title: High-frequency focal repetitive cerebellar stimulation induces prolonged increases in human pharyngeal motor cortex excitability.
abstract: CONCLUSIONS
  Neurostimulation is a rapidly emerging approach to swallowing rehabilitation, but cerebellar stimulation has not been explored as a treatment. Such proposed therapies for post-stroke dysphagia have required confirmation of physiological effects and optimisation of parameters in healthy humans prior to translational progression into patient groups. There is strong evidence for a role of the cerebellum in swallowing physiology, but this relationship has been under-explored. Recently, single pulses of cerebellar magnetic stimulation have been shown to directly evoke responses from pharyngeal musculature and produce short-term enhancement of cortico-pharyngeal motor evoked potentials, suggesting the feasibility of a cerebellar approach to neurostimulation in the swallowing system. We therefore examined multiple parameters of repetitive cerebellar magnetic stimulation and have described the optimal settings to provoke longer-lasting changes in swallowing neurophysiology. Based on evidence from the post-stroke dysphagia neurostimulation literature, these changes may have a therapeutic potential for swallowing rehabilitation.
  Brain neurostimulation has been shown to modulate cortical swallowing neurophysiology in post-stroke dysphagia with therapeutic effects which are critically dependent on the stimulation parameters. Cerebellar neurostimulation is, however, a novel, unexplored approach to modulation of swallowing pathways as a prelude to therapy for dysphagia. Here, we randomised healthy human subjects (n = 17) to receive one of five cerebellar repetitive TMS (rTMS) interventions (Sham, 1 Hz, 5 Hz, 10 Hz and 20 Hz) on separate visits to our laboratory. Additionally, a subset of subjects randomly received each of three different durations (50, 250, 500 pulses) of optimal frequency versus sham cerebellar rTMS. Prior to interventions subjects underwent MRI-guided single-pulse transcranial magnetic stimulation (TMS) to co-localise pharyngeal and thenar representation in the cortex and cerebellum (midline and hemispheric) before acquisition of baseline motor evoked potential (MEP) recordings from each site as a measure of excitability. Post-interventional MEPs were recorded for an hour and compared to sham using repeated measures ANOVA. Only 10 Hz cerebellar rTMS increased cortico-pharyngeal MEP amplitudes (mean bilateral increase 52%, P = 0.007) with effects lasting 30 min post-intervention with an optimal train length of 250 pulses (P = 0.019). These optimised parameters of cerebellar rTMS can produce sustained increases in corticobulbar excitability and may have clinical translation in future studies of neurogenic dysphagia.
authors: Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK.
authors: Dipesh H
authors: DH
authors: Vasant
authors: Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK.
authors: Emilia
authors: E
authors: Michou
authors: Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK.
authors: Satish
authors: S
authors: Mistry
authors: Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, London, UK.
authors: John C
authors: JC
authors: Rothwell
authors: Gastrointestinal Centre, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK.
authors: Shaheen
authors: S
authors: Hamdy
mesh_terms: D000328:Adult; D002531:Cerebellum / Q000502:physiology*; D003679:Deglutition; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000502:physiology*; D010614:Pharynx / Q000294:innervation / Q000502:physiology*; D050781:Transcranial Magnetic Stimulation