Mylohyoid motor‐evoked potentials relate to swallowing function after chronic stroke dysphagia

Gallas, Syrine; Moirot, Pierre; Debono, G; Navarre, I; Denis, P.; Marie, Jean; Vérin, Eric

doi:10.1111/j.1365-2982.2006.00892.x

Cited by 27 publications

(34 citation statements)

References 20 publications

(27 reference statements)

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“…All the different best points that were identified and then used for pharyngeal cortical stimulations on the healthy hemisphere corresponded to that described for the mylohyoid muscle [14]. The threshold was 79 ± 9% of maximal intensity of the stimulator output and did not change during the different sessions.…”

Section: Resultsmentioning

confidence: 99%

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Poststroke Dysphagia Rehabilitation by Repetitive Transcranial Magnetic Stimulation: A Noncontrolled Pilot Study

Vérin

Leroi

2008

Dysphagia

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Poststroke dysphagia is frequent and significantly increases patient mortality. In two thirds of cases there is a spontaneous improvement in a few weeks, but in the other third, oropharyngeal dysphagia persists. Repetitive transcranial magnetic stimulation (rTMS) is known to excite or inhibit cortical neurons, depending on stimulation frequency. The aim of this noncontrolled pilot study was to assess the feasibility and the effects of 1-Hz rTMS, known to have an inhibitory effect, on poststroke dysphagia. Seven patients (3 females, age = 65 +/- 10 years), with poststroke dysphagia due to hemispheric or subhemispheric stroke more than 6 months earlier (56 +/- 50 months) diagnosed by videofluoroscopy, participated in the study. rTMS at 1 Hz was applied for 20 min per day every day for 5 days to the healthy hemisphere to decrease transcallosal inhibition. The evaluation was performed using the dysphagia handicap index and videofluoroscopy. The dysphagia handicap index demonstrated that the patients had mild oropharyngeal dysphagia. Initially, the score was 43 +/- 9 of a possible 120 which decreased to 30 +/- 7 (p < 0.05) after rTMS. After rTMS, there was an improvement of swallowing coordination, with a decrease in swallow reaction time for liquids (p = 0.0506) and paste (p < 0.01), although oral transit time, pharyngeal transit time, and laryngeal closure duration were not modified. Aspiration score significantly decreased for liquids (p < 0.05) and residue score decreased for paste (p < 0.05). This pilot study demonstrated that rTMS is feasible in poststroke dysphagia and improves swallowing coordination. Our results now need to be confirmed by a randomized controlled study with a larger patient population.

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Section: Resultsmentioning

confidence: 99%

“…Each pair was positioned submentally, 2 cm lateral to midline, with one pair over the left mylohyoid muscle and the other pair over the right mylohyoid muscle [13]. They were connected to an EMG recording system (EMG 100C, Biopac), with the filters set at 2-5 kHz, the frequency at 20 kHz, and the sweep length at 1 s [14].…”

Section: Electromyographic Recordingsmentioning

confidence: 99%

Poststroke Dysphagia Rehabilitation by Repetitive Transcranial Magnetic Stimulation: A Noncontrolled Pilot Study

Vérin

Leroi

2008

Dysphagia

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“…Although independent of handedness, this would suggest that one hemisphere is ''dominant'' [28] in much the same way as for the control of speech. Electrical activity in muscles innervated by the cranial nerves can also be elicited ipsilaterally through stimulation of either hemisphere [27,29,30]. Thus, in addition to decussating pathways, uncrossed corticonuclear projections are likely to contribute to normal swallowing function and may provide a potential substrate for reorganisation in the event of stroke.…”

Section: Cortical Plasticity and Functional Recoverymentioning

confidence: 97%

“…Indeed, videofluoroscopy and TMS have been used to demonstrate that the degree of swallowing difficulty after dysphagic stroke is inversely related to the magnitude of MEPs evoked within the mylohyoid muscles [27], which are important in the oropharyngeal stage of the swallow [6].…”

Section: Cortical Plasticity and Functional Recoverymentioning

confidence: 99%

Role of Cerebral Cortex Plasticity in the Recovery of Swallowing Function Following Dysphagic Stroke

Barritt

Smithard

2008

Dysphagia

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Effective swallowing is an essential part of life and is performed thousands of times per day, often without conscious consideration. Difficulty in swallowing (dysphagia) commonly arises in stroke patients following ischemia of the cerebral cortex. However, whereas this tends to resolve spontaneously in the majority of patients, a small percentage will be left with a persistent dysphagia, which predisposes to airway compromise and aspiration pneumonia. This article reviews the recent research into ways of restoring swallowing function in these patients through promoting plasticity and reorganisation of the remaining, viable cerebral cortex.

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“…The distance between the two electrodes of each pair was 1 cm [17]. They were connected to an EMG recording system (EMG 100C, Biopac, Santa Barbara, CA), with the filters set from 2 Hz to 5 kHz, the frequency at 20 kHz, and the sweep length at 0.5 s [20].…”

Section: Pharyngeal Cortical Stimulationsmentioning

confidence: 99%

Sensory Transcutaneous Electrical Stimulation Improves Post-Stroke Dysphagic Patients

et al. 2009

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Oropharyngeal dysphagia is frequent in stroke patients and increases mortality, mainly because of pulmonary complications. We hypothesized that sensitive transcutaneous electrical stimulation applied submentally during swallowing could help rehabilitate post-stroke oropharyngeal dysphagia by improving cortical sensory motor circuits. Eleven patients were recruited for the study (5 females, 68 ± 11 years). They all suffered from recent oropharyngeal dysphagia (>eight weeks) induced by a hemispheric (n = 7) or brainstem (n = 4) stroke, with pharyngeal residue and/or laryngeal aspiration diagnosed by videofluoroscopy. Submental electrical stimulations were performed for 1 h every day for 5 days (electrical trains: 5 s every minute, 80 Hz, under motor threshold). During the electrical stimulations, the patients were asked to swallow one teaspoon of paste or liquid. Swallowing was evaluated before and after the week of stimulations using a dysphagia handicap index questionnaire, videofluoroscopy, and cortical mapping of pharyngeal muscles. The results of the questionnaire showed that oropharyngeal dysphagia symptoms had improved (p < 0.05), while the videofluoroscopy measurements showed that laryngeal aspiration (p < 0.05) and pharyngeal residue (p < 0.05) had decreased and that swallowing reaction time (p < 0.05) had improved. In addition, oropharyngeal transit time, pharyngeal transit time, laryngeal closure duration, and cortical pharyngeal muscle mapping after the task had not changed. These results indicated that sensitive submental electrical stimulations during swallowing tasks could help to rehabilitate post-stroke swallowing dysphagia by improving swallowing coordination. Plasticity of the sensory swallowing cortex is suspected.

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Mylohyoid motor‐evoked potentials relate to swallowing function after chronic stroke dysphagia

Cited by 27 publications

References 20 publications

Poststroke Dysphagia Rehabilitation by Repetitive Transcranial Magnetic Stimulation: A Noncontrolled Pilot Study

Poststroke Dysphagia Rehabilitation by Repetitive Transcranial Magnetic Stimulation: A Noncontrolled Pilot Study

Role of Cerebral Cortex Plasticity in the Recovery of Swallowing Function Following Dysphagic Stroke

Sensory Transcutaneous Electrical Stimulation Improves Post-Stroke Dysphagic Patients

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