Pharyngeal electrical stimulation can modulate swallowing in cortical processing and behavior — Magnetoencephalographic evidence

Suntrup, Sonja; Teismann, Inga; Wollbrink, Andreas; Winkels, Martin; Warnecke, Tobias; Pantev, Christo; Dziewas, Rainer

doi:10.1016/j.neuroimage.2014.10.016

Cited by 43 publications

(60 citation statements)

References 67 publications

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“…During the MEG measurement, the participants' head movements were continuously recorded. For later rejection of stimulation trials contaminated by swallowing artifacts, swallowing acts were identified by surface electromyographic (EMG) recording with bipolar skin electrodes (Ag-AgCl) placed on the submental muscle groups as previously performed [7,17]. The electrodes were connected to a bipolar amplifier (DSQ 2017E EOG/EMG system, CTF Systems Inc., Canada).…”

Section: Meg Data Acquisitionmentioning

confidence: 99%

“…Stimulation episodes contaminated by swallows were rejected. By applying a fourth order two-pass Butterworth filter prior to further computations, MEG data were filtered within five different frequency bands: theta (4-8 Hz), alpha (8-13 Hz), beta (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), low gamma (30-60 Hz), and high-gamma (60-80 Hz).…”

Section: Meg Data Analysismentioning

confidence: 99%

“…Sensory stimulation is known to evoke an event related desynchronization (ERD) in respective cortical regions [22]. Source localization of each single subject's cortical ERD changes due to pneumatic pharyngeal stimulation was performed separately in all frequency bands for the anesthesia and no-anesthesia condition applying a linearly constrained minimum variance (LCMV) beamformer and a single shell volume conduction model [23] generated from the canonical single subject T1-weighted MRI (SPM8, http://www.fil.ion.ucl.ac.uk/spm) implemented in FieldTrip as previously described [17,24]. Relative power changes were determined by contrasting the active stage (0 to 500 ms) after the pneumatic stimulus against baseline (-500 to 0 ms) prior to the stimulus, because these time windows could be identified as relevant in previous time-frequency wavelet analysis for this stimulation task [15].…”

Section: Meg Data Analysismentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Meg Data Acquisitionmentioning

confidence: 99%

Section: Meg Data Analysismentioning

confidence: 99%

Section: Meg Data Analysismentioning

confidence: 99%

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

et al. 2018

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“…Subsequently the stimulation parameter with a pulse duration of 0.2 ms at a frequency of 5 Hz with 280 V were found to be most effective for this treatment [18]. In a magnetoencephalography (MEG) study, one session of PES was associated with changes of swallow-related brain activation within specific cortical areas such as the right primary and secondary sensorimotor cortex and the right supplementary motor area [19]. …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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 success. Methods: 23 tracheotomized stroke patients who could not be decannulated due to severe and persisting dysphagia according to endoscopic evaluation received PES for 10 minutes a day over three consecutive days in this prospective single-center study. If initial treatment failed, repetitive stimulation cycles were provided. Saliva samples were collected before and directly after each PES. Results: 61% of participants were decannulated after the first treatment cycle. Increase of SP levels post-stimulation was closely related to treatment success, i.e. decannulation with 79% of successfully treated patients showing increase of SP, whereas 89% of unsuccessfully treated patients had stable or decreased SP levels. Applying logistic regression analysis, increase of SP level remained the only independent predictor of decannulation after PES. All 3 repetitively treated patients showed increased SP levels when progressing from the 1^st to the 2^nd cycle, two of whom were decannulated hereafter. Conclusions: The physiological mechanism of PES may consist in restoration of sensory feedback, which is known to be crucial for the execution of a safe swallow. SP possibly acts as a biomarker for indicating response to PES.

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“…However, TT has varying degrees of success [2]. In order to improve the clinical outcomes for dysphagic patients, different treatment approaches have been developed, including pharyngeal electrical stimulation [3], repetitive transcranial stimulation [4], transcranial direct current stimulation [5] and chemical stimulation [6]. Among these, a new treatment option, neuromuscular electrical stimulation (NMES), has recently been proposed [7].…”

Section: Introductionmentioning

confidence: 99%

Neuromuscular Electrical Stimulation for Treatment-Refractory Chronic Dysphagia in Tube-Fed Patients: A Prospective Case Series

Scarponi

Mozzanica

Cristofaro

et al. 2015

Folia Phoniatr Logop

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Objective: The aim of this study was to evaluate the role of neuromuscular electrical stimulation (NMES) in tube-fed patients with severe and chronic dysphagia refractory to traditional swallowing therapy (TT). Patients and Methods: A total of 11 consecutive dysphagic patients with tube-dependent nutrition and who had not responded to 6 months of TT were enrolled. Each patient received NMES for 30 min and TT for 30 min, twice a day, 5 days per week for 4 weeks. In order to evaluate the swallowing impairment, each patient underwent a fiberoptic endoscopic examination of swallowing immediately before the beginning of the treatment, after 2 weeks and after 4 weeks. Results: All enrolled patients managed to complete the swallowing treatment protocol for at least 2 weeks. After the 4-week treatment, 6 of 11 enrolled patients passed to a total oral diet with single or multiple consistencies despite specific food limitations or special preparation or compensation. Five patients, all affected by the most severe form of dysphagia, maintained tube-dependent nutrition. Conclusion: NMES as adjunctive treatment to TT may offer a new possibility for the management of tube-fed patients who are refractory to TT.

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Pharyngeal electrical stimulation can modulate swallowing in cortical processing and behavior — Magnetoencephalographic evidence

Cited by 43 publications

References 67 publications

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

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

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

Neuromuscular Electrical Stimulation for Treatment-Refractory Chronic Dysphagia in Tube-Fed Patients: A Prospective Case Series

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