Effects of Insular Cortex on Post-Stroke Dysphagia: A Systematic Review and Meta Analysis

Abstract

Objective: To investigate the relationship of lobar and deep brain regions with post-stroke dysphagia (PSD). Method: The databases of Medline, Embase, Web of Science, and Cochrane Library were searched from the establishment to May 2022. Studies that investigated the effects of lesions in lobar and deep brain regions on swallowing function after stroke were screened. The primary outcomes were PSD-related brain regions (including aspiration-related and oral transit time-related brain regions). The secondary outcomes were the incidence rate of PSD. The brain regions with the most overlap in the included studies were considered to be most relevant to PSD, and were presented as percentages. Data were compared utilizing the t-tests for continuous variables and χ2 for frequency-based variables. Result: A total of 24 studies and 2306 patients were included. The PSD-related lobar and deep brain regions included the insular cortex, frontal lobe, temporal gyrus, basal ganglia, postcentral, precentral, precuneus, corona radiate, etc. Among these brain regions, the insular cortex was most frequently reported (taking up 54.2%) in the included studies. Furthermore, the total incidence rate of PSD was around 40.4%, and the incidence of male was nearly 2.57 times as much as that of female (χ2 = 196.17, p < 0.001). Conclusions: In lobar and deep brain regions, the insular cortex may be most relevant to PSD and aspiration, which may be a potentially promising target in the treatment of PSD.

Research hotspots and trends in post-stroke dysphagia: a bibliometric analysis

“…Hamdy indicated that the cortical control of the pharynx represented interhemispheric asymmetry, and acute ischemic stroke in the right hemisphere could cause more severe pharyngeal dysfunction ( Hamdy et al, 1998 ; Wilmskoetter et al, 2018 ). In addition, the insular cortex is a commonly affected area and may be associated with aspiration ( Qiao et al, 2022 ). The recovery of oral intake could be affected by white matter lesions within the first week, whereas the dysphagia recovery was influenced by lesions in specific cortical nodes of swallowing during the 2–4 weeks ( Galovic et al, 2017 ).…”

Neural basis of dysphagia in stroke: A systematic review and meta-analysis

“…The reason for the association between lesion location and stroke recovery may be the possibility of compensatory neurological recovery, such as the recruitment of new residual brain regions, depending on the damaged brain region (Wilmskoetter et al, 2020). Qiao et al (2022) performed a qualitative structural neuroimaging analysis of poststroke dysphagia (PSD) and found that the insular cortex, frontal lobe, temporal gyrus, basal ganglia, postcentral gyrus, precentral gyrus, precuneus, and radial corona were the relevant brain areas for dysphagia and the insular cortex probably had the greatest association with PSD and aspiration, but the results obtained lacked quantitative analysis. In related functional MRI methods studies, for example, Mihai et al (2016) found hyperactivation of the contralateral primary somatosensory cortex but hypoactivation of the bilateral primary motor cortex, supplementary motor cortex, thalamus, and insula in patients with PSD compared to controls.…”