CHICAGO — Electrically stimulating the swallowing apparatus at the back of the throat improves swallow function and speeds the recovery of normal feeding in patients with dysphagia following stroke, according to a small, randomized trial.
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, United Kingdom. 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 (PA) score of 3 or more on an 8-point scale.
PES was associated with a significant reduction in mean cumulative PA scores 2 weeks post-treatment, with a 16% improvement in cumulative PA 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 PA scores greater than 3. The University of Manchester provided support for the current study. The investigators reported no conflicts of interest.
Electrical stimulation is provided with an indwelling pharyngeal catheter.
Source Courtesy Dr. Vanoo Jayasekeran