Volume 32, Issue 5 e13791
ORIGINAL ARTICLE

Anodal transcranial direct current stimulation and intermittent theta-burst stimulation improve deglutition and swallowing reproducibility in elderly patients with dysphagia

Giuseppe Cosentino

Giuseppe Cosentino

Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy

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Cristina Tassorelli

Cristina Tassorelli

Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy

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Paolo Prunetti

Paolo Prunetti

Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy

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Giulia Bertino

Giulia Bertino

Department of Otolaryngology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy

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Roberto De Icco

Roberto De Icco

Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy

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Massimiliano Todisco

Massimiliano Todisco

Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy

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Salvatore Di Marco

Salvatore Di Marco

Department of Biomedicine Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy

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Filippo Brighina

Filippo Brighina

Department of Biomedicine Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy

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Antonio Schindler

Antonio Schindler

Department of Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy

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Mariangela Rondanelli

Mariangela Rondanelli

Section of Human Nutrition and Dietetics, Department of Public Health and Experimental and Forensic Medicine, University of Pavia, Pavia, Italy

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Mauro Fresia

Mauro Fresia

Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy

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Luca Mainardi

Luca Mainardi

Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy

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Domenico A. Restivo

Domenico A. Restivo

Department of Neurology, Garibaldi Hospital, Catania, Italy

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Alberto Priori

Alberto Priori

Department of Neurological Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

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Giorgio Sandrini

Giorgio Sandrini

Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

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Enrico Alfonsi

Corresponding Author

Enrico Alfonsi

Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy

Correspondence

Enrico Alfonsi, Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy.

Email: [email protected]

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First published: 23 January 2020
Citations: 23

Funding information

This study was supported by a Grant from the Italian Ministry of Health related to the Project “Presbyphagia: analysis of diagnostic criteria and identification of potential innovative treatments” RF-2010-231945.

Abstract

Background

Dysphagia in the elderly, known as presbydysphagia, has become a relevant public health problem in several countries. Swallowing disorders may be a consequence of different neurological disorders (secondary presbydysphagia) or the expression of the aging process itself (primary presbydysphagia). We aimed to test the therapeutic potential of two different non-invasive brain stimulation (NIBS) techniques in subjects with primary or secondary presbydysphagia.

Methods

A blinded randomized controlled trial with crossover design was carried out in 42 patients, randomly assigned to anodal transcranial direct current stimulation (tDCS) or intermittent theta-burst stimulation (TBS) group. Both tDCS and TBS were applied for 5 consecutive days over the right swallowing motor cortex. The swallowing function was assessed before and 1 and 3 months after the stimulation using the Dysphagia Outcome and Severity Scale (DOSS), scored based on clinical assessment and fiberoptic endoscopic evaluation of swallowing. An electrophysiological method was also applied to evaluate changes in the reproducibility of the swallowing behavior.

Key Results

Both real tDCS and TBS had beneficial effects on the swallowing function in patients with primary and secondary presbydysphagia. Anodal tDCS resulted in an improvement of 0.5 points in DOSS at 1-month follow-up (P = .014), whereas intermittent TBS induced an increase of 0.7 and 0.6 points at 1- and 3-month follow-up evaluations, respectively (P = .0001 and P = .005, respectively). Reproducibility of both the oral and pharyngeal phases of swallowing significantly increased at 1-month follow-up.

Conclusions and Inferences

Our results suggest that non-invasive cortical stimulation may be useful for dysphagia recovery in elderly patients.

CONFLICT OF INTEREST

The authors report no conflicts of interest.

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