Pharyngeal Electrical Stimulation for Treatment of Dysphagia in Subacute Stroke

Abstract

Supplemental Digital Content is available in the text.

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

“…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.…”

“…Thus, motor-cortical reorganization subsequent to PES might indeed show its full effect only after several days post-treatment. It was basically this assumption that made the authors of all previous PES studies recruiting “regular” stroke patients to determine the primary endpoint around 14 days after the start of PES [30, 37, 38]. Opposed to this, the restoration of afferent sensory feedback happens probably much faster.…”

“…PES was also used with good success in a small trial including dysphagic patients suffering from multiple sclerosis [42]. The comparatively larger STEPS trial ( S wallowing T reatment Using E lectrical P haryngeal S timulation) recruited 162 patients with post-stroke dysphagia from 20 sites [30]. PES treatment was applied in median 13.4 days post-stroke (standard deviation: 9.7 days).…”

“…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.…”

Stroke

“…There is evidence from magnetic resonance studies that this treatment has potential but the amount, frequency, timing and duration of treatment is not known. A randomised, sham-controlled trial of a novel pharyngeal stimulation device to stimulate swallowing recovery 23 was negative but has given useful information to guide future studies and remains an exciting area for further research.…”