Anodal transcranial direct current stimulation and intermittent theta-burst stimulation improve deglutition and swallowing reproducibility in elderly patients with dysphagia
Giuseppe Cosentino
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorCristina Tassorelli
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorPaolo Prunetti
Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorGiulia Bertino
Department of Otolaryngology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
Search for more papers by this authorRoberto De Icco
Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorMassimiliano Todisco
Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorSalvatore Di Marco
Department of Biomedicine Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
Search for more papers by this authorFilippo Brighina
Department of Biomedicine Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
Search for more papers by this authorAntonio Schindler
Department of Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
Search for more papers by this authorMariangela Rondanelli
Section of Human Nutrition and Dietetics, Department of Public Health and Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
Search for more papers by this authorMauro Fresia
Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorLuca Mainardi
Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
Search for more papers by this authorDomenico A. Restivo
Department of Neurology, Garibaldi Hospital, Catania, Italy
Search for more papers by this authorAlberto Priori
Department of Neurological Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
Search for more papers by this authorGiorgio Sandrini
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
Search for more papers by this authorCorresponding 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]
Search for more papers by this authorGiuseppe Cosentino
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorCristina Tassorelli
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorPaolo Prunetti
Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorGiulia Bertino
Department of Otolaryngology, University of Pavia, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
Search for more papers by this authorRoberto De Icco
Neurorehabilitation Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorMassimiliano Todisco
Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorSalvatore Di Marco
Department of Biomedicine Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
Search for more papers by this authorFilippo Brighina
Department of Biomedicine Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
Search for more papers by this authorAntonio Schindler
Department of Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
Search for more papers by this authorMariangela Rondanelli
Section of Human Nutrition and Dietetics, Department of Public Health and Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
Search for more papers by this authorMauro Fresia
Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
Search for more papers by this authorLuca Mainardi
Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
Search for more papers by this authorDomenico A. Restivo
Department of Neurology, Garibaldi Hospital, Catania, Italy
Search for more papers by this authorAlberto Priori
Department of Neurological Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
Search for more papers by this authorGiorgio Sandrini
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
Search for more papers by this authorCorresponding 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]
Search for more papers by this authorFunding 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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