title: Transcranial direct current stimulation reverses neurophysiological and behavioural effects of focal inhibition of human pharyngeal motor cortex on swallowing.
abstract: The human cortical swallowing system exhibits bilateral but functionally asymmetric representation in health and disease as evidenced by both focal cortical inhibition (pre-conditioning with 1 Hz repetitive transcranial magnetic stimulation; rTMS) and unilateral stroke, where disruption of the stronger (dominant) pharyngeal projection alters swallowing neurophysiology and behaviour. Moreover, excitatory neurostimulation protocols capable of reversing the disruptive effects of focal cortical inhibition have demonstrated therapeutic promise in post-stroke dysphagia when applied contralaterally. In healthy participants (n = 15, 8 males, mean age (±SEM) 35 ± 9 years), optimal parameters of transcranial direct current stimulation (tDCS) (anodal, 1.5 mA, 10 min) were applied contralaterally after 1 Hz rTMS pre-conditioning to the strongest pharyngeal projection. Swallowing neurophysiology was assessed in both hemispheres by intraluminal recordings of pharyngeal motor-evoked responses (PMEPs) to single-pulse TMS as a measure of cortical excitability. Swallowing behaviour was examined using a pressure-based reaction time protocol. Measurements were made before and for up to 60 min post intervention. Subjects were randomised to active or sham tDCS after 1 Hz rTMS on separate days and data were compared using repeated measures ANOVA. Active tDCS increased PMEPs bilaterally (F1,14 = 7.4, P = 0.017) reversing the inhibitory effects of 1 Hz rTMS in the pre-conditioned hemisphere (F1,14 = 10.1, P = 0.007). Active tDCS also enhanced swallowing behaviour, increasing the number of correctly timed challenge swallows compared to sham (F1,14 = 6.3, P = 0.025). Thus, tDCS to the contralateral pharyngeal motor cortex reverses the neurophysiological and behavioural effects of focal cortical inhibition on swallowing in healthy individuals and has therapeutic potential for dysphagia rehabilitation.
authors.affiliation: Gastrointestinal Centre, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Salford Royal NHS Foundation Trust, Salford M6 8HD, UK.  shaheen.hamdy@manchester.ac.uk.
authors.forename: Dipesh H
authors.initials: DH
authors.lastname: Vasant
authors.forename: Satish
authors.initials: S
authors.lastname: Mistry
authors.forename: Emilia
authors.initials: E
authors.lastname: Michou
authors.forename: Samantha
authors.initials: S
authors.lastname: Jefferson
authors.forename: John C
authors.initials: JC
authors.lastname: Rothwell
authors.forename: Shaheen
authors.initials: S
authors.lastname: Hamdy
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation; D003679:Deglutition; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000502:physiology*; D009433:Neural Inhibition; D010614:Pharynx / Q000294:innervation / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation