Abstract
Swallowing difficulties are a common symptom of multiple sclerosis (MS). The early detection and treatment of dysphagia is critical to prevent complications, including poor nutrition, dehydration, and lung infections. Recently, transcranial direct current stimulation (tDCS) has been proven to be effective in ameliorating swallowing problems in stroke patients. In this pilot study, we aimed to assess safety and efficacy of transcranial direct current stimulation (tDCS) in the treatment of dysphagia in MS patients. We screened 30 patients by using the 10-item DYsphagia in MUltiple Sclerosis (DYMUS) questionnaire, and patients at risk for dysphagia underwent a clinical and fiberoptic endoscopic evaluation of swallowing (FEES). Six patients who presented with mild to moderate dysphagia underwent the experimental procedures. These consisted of 5 sessions of anodal tDCS applied in consecutive days over the right swallowing motor cortex. Patients were followed-up at 1 week, 1 month and 3 months after treatment, and changes in the Dysphagia Outcome and Severity Scale (DOSS) score between baseline and post-tDCS were assessed. Our results showed that in all patients, the tDCS treatment determined a mild but significant clinical benefit (one-point improvement in the DOSS score) lasting up to 1 month. In conclusion, our preliminary results show that anodal tDCS has therapeutic potential in the treatment of swallowing problems in patients suffering with MS. However, future double-blind, randomized, and sham-controlled studies are needed to confirm the present findings.
References
Alfonsi E, Bergamaschi R, Cosentino G, Ponzio M, Montomoli C, Restivo DA, Brighina F, Ravaglia S, Prunetti P, Bertino G, Benazzo M, Fontana D, Moglia A (2013) Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis. Clin Neurophysiol 124(8):1638–1645
Alali D, Ballard K, Bogaardt H (2016) Treatment effects for dysphagia in adults with multiple sclerosis: a systematic review. Dysphagia 31(5):610–618
Cosentino G, Alfonsi E, Brighina F, Fresia M, Fierro B, Sandrini G, Schindler A, Valentino F, Fontana D, Priori A (2014) Transcranial direct current stimulation enhances sucking of a liquid bolus in healthy humans. Brain Stimul 7(6):817–822
Jefferson S, Mistry S, Singh S, Rothwell J, Hamdy S (2009) Characterizing the application of transcranial direct current stimulation in human pharyngeal motor cortex. Am J Physiol Gastrointest Liver Physiol 297(6):G1035–G1040
Kumar S, Wagner CW, Frayne C, Zhu L, Selim M, Feng W, Schlaug G (2011) Noninvasive brain stimulation may improve stroke-related dysphagia: a pilot study. Stroke 42(4):1035–1040
Shigematsu T, Fujishima I, Ohno K (2013) Transcranial direct current stimulation improves swallowing function in stroke patients. Neurorehabil Neural Repair 27(4):363–369
Bergamaschi R, Crivelli P, Rezzani C, Patti F, Solaro C, Rossi P, Restivo D, Maimone D, Romani A, Bastianello S, Tavazzi E, D'Amico E, Montomoli C, Cosi V (2008) The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis. J Neurol Sci 269(1–2):49–53
Hamdy S, Aziz Q, Rothwell JC, Singh KD, Barlow J, Hughes DG, Tallis RC, Thompson DG (1996) The cortical topography of human swallowing musculature in health and disease. Nat Med 2:1217e24
Suntrup S, Teismann I, Wollbrink A, Winkels M, Warnecke T, Flöel A, Pantev C, Dziewas R (2013) Magnetoencephalographic evidence for the modulation of cortical swallowing processing by transcranial direct current stimulation. NeuroImage 83:346–354
Zhao S, Dou Z, Wei X, Li J, Dai M, Wang Y, Yang Q, He H (2015) Task-concurrent anodal tDCS modulates bilateral plasticity in the human suprahyoid motor cortex. Front Hum Neurosci 9:370
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Cosentino, G., Gargano, R., Bonura, G. et al. Anodal tDCS of the swallowing motor cortex for treatment of dysphagia in multiple sclerosis: a pilot open-label study. Neurol Sci 39, 1471–1473 (2018). https://doi.org/10.1007/s10072-018-3443-x
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DOI: https://doi.org/10.1007/s10072-018-3443-x