4.6 Article

A pilot study on the efficacy of transcranial direct current stimulation applied to the pharyngeal motor cortex for dysphagia associated with brainstem involvement in multiple sclerosis

Journal

CLINICAL NEUROPHYSIOLOGY
Volume 130, Issue 6, Pages 1017-1024

Publisher

ELSEVIER IRELAND LTD
DOI: 10.1016/j.clinph.2019.04.003

Keywords

Multiple sclerosis-associated dysphagia; Transcranial direct current stimulation (tDCS); Cortico-pharyngeal excitability; Swallowing motor cortex; Cricopharyngeal muscle; Pharyngeal MEPs

Funding

  1. FISM (Fondazione Italiana Sclerosi Multipla onlus) [2012/R14]

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Objective: we investigated the effect of anodal transcranial direct current stimulation (tDCS) applied over the pharyngeal motor area in dysphagia associated with multiple sclerosis (MS). Methods: Eighteen MS patients with dysphagia associated with brainstem involvement were randomized to receive either real or sham tDCS. Primary outcome: The Penetration/Aspiration Scale (PAS). Secondary outcomes: changes in electromyographic (EMG) parameters and pharyngeal cortical motor evoked potentials (MEPs). Patients were evaluated at baseline (T-0), at the end of 5-session cycle of tDCS stimulations (T-1), after two (T-2), and four (T-3) weeks. Results: the PAS values were significantly lower in the active group than in sham group at T-1, and at T-3. Over the post-stimulation periods, PAS significantly improved only in the real group. As regards the secondary outcomes, we observed a statistically significant difference between the 2 groups only in the MEPs amplitude at T-1. The comparison between baseline and each of the post-stimulation times showed significant differences only of the real group across all the secondary parameters. Conclusions: Our findings support a beneficial effect of anodal tDCS applied to the pharyngeal motor cortex in MS-associated dysphagia. Significance: Considering its safety and efficacy, tDCS may represent an important resource in MS-associated dysphagia. (C) 2019 Published by Elsevier B.V. on behalf of International Federation of Clinical Neurophysiology.

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