Dysphagia Following Posterior Fossa Surgery in Adults

Wadhwa, Rishi; Toms, Jamie; Chittiboina, Prashant; Tawfik, Tamir; Glenn, Chad A.; Caldito, Gloria; Guthikonda, Bharat; Nanda, Anil

doi:10.1016/j.wneu.2013.01.035

Cited by 20 publications

(12 citation statements)

References 11 publications

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“…; Wadhwa et al . ). However, despite these studies, the physiological role of the cerebellum in the control of human swallowing remains incompletely understood.…”

Section: Introductionmentioning

confidence: 97%

Cerebellar repetitive transcranial magnetic stimulation restores pharyngeal brain activity and swallowing behaviour after disruption by a cortical virtual lesion

Sasegbon

Watanabe

Simons

et al. 2019

The Journal of Physiology

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Key points Despite evidence that the human cerebellum has an important role in swallowing neurophysiology, the effects of cerebellar stimulation on swallowing in the disrupted brain have not been explored. In this study, for the first time, the application of cerebellar neurostimulation is characterized in a human model of disrupted swallowing (using a cortical virtual lesion). It is demonstrated that cerebellar stimulation can reverse the suppressed activity in the cortical swallowing system and restore swallowing function in a challenging behavioural task, suggesting the findings may have important therapeutic implications. Abstract Repetitive transcranial magnetic stimulation (rTMS) can alter neuronal activity within the brain with therapeutic potential. Low frequency stimulation to the ‘dominant’ cortical swallowing projection induces a ‘virtual‐lesion’ transiently suppressing cortical excitability and disrupting swallowing behaviour. Here, we compared the ability of ipsi‐lesional, contra‐lesional and sham cerebellar rTMS to reverse the effects of a ‘virtual‐lesion’ in health. Two groups of healthy participants (n = 15/group) were intubated with pharyngeal catheters. Baseline pharyngeal motor evoked potentials (PMEPs) and swallowing performance (reaction task) were measured. Participants received 10 min of 1 Hz rTMS to the pharyngeal motor cortex which elicited the largest PMEPs to suppress cortical activity and disrupt swallowing behaviour. Over six visits, participants were randomized to receive 250 pulses of 10 Hz cerebellar rTMS to the ipsi‐lesional side, contra‐lesional side or sham while assessing PMEP amplitude or swallowing performance for an hour afterwards. Compared to sham, active cerebellar rTMS, whether administered ipsi‐lesionally (P = 0.011) or contra‐lesionally (P = 0.005), reversed the inhibitory effects of the cortical ‘virtual‐lesion’ on PMEPs and swallowing accuracy (ipsi‐lesional, P < 0.001, contra‐lesional, P < 0.001). Cerebellar rTMS was able to reverse the disruptive effects of a ‘virtual lesion’. These findings provide evidence for developing cerebellar rTMS into a treatment for post‐stroke dysphagia.

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“…; Wadhwa et al . ). However, despite these studies, the physiological role of the cerebellum in the control of human swallowing remains incompletely understood.…”

Section: Introductionmentioning

confidence: 97%

Cerebellar repetitive transcranial magnetic stimulation restores pharyngeal brain activity and swallowing behaviour after disruption by a cortical virtual lesion

Sasegbon

Watanabe

Simons

et al. 2019

The Journal of Physiology

View full text Add to dashboard Cite

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“…; Wadhwa et al . ). Despite its apparent neurophysiological importance, the physiological relevance of the cerebellum in swallowing remains relatively unexplored.…”

Section: Introductionmentioning

confidence: 97%

“…Evidence from animal studies (Mussen, 1927(Mussen, , 1930Reis et al 1973;Ball et al 1974;Colombel et al 2002;Zhu et al 2006) and human functional brain imaging (Hamdy et al 1999;Mosier et al 1999;Zald & Pardo, 1999;Mosier & Bereznaya, 2001;Suzuki et al 2003;Harris et al 2005;Malandraki et al 2009;Mihai et al 2013) implies cerebellar involvement in the neurophysiological control of swallowing. Furthermore, additional evidence for the role of the cerebellum in swallowing comes from pathological associations between oropharyngeal dysphagia and cerebellar stroke (Perie et al 1999;Prosiegel et al 2005;Iwanami et al 2007;Steinhagen et al 2009), degenerative cerebellar diseases (Ramio-Torrentia et al 2006;Isono et al 2013), partial cerebellectomy (Fukuda et al 2012) and pre-and post-operative dysphagia in posterior fossa tumours (Prosiegel et al 2005;Morgan et al 2008;Wadhwa et al 2013). Despite its apparent neurophysiological importance, the physiological relevance of the cerebellum in swallowing remains relatively unexplored.…”

Section: Introductionmentioning

confidence: 99%

High‐frequency focal repetitive cerebellar stimulation induces prolonged increases in human pharyngeal motor cortex excitability

Vasant

Michou

Mistry

et al. 2015

The Journal of Physiology

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Key pointsr Neurostimulation is a rapidly emerging approach to swallowing rehabilitation, but cerebellar stimulation has not been explored as a treatment. Such proposed therapies for post-stroke dysphagia have required confirmation of physiological effects and optimisation of parameters in healthy humans prior to translational progression into patient groups.r There is strong evidence for a role of the cerebellum in swallowing physiology, but this relationship has been under-explored.r Recently, single pulses of cerebellar magnetic stimulation have been shown to directly evoke responses from pharyngeal musculature and produce short-term enhancement of cortico-pharyngeal motor evoked potentials, suggesting the feasibility of a cerebellar approach to neurostimulation in the swallowing system. r We therefore examined multiple parameters of repetitive cerebellar magnetic stimulation and have described the optimal settings to provoke longer-lasting changes in swallowing neurophysiology. Based on evidence from the post-stroke dysphagia neurostimulation literature, these changes may have a therapeutic potential for swallowing rehabilitation. AbstractBrain neurostimulation has been shown to modulate cortical swallowing neurophysiology in post-stroke dysphagia with therapeutic effects which are critically dependent on the stimulation parameters. Cerebellar neurostimulation is, however, a novel, unexplored approach to modulation of swallowing pathways as a prelude to therapy for dysphagia. Here, we randomised healthy human subjects (n = 17) to receive one of five cerebellar repetitive TMS (rTMS) interventions (Sham, 1 Hz, 5 Hz, 10 Hz and 20 Hz) on separate visits to our laboratory. Additionally, a subset of subjects randomly received each of three different durations (50, 250, 500 pulses) of optimal frequency versus sham cerebellar rTMS. Prior to interventions subjects underwent MRI-guided single-pulse transcranial magnetic stimulation (TMS) to co-localise pharyngeal and thenar representation in the cortex and cerebellum (midline and hemispheric) before acquisition of baseline motor evoked potential (MEP) recordings from each site as a measure of excitability. Post-interventional MEPs were recorded for an hour and compared to sham using repeated measures ANOVA. Only 10 Hz cerebellar rTMS increased cortico-pharyngeal MEP amplitudes (mean bilateral increase 52%, P = 0.007) with effects lasting 30 min post-intervention with an optimal train length of 250 pulses (P = 0.019). These optimised parameters of cerebellar rTMS can produce sustained increases in corticobulbar excitability and may have clinical translation in future studies of neurogenic dysphagia.

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“…21 The mechanism itself is divided into four stages: oral preparatory, oral, pharyngeal, and esophageal stages. 22 The oral preparatory and oral phases are coordinated by CN VII and hypoglossal nerve, which innervate muscles of the lips and the tongue. 23 The pharyngeal and esophageal phases, which protect the airway while pushing the bolus to through the pharynx and into the esophagus, are largely controlled by CNs IX and X, with some CN XI involvement.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Evaluation of Swallowing and Speech in Patients with Neurofibromatosis Type 2

Rajendran

Antonios

Solomon

et al. 2019

J Neurol Surg B Skull Base

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Objective Neurofibromatosis type 2 (NF2) patients report that swallowing and speech problems significantly affect their quality of life, but the etiology of these phenomena is poorly understood. Swallowing and speech deficits may arise due to the neuropathy of involved nerves, due to posterior fossa tumor growth, or as iatrogenic effects from neurosurgical procedures to remove these tumors. This study aims to identify the natural history of swallowing and speech deficits in an NF2 cohort and to characterize the factors that may lead to those deficits. Methods Subjects (n = 168) were enrolled in a prospective, longitudinal study of NF2 with yearly imaging and clinical exams. The patients completed a self-reported questionnaire that included responses regarding subjective swallowing and speech dysfunction. A formal speech-language pathology evaluation and modified barium swallow (MBS) study (reported as American Speech-Language Hearing Association [ASHA] swallowing independency score from 1 through 7) was obtained when a speech/swallowing deficit was reported on the questionnaire. Results Of the 168 enrolled subjects, 55 (33%, median age = 31 years) reported subjective speech and/or swallowing deficits. These patients underwent one (n = 37) or multiple (n = 18) MBS studies during 44.8 ± 10.4 months follow-up. During MBS, a majority demonstrated near-normal swallowing (ASHA score >6, 82%), and no evidence of aspiration (aspiration/laryngeal penetration score = 1, 96%). Prior to initial MBS consultation, 38 (69%) patients had undergone relevant neurosurgical procedures. In those with recent (<1 week) posterior fossa surgery (n = 12), 2 (17%) patients had severe dysphagia and high aspiration risk on postoperative MBS. Both of these patients recovered to functionally independent swallowing status. Unilateral (n = 10) or bilateral (n = 6) tongue deficits unrelated to previous history suggestive of hypoglossal nerve injury were detected on clinical examination. There was a correlation between the presence of dysarthria and tongue deficits and tumors associated with the hypoglossal canal noted on imaging. Conclusion A large proportion of patients with NF2 report speech and swallow deficits that are not evident on objective measurements. We also found hypoglossal neuropathy unrelated to prior surgical interventions. Our findings suggest that swallowing and speech problems in NF2 are associated with lower cranial nerve neuropathy, some due to compressive effects of posterior fossa tumors. Adaptation over the course of the disease allows for the compensation of these deficits and subsequent normal findings on objective testing.

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Dysphagia Following Posterior Fossa Surgery in Adults

Cited by 20 publications

References 11 publications

Cerebellar repetitive transcranial magnetic stimulation restores pharyngeal brain activity and swallowing behaviour after disruption by a cortical virtual lesion

Cerebellar repetitive transcranial magnetic stimulation restores pharyngeal brain activity and swallowing behaviour after disruption by a cortical virtual lesion

High‐frequency focal repetitive cerebellar stimulation induces prolonged increases in human pharyngeal motor cortex excitability

A Prospective Evaluation of Swallowing and Speech in Patients with Neurofibromatosis Type 2

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