Effects of Bilateral Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia

Park, Eun-Hee; Kim, Min Su; Chang, Won Hyuk; Oh, Sung Min; Kim, Yun Kwan; Lee, Ahee; Kim, Yun-Hee

doi:10.1016/j.brs.2016.08.005

Cited by 98 publications

(110 citation statements)

References 30 publications

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“…; Khedr & Abo‐Elfetoh, ; Park et al . ). These studies have shown that both undamaged and damaged areas may be important in the improvement of swallowing function (Khedr et al .…”

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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“…; Khedr & Abo‐Elfetoh, ; Park et al . ). These studies have shown that both undamaged and damaged areas may be important in the improvement of swallowing function (Khedr et al .…”

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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“…However, the application of TMS for rehabilitating such functionality is still hindered by the small sample size of various studies, the heterogeneity among recruited subjects and the target position of both the stimulating coil on the scalp and the recording electrodes along the esophagus. For example, Eunhee Park et al and Khedr EM et al applied rTMS to the esophageal region of the cerebral cortex without describing the exact location of the stimulating coil [4,5]. E.M. Khedr et al in particular somewhat crudely placed the coil at 2 cm posterior and 2 cm lateral to the cranial vertex (Cz) which only covers the motor and premotor areas [6,7].…”

Section: Introductionmentioning

confidence: 99%

TMS brain mapping of the pharyngeal cortical representation in healthy subjects

Lin

et al. 2020

Brain Stimulation

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a b s t r a c tBackground: Brain mapping is fundamental to understanding brain organization and function. However, a major drawback to the traditional Brodmann parcellation technique is the reliance on the use of postmortem specimens. It has therefore historically been difficult to make any comparison regarding functional data from different regions or hemispheres within the same individual. Moreover, this method has been significant limited by subjective boundaries and classification criteria and therefore suffer from reproducibility issues. The development of transcranial magnetic stimulation (TMS) offers an alternative approach to brain mapping, specifically the motor cortical regions by eliciting quantifiable functional reactions. Objective: To precisely describe the motor cortical topographic representation of pharyngeal constrictor musculature using TMS and to further map the brain for use as a tool to study brain plasticity. Methods: 51 healthy subjects (20 male/31 female, 19e26 years old) were tested using single-pulse TMS combined with intraluminal catheter-guided high-resolution manometry and a standardized grid cap. We investigated various parameters of the motor-evoked potential (MEP) that include the motor map area, amplitude, latency, center of gravity (CoG) and asymmetry index. Results: Cortically evoked response latencies were similar for the left and right hemispheres at 6.79 ± 0.22 and 7.24 ± 0.27 ms, respectively. The average scalp positions (relative to the vertex) of the pharyngeal motor cortical representation were 10.40 ± 0.19 (SE) cm medio-lateral and 3.20 ± 0.20 (SE) cm antero-posterior in the left hemisphere and 9.65 ± 0.24 (SE) cm medio-lateral and 3.18 ± 0.23 (SE) cm antero-posterior in the right hemisphere. The mean motor map area of the pharynx in the left and right hemispheres were 9.22 ± 0.85(SE) cm 2 and 10.12 ± 1.24(SE) cm 2 , respectively. The amplitudes of the MEPs were 35.94 ± 1.81(SE)uV in the left hemisphere and 34.49 ± 1.95(SE)uV in the right hemisphere. By comparison, subtle but consistent differences in the degree of the bilateral hemispheric representation were also apparent both between and within individuals. Conclusion: The swallowing musculature has a bilateral motor cortical representation across individuals, but is largely asymmetric within single subjects. These results suggest that TMS mapping using a guided Abbreviations: RMT, rest motor threshold; EMG, electromyography; MEPs, motor evoked potentials; MSO, maximum stimulator output; PMEP, pharyngeal motor evoked potential; CoG, center of gravity; UES, upper esophageal sphincter; HRM, solid-state high-resolution manometry; IC, intra-luminal catheter; SE, standard error of mean. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). (2020) 891e899 intra-pharyngeal EMG catheter combined with a standardized gridded cap might be a useful tool to localize brain function/dysfunction by linking brain activation to the corresponding physical reaction. Brain Stimu...

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“…Park et al [39] compared the efficacy of the stimulation of both hemispheres to the stimulation of the affected hemisphere, both at 10 Hz, and observed a considerable superior improvement with bilateral stimulation. Actually, unilateral stimulation was not significantly more effective than sham stimulation in their work, contrarily to what was reported in the literature, which the authors justified with the variability on subjects' characteristics and the small sample size.…”

Section: Tms Application To Improve Dysphagiamentioning

confidence: 99%

“…Moreover, applying rTMS in the early phase can be a source of bias when interpreting the intervention results, since patients frequently recover their swallowing abilities in this stage by natural mechanisms [18]. rTMS was applied to the oesophageal cortical representation area [6,19], pharyngeal motor cortex [18], suprahyoid muscle cortical area [7], mylohyoid cortical area [17,38,39], tongue cortical area [16] or abductor pollicis brevis cortical area [7]. A great difference between protocols was observed.…”

Section: Tms Application To Improve Dysphagiamentioning

confidence: 99%

“…Studies applied low-frequency rTMS to suppress the nonlesioned hemisphere [17,38], or high-frequency to facilitate the excitability of either the unaffected [18], the affected [6,7,16,17] or even both hemispheres simultaneously [19]. Park et al [39] set up a treatment group where patients received high-frequency rTMS (HF-rTMS) over mylohyoid cortical area of the affected hemisphere followed by the same protocol over the unaffected hemisphere and a group receiving HF-rTMS to the affected hemisphere and sham stimulation on the unaffected hemisphere. Stimulation of either hemisphere is hypothetically valid since the swallowing musculature has its representation on both hemispheres and is innervated bilaterally [17].…”

Section: Tms Application To Improve Dysphagiamentioning

confidence: 99%

See 1 more Smart Citation

Transcranial Magnetic Stimulation as an Intervention Tool to Recover from Language, Swallowing and Attentional Deficits after Stroke: A Systematic Review

2018

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Background: Following a stroke event, patients often are severely affected by disabilities that hinder their quality-of-life. There are currently several rehabilitative options and strategies, and it is crucial to find the most effective interventions. The applicability of transcranial magnetic stimulation (TMS) to the recovery of nonmotor functions such as communication skills, swallowing ability and spatial attention after stroke remains important clinical questions. Summary: We searched PubMed and ISI Web of Science for articles that used repetitive TMS protocols to rehabilitate post-stroke deficits. We analysed qualitatively 38 articles that met the eligibility criteria; of these, 21 dealt with aphasia, 8 with dysphagia, 8 with neglect and 1 with visual extinction. The efficacy of TMS as an intervention for post-stroke rehabilitation of these nonmotor deficits was studied as well as the current limitations were assessed. Key Messages: Most part of the included studies reported statistically significant functional improvements, supporting the use of TMS for the rehabilitation of aphasia, dysphagia and neglect. Future research, with larger sample sizes, is mandatory to confirm its efficacy, determine the optimal stimulation parameters and investigate inter-subject variability.

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Effects of Bilateral Repetitive Transcranial Magnetic Stimulation on Post-Stroke Dysphagia

Cited by 98 publications

References 30 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

TMS brain mapping of the pharyngeal cortical representation in healthy subjects

Transcranial Magnetic Stimulation as an Intervention Tool to Recover from Language, Swallowing and Attentional Deficits after Stroke: A Systematic Review

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