Universität zu Köln

Suntrup-Krueger, Sonja, Ringmaier, Corinna, Muhle, Paul, Wollbrink, Andreas, Kemmling, Andre, Hanning, Uta, Claus, Inga, Warnecke, Tobias, Teismann, Inga, Pantev, Christo and Dziewas, Rainer ORCID: 0000-0003-1592-8461 (2018). Randomized trial of transcranial direct current stimulation for poststroke dysphagia. Ann. Neurol., 83 (2). S. 328 - 341. HOBOKEN: WILEY. ISSN 1531-8249

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Abstract

ObjectiveWe evaluated whether transcranial direct current stimulation (tDCS) is able to enhance dysphagia rehabilitation following stroke. Besides relating clinical effects with neuroplastic changes in cortical swallowing processing, we aimed to identify factors influencing treatment success. MethodsIn this double-blind, randomized study, 60 acute dysphagic stroke patients received contralesional anodal (1mA, 20 minutes) or sham tDCS on 4 consecutive days. Swallowing function was thoroughly assessed before and after the intervention using the validated Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS) and clinical assessment. In 10 patients, swallowing-related brain activation was recorded applying magnetoencephalography before and after the intervention. Voxel-based statistical lesion pattern analysis was also performed. ResultsStudy groups did not differ according to demographic data, stroke characteristics, or baseline dysphagia severity. Patients treated with tDCS showed greater improvement in FEDSS than the sham group (1.3 vs 0.4 points, mean difference=0.9, 95% confidence interval [CI]=0.4-1.4, p<0.0005). Functional recovery was accompanied by a significant increase of activation (p<0.05) in the contralesional swallowing network after real but not sham tDCS. Regarding predictors of treatment success, for every hour earlier that treatment was initiated, there was greater improvement on the FEDSS (adjusted odds ratio=0.99, 95% CI=0.98-1.00, p<0.05) in multivariate analysis. Stroke location in the right insula and operculum was indicative of worse response to tDCS (p<0.05). InterpretationApplication of tDCS over the contralesional swallowing motor cortex supports swallowing network reorganization, thereby leading to faster rehabilitation of acute poststroke dysphagia. Early treatment initiation seems beneficial. tDCS may be less effective in right-hemispheric insulo-opercular stroke. Ann Neurol 2018;83:328-340

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Suntrup-Krueger, Sonja UNSPECIFIED UNSPECIFIED UNSPECIFIED Ringmaier, Corinna UNSPECIFIED UNSPECIFIED UNSPECIFIED Muhle, Paul UNSPECIFIED UNSPECIFIED UNSPECIFIED Wollbrink, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Kemmling, Andre UNSPECIFIED UNSPECIFIED UNSPECIFIED Hanning, Uta UNSPECIFIED UNSPECIFIED UNSPECIFIED Claus, Inga UNSPECIFIED UNSPECIFIED UNSPECIFIED Warnecke, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED Teismann, Inga UNSPECIFIED UNSPECIFIED UNSPECIFIED Pantev, Christo UNSPECIFIED UNSPECIFIED UNSPECIFIED Dziewas, Rainer UNSPECIFIED orcid.org/0000-0003-1592-8461 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-197519
DOI:	10.1002/ana.25151
Journal or Publication Title:	Ann. Neurol.
Volume:	83
Number:	2
Page Range:	S. 328 - 341
Date:	2018
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1531-8249
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NONINVASIVE BRAIN-STIMULATION; SCREENING SWALLOWING FUNCTION; LESION LOCATION; ACUTE STROKE; PART 2; MOTOR; TDCS; TOOL; IDENTIFICATION; COMPLICATIONS Multiple languages Clinical Neurology; Neurosciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19751