Pharyngeal Electrical Stimulation in Dysphagia Poststroke

Abstract

Background. Pharyngeal electrical stimulation (PES) appears to promote cortical plasticity and swallowing recovery poststroke. Objective. We aimed to assess clinical effectiveness with longer follow-up. Methods. Dysphagic patients (n = 36; median = 71 years; 61% male) recruited from 3 trial centers within 6 weeks of stroke, received active or sham PES in a single-blinded randomized design via an intraluminal pharyngeal catheter (10 minutes, for 3days). The primary outcome measure was the Dysphagia Severity Rating (DSR) scale (<4, no-mild; ≥4, moderate-severe). Secondary outcomes included unsafe swallows on the Penetration-Aspiration Scale (PAS ≥ 3), times to hospital discharge, and nasogastric tube (NGT) removal. Data were analyzed using logistic regression. Odds/hazard ratios (ORs/HRs) >1 for DSR <4, hospital discharge, and NGT removal and OR <1 for PAS ≥3, indicated favorable outcomes for active PES. Results. Two weeks post-active PES, 11/18 (61%) had DSR <4: OR (95% CI) = 2.5 (0.52, 14). Effects of active versus sham for secondary outcomes included the following: PAS ≥3 at 2 weeks, OR (95% CI) = 0.61 (0.27, 1.4); times to hospital discharge, 39 days versus 52 days, HR (95% CI) = 1.2 (0.55, 2.5); NGT removal 8 versus 14 days, HR (95% CI) = 2.0 (0.51, 7.9); and DSR <4 at 3 months, OR (95% CI) = 0.97 (0.13, 7.0). PES was well tolerated, without adverse effects or associations with serious complications (chest infections/death). Conclusions. Although the direction of observed differences were consistent with PES accelerating swallowing recovery over the first 2 weeks postintervention, suboptimal recruitment prevents definitive conclusions. Our study design experience and outcome data are essential to inform a definitive, multicenter randomized trial.

Increase of Substance P Concentration in Saliva after Pharyngeal Electrical Stimulation in Severely Dysphagic Stroke Patients – an Indicator of Decannulation Success?

“…Based on the proof-of-principle study in 2010 [37], PES is usually applied as single treatment cycle comprising 3 stimulations on 3 consecutive days [27, 30, 38]. The present study provides the first data to re-evaluate this standard procedure.…”

“…Thus, motor-cortical reorganization subsequent to PES might indeed show its full effect only after several days post-treatment. It was basically this assumption that made the authors of all previous PES studies recruiting “regular” stroke patients to determine the primary endpoint around 14 days after the start of PES [30, 37, 38]. Opposed to this, the restoration of afferent sensory feedback happens probably much faster.…”

“…In non-intubated stroke patients, two smaller randomized controlled trials and one related meta-analysis showed significant improvement of swallowing function and in particular a reduction of aspiration risk post PES [37, 38, 41]. PES was also used with good success in a small trial including dysphagic patients suffering from multiple sclerosis [42].…”

<p>Effectiveness of Neuromuscular Electrical Stimulation on Post-Stroke Dysphagia: A Systematic Review of Randomized Controlled Trials</p>

“…34,35 Interventions Studies comparing the effectiveness of nNMES, and/or conventional swallowing therapy with controlled group; conventional swallowing therapies, and/or placebo/sham stimulations were considered. The treatment duration ranged from 10-60 minutes for each session, 35,36 2-5 times per week 33,34,37 for a 2-6 week period. 30,38…”

“…Of all included studies, 6 studies evaluated swallowing function by using PAS. 30,[34][35][36]38,39 Four studies evaluated swallowing function by using VFDS, 30,32,38,40 and only three studies used FDS. 34,35,38…”