Electrical stimulation improves dysphagia.
Dysphagia is common after stroke and is a risk factor for disruption of normal eating patterns, need for artificial feeding, and aspiration pneumonia. Patients with dysphagia can require frequent hospitalizations for pneumonia, prolonged hospital stays, and increased need for institutionalized care.
The management of dysphagia has thus far failed to provide reliable, effective rehabilitation for these patients, according to Dr. Vanoo Jayasekeran, a clinical research fellow and GI specialist at the School of Translational Medicine, University of Manchester (England).
However, pharyngeal electrical stimulation (PES) has been shown in stroke patients to enhance cortical excitability of swallowing pathways (Gastroenterology 1998;115:1104-12) and to induce changes in the motor cortex that mimic natural recovery of dysphagia (Neuron 2002;34:831-40).
Dr. Jayasekeran and his colleagues randomly allocated 26 dysphagic stroke patients, mean age 75 years, to PES delivered via a custom-made intraluminal indwelling pharyngeal catheter or sham stimulation via an in situ catheter with no current. The PES group received the treatment for 10 minutes at 5 Hz for 3 consecutive days.
At baseline, patients had a mean score on the National Institutes of Health Stroke Survey of 10 and a penetration-aspiration scale score of 3 or more on an 8-point scale.
PES was associated with a significant reduction in mean cumutative penetration-aspiration scale scores 2 weeks post treatment, with a 16% improvement in cumulative penetration-aspiration scale scores from baseline in the PES group and an 11% deterioration in the sham group, the authors reported in a poster at a meeting on neurogastroenterology and motility.
The PES group also had a significant reduction of abnormal swallows, as indicated by fewer penetration-aspiration scale scores greater than 3. The improvement in swallowing safety was "above what is expected in natural recovery," Dr. Jayasekeran explained in an interview.
Patients who received PES were also significantly more likely than those in the sham group to progress to eating and drinking a normal diet, and were more likely to enjoy independent feeding.
At 2 weeks post treatment, feeding status scores improved by an average of 60% in the PES group, compared with an average of only 15% in the sham group.
Notably, patients treated with PES also had significantly shorter hospital stays than patients in the sham group (median 25 days vs. 33 days), the authors reported at the meeting, which was hosted by the Functional Brain-Gut Research Group.
"It is conceivable that this treatment tool may expedite the rehabilitation process, allowing for adequate patient fitness for medical discharge," Dr. Jayasekeran said. "This may be a crucial economic consideration for health care providers and stakeholders alike."
He noted that a large, multicenter, randomized PES trial sponsored by the University of Manchester is now underway in 120 dysphagic stroke patients to help determine whether this novel form of neurostimulation can reduce the time needed for patients to return to normal swallowing and thus reduce the dependence on artificial feeding.
The University of Manchester provided support for the current study. The investigators reported no conflicts of interest.
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RELATED ARTICLE: Dysphagia Seen In Community
Although dysphagia occurs frequently among stroke patients and the elderly, a population-based study suggests that it is also surprisingly common in the general community.
Among 3,669 residents of Olmsted County, Minn., who responded to a survey, 1,105 (30%) reported having difficulty swallowing in the past year, and 168 (4.6%) reported having frequent dysphagia, defined as at least weekly.
The age-adjusted prevalence for frequent dysphagia was 3%, Dr. Rok Seon Choung, a research fellow at the Mayo Clinic, Rochester., Minn., and his associates reported in a poster at a meeting on neurogastroenterology and motility.
In a univariate analysis that adjusted for age, gender, and Somatic Symptom Checklist (SSC) scores, frequent dysphagia was significantly associated with increasing age (odds ratio 1.1), SSC scores (OR 5.9), proton pump inhibitor use (OR 3.1), and a variety of GI symptoms including acid regurgitation (OR 10.6), postprandial fullness (OR 7.2), frequent heartburn (OR 5.9), and vomiting (OR 7.5), Dr. Choung reported at the meeting, hosted by the Functional Brain-Gut Research Group.
"We may be missing some dysphagia patients in the community, and these data suggest that many people in the community might have functional dysphagia," he said in an interview.
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|Publication:||Internal Medicine News|
|Date:||Oct 15, 2009|
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