A feasibility pilot study of the effects of neurostimulation on dysphagia recovery in Parkinson’s Disease

Ulrike Hammerbeck,Charlotte James,Ivy Cheng,Emilia Michou,Ayodele Sasegbon,Mengqing Zhang,Shaheen Hamdy

doi:10.12688/amrcopenres.13007.1

Ulrike Hammerbeck, Charlotte James + Show 5 more

Open Access

https://doi.org/10.12688/amrcopenres.13007.1

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Abstract

Introduction: Dysphagia often occurs during Parkinson’s disease (PD) and can have severe consequences. Recently, neuromodulatory techniques have been used to treat neurogenic dysphagia. Here we aimed to compare the neurophysiological and swallowing effects of three different types of neurostimulation, 5 Hertz (Hz) repetitive transcranial magnetic stimulation (rTMS), 1 Hz rTMS and pharyngeal electrical stimulation (PES). Method: 12 PD patients with dysphagia were randomised to receive either 5 Hz rTMS, 1 Hz rTMS, or PES. In a cross-over design, patients were assigned to one intervention and received both real and sham stimulation. Patients received a baseline videofluoroscopic (VFS) assessment of their swallowing, enabling penetration aspiration scores (PAs) to be calculated for: thin fluids, paste, solids and cup drinking. Swallowing timing measurements were also performed on thin fluid swallows only. They then had baseline recordings of motor evoked potentials (MEPs) from both pharyngeal and (as a control) abductor pollicis brevis (APB) cortical areas using single-pulse TMS. Subsequently, the intervention was administered and post interventional TMS recordings were taken at 0 and 30 minutes followed by a repeat VFS within 60 minutes of intervention. Results: All interventions were well tolerated. Due to lower than expected recruitment, statistical analysis of the data was not undertaken. However, with respect to PAs swallowing timings and MEP amplitudes, there was visual separation in a positive direction between active and sham groups for all interventions. Conclusion: PES, 5 Hz rTMS and 1 Hz rTMS are tolerable interventions in PD related dysphagia. Due to small patient numbers no definitive conclusions could be drawn from the data with respect to individual interventions improving swallowing function and comparative effectiveness between interventions. Larger future studies are needed to further explore the efficacy of these neuromodulatory treatments in Parkinson’s Disease associated dysphagia.

Highlights

Dysphagia often occurs during Parkinson’s disease (PD) and can have severe consequences
For each of the three interventions; 1Hz repetitive transcranial magnetic stimulation (rTMS), 5Hz rTMS and pharyngeal electrical stimulation (PES), active stimulation was compared with sham
Five patients were randomly allocated to the 5 Hz rTMS group (4 male 1 female), 3 to the PES group (3 males) and 4 to the 1 Hz rTMS group (3 males 1 female)

Summary

Introduction

Dysphagia often occurs during Parkinson’s disease (PD) and can have severe consequences. Due to small patient numbers no definitive conclusions could be drawn from the data with respect to individual interventions improving swallowing function and comparative. Parkinson’s disease (PD) is a common neurodegenerative condition of unclear aetiology wherein there is a build-up of Lewy Bodies within dopaminergic regions of the brain[1]. These Lewy Bodies are primarily composed of the protein alpha synuclein and cause damage to the internal workings of neurones[2,3]. The direct pathway occurs as a result of Lewy body related damage to swallowing centres within the brain[12]. The indirect pathway is due to damage to non-motor brain areas which results in dementia[13] which causes dysphagia[14]

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