Electrical pharyngeal stimulation for dysphagia treatment in tracheotomized stroke patients: a randomized controlled trial

Abstract

In this pilot study, EPS enhanced remission of dysphagia as assessed with fiberoptic endoscopic evaluation of swallowing (FEES), thereby enabling decannulation in 75% of patients.

Increase of Substance P Concentration in Saliva after Pharyngeal Electrical Stimulation in Severely Dysphagic Stroke Patients – an Indicator of Decannulation Success?

“…The results of this and of a preceding study by our group suggest that in addition to stimulation driven motor-cortical reorganization, restoration of peripheral sensory feedback may play a role here. Thus, in line with our previous study [27], we observed a slight decline of stimulation intensities in patients showing clinically relevant treatment response, which might be interpreted as partial recuperation of the afferent sensory system induced by PES. More importantly, however, the close relation of SP increase and successful PES treatment alludes to a causal role of SP in the underlying physiological mechanism.…”

“…Based on the proof-of-principle study in 2010 [37], PES is usually applied as single treatment cycle comprising 3 stimulations on 3 consecutive days [27, 30, 38]. The present study provides the first data to re-evaluate this standard procedure.…”

“…Every eligible patient received at least one FEES according to the protocol proposed by Warnecke and co-workers [28]. Opposed to other trials in this area [27, 29, 30], no further exclusion criteria were adopted. In particular, patients with pre-existing dysphagia or conditions known to be related to dysphagia (neurodegenerative diseases, neuromuscular disorders, malignancies of the oral cavity or throat, history of stroke) were all allowed to participate in this trial.…”

“…In the present study, we moved this topic into the clinical context and tried to find out whether PES treatment in dysphagic stroke patients is also associated with changes in salivary SP concentrations, and, in particular, whether a potential increase in SP concentration is associated with treatment success. Since we previously had shown that PES enhances remission of dysphagia in severely affected tracheotomized stroke patients, which subsequently allowed post-treatment decannulation [27] in the majority of cases, we chose a comparable cohort as a target group here.…”

Focus on clinical neuroscience

“…Neurostimulation strategies for the treatment of post-stroke dysphagia have been employed with variable degrees of success. A recent RCT in severely dysphagic tracheotomized patients found that electrical pharyngeal stimulation was significantly associated with improved airway protection and resolution of the dysphagia; it also facilitated decannulation in the majority of patients [19].…”