosc...
16 CitationsSource
#1Marcel ArnoldH-Index: 53
#2Kai Timo LiesirovaH-Index: 3
Last. Hakan SarikayaH-Index: 20
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BACKGROUND Reported frequency of post-stroke dysphagia in the literature is highly variable. In view of progress in stroke management, we aimed to assess the current burden of dysphagia in acute ischemic stroke. METHODS We studied 570 consecutive patients treated in a tertiary stroke center. Dysphagia was evaluated by using the Gugging Swallowing Screen (GUSS). We investigated the relationship of dysphagia with pneumonia, length of hospital stay and discharge destination and compared rates of fa...
62 CitationsSource
#1Rainer WirthH-Index: 20
#2Rainer DziewasH-Index: 34
Last. Dorothee VolkertH-Index: 28
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Oropharyngeal dysphagia (OD) is a highly prevalent and growing condition in the older population. Although OD may cause very severe complications, it is often not detected, explored, and treated. Older patients are frequently unaware of their swallowing dysfunction which is one of the reasons why the consequences of OD, ie, aspiration, dehydration, and malnutrition, are regularly not attributed to dysphagia. Older patients are particularly vulnerable to dysphagia because multiple age-related cha...
79 CitationsSource
#1Jessica M. Pisegna (BU: Boston University)H-Index: 7
#2Asako Kaneoka (BU: Boston University)H-Index: 6
Last. Susan E. Langmore S E (BU: Boston University)H-Index: 33
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Abstract Objective The primary aim of this review is to evaluate the effects of non-invasive brain stimulation on post-stroke dysphagia. Methods Thirteen databases were systematically searched through July 2014. Studies had to meet pre-specified inclusion and exclusion criteria. Each study's methodological quality was examined. Effect sizes were calculated from extracted data and combined for an overall summary statistic. Results Eight randomized controlled trials were included. These trials rev...
39 CitationsSource
#1Shaheen HamdyH-Index: 42
#2Christopher FraserH-Index: 3
Last. David R. Thompson RnH-Index: 66
view all 5 authors...
3 Citations
#1Polly ScuttH-Index: 11
#2Han S. LeeH-Index: 2
Last. Philip M.W. Bath (University of Nottingham)H-Index: 67
view all 4 authors...
Background. Dysphagia after stroke is common, associated independently with poor outcome, and has limited treatment options. Pharyngeal electrical stimulation (PES) is a novel treatment being evaluated for treatment of poststroke dysphagia. Methods. We searched electronically for randomised controlled trials of PES in dysphagic patients within 3 months of stroke. Individual patient data were analysed using regression, adjusted for trial, age, severity, and baseline score. The coprimary outcomes ...
20 CitationsSource
#1Sonja Suntrup (WWU: University of Münster)H-Index: 15
#2André Kemmling (WWU: University of Münster)H-Index: 21
Last. Rainer Dziewas (WWU: University of Münster)H-Index: 34
view all 9 authors...
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...
40 CitationsSource
#1Sonja Suntrup (WWU: University of Münster)H-Index: 15
#2Inga K. Teismann (WWU: University of Münster)H-Index: 21
Last. Rainer Dziewas (WWU: University of Münster)H-Index: 34
view all 7 authors...
Abstract Background The act of swallowing is a complex neuromuscular function that is processed in a distributed network involving cortical, subcortical and brainstem structures. Difficulty in swallowing arises from a variety of neurologic diseases for which therapeutic options are currently limited. Pharyngeal electrical stimulation (PES) is a novel intervention designed to promote plastic changes in the pharyngeal motor cortex to aid dysphagia rehabilitation. In the present study we evaluate t...
14 CitationsSource
Cited By3
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#1Bendix LabeitH-Index: 1
#2Paul MuhleH-Index: 7
Last. Rainer DziewasH-Index: 34
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BACKGROUND: Intact pharyngeal sensation is essential for a physiological swallowing process, and conversely, pharyngeal hypesthesia can cause dysphagia. This study introduces and validates a diagnostic test to quantify pharyngeal hypesthesia. METHODS: A total of 20 healthy volunteers were included in a prospective study. Flexible endoscopic evaluation of swallowing (FEES) and a sensory test were performed both before and after pharyngeal local anesthesia. To test pharyngeal sensation, a small tu...
2 CitationsSource
#1Patrick Zuercher (University of Bern)H-Index: 1
#2Céline S. Moret (University of Bern)
Last. Joerg C. Schefold (University of Bern)H-Index: 26
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Dysphagia may present in all critically ill patients and large-scale clinical data show that e.g. post-extubation dysphagia (PED) is commonly observed in intensive care unit (ICU) patients. Recent data demonstrate that dysphagia is mostly persisting and that its presence is independently associated with adverse patient-centered clinical outcomes. Although several risk factors possibly contributing to dysphagia development were proposed, the underlying exact mechanisms in ICU patients remain inco...
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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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