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

Abstract

ObjectivesDysphagia is a major cause of stroke infection and death, and identification of structural and functional brain area changes associated with post-stroke dysphagia (PSD) can help in early screening and clinical intervention. Studies on PSD have reported numerous structural lesions and functional abnormalities in brain regions, and a systematic review is lacking. We aimed to integrate several neuroimaging studies to summarize the empirical evidence of neurological changes leading to PSD.MethodsWe conducted a systematic review of studies that used structural neuroimaging and functional neuroimaging approaches to explore structural and functional brain regions associated with swallowing after stroke, with additional evidence using a live activation likelihood estimation (ALE) approach.ResultsA total of 35 studies were included, including 20 studies with structural neuroimaging analysis, 14 studies with functional neuroimaging analysis and one study reporting results for both. The overall results suggest that structural lesions and functional abnormalities in the sensorimotor cortex, insula, cerebellum, cingulate gyrus, thalamus, basal ganglia, and associated white matter connections in individuals with stroke may contribute to dysphagia, and the ALE analysis provides additional evidence for structural lesions in the right lentiform nucleus and right thalamus and functional abnormalities in the left thalamus.ConclusionOur findings suggest that PSD is associated with neurological changes in brain regions such as sensorimotor cortex, insula, cerebellum, cingulate gyrus, thalamus, basal ganglia, and associated white matter connections. Adequate understanding of the mechanisms of neural changes in the post-stroke swallowing network may assist in clinical diagnosis and provide ideas for the development of new interventions in clinical practice.

The impact of physical therapy on dysphagia in neurological diseases: a review

“…Such diseases include stroke, Parkinson’s disease, and multiple sclerosis, among other neurodegenerative disease processes ( Chandran and Doucet, 2024 ). Dysphagia following stroke primarily stems from cerebral cortex and subcortical structures damage, affecting areas like the motor cortex, cerebellum, thalamus, and other parts, as well as sensory defects of the pharyngeal mucosa ( Teismann et al, 2007 ; Qin et al, 2023 ). It is characterized by a delayed or absent swallowing reflex and a premature overflow of bolus ( Labeit et al, 2023 ), pharyngeal food residues and pharyngeal motility disorders ( Warnecke et al, 2021 ).…”

Recent Computational Methods for Pathological Brain Detection

“…Voxel-Based Morphometry (VBM) [48,49] is a neuroimaging technique used to detect and analyze structural changes in the brain, making it a valuable tool for identifying pathological brains. VBM involves comparing an individual's brain image to a standardized brain template or atlas.…”

Efficacy of Feedback Based Therapy for Dysphagia in Post Stroke Patients

“…6 Tongue Push Forward Open mouth and move tongue such that tongue tip rests against the lower lip, patient attempts to move tongue forward, hold for 5 seconds, repeat 10 times. 7 Tongue Push Up Extend tongue out of mouth, patient attempts to move tongue upward against the upper lip, hold for 5 seconds, repeat 10 times…”

“…Some patients with severe dysphagia requires a nasogastric feeding tube for months, even to years to compensate for adequate nutrition demand and water intake [6]. The structural neuroimaging analysis in poststroke dysphagia patients 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 poststroke dysphagia [7].…”