title: Noninvasive brain stimulation may improve stroke-related dysphagia: a pilot study.
abstract: OBJECTIVE
  Treatment options for stroke-related dysphagia are currently limited. In this study, we investigated whether noninvasive brain stimulation in combination with swallowing maneuvers facilitates swallowing recovery in dysphagic stroke patients during early stroke convalescence.
  
  
  METHODS
  Fourteen patients with subacute unilateral hemispheric infarction were randomized to anodal transcranial direct current stimulation (tDCS) versus sham stimulation to the sensorimotor cortical representation of swallowing in the unaffected hemisphere over the course of 5 consecutive days with concurrent standardized swallowing maneuvers. Severity of dysphagia was measured using a validated swallowing scale, Dysphagia Outcome and Severity scale, before the first and after the last session of tDCS or sham. The effect of tDCS was analyzed in a multivariate linear regression model using changes in Dysphagia Outcome and Severity Scale as the outcome variable after adjusting for the effects of other potential confounding variables such as the National Institutes of Health Stroke Scale and Dysphagia Outcome and Severity scale scores at baseline, acute ischemic lesion volumes, patient age, and time from stroke onset to stimulation.
  
  
  RESULTS
  Patients who received anodal tDCS gained 2.60 points of improvement in Dysphagia Outcome and Severity scale scores compared to patients in the sham stimulation group who showed an improvement of 1.25 points (P=0.019) after controlling for the effects of other aforementioned variables. Six out 7 (86%) patients in tDCS stimulation group gained at least 2 points of improvement compared with 3 out 7 (43%) patients in the sham group (P=0.107).
  
  
  CONCLUSIONS
  Because brain stem swallowing centers have bilateral cortical innervations, measures that enhance cortical input and sensorimotor control of brain stem swallowing may be beneficial for dysphagia recovery.
authors: Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Avenue, Palmer 127 Boston, MA 02215, USA. skumar@bidmc.harvard.edu
authors: Sandeep
authors: S
authors: Kumar
authors: Cynthia W
authors: CW
authors: Wagner
authors: Colleen
authors: C
authors: Frayne
authors: Lin
authors: L
authors: Zhu
authors: Magdy
authors: M
authors: Selim
authors: Wuwei
authors: W
authors: Feng
authors: Gottfried
authors: G
authors: Schlaug
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome