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Transcranial direct current stimulation reverses neurophysiological and behavioural effects of focal inhibition of human pharyngeal motor cortex on swallowing.
J Physiol. 2014 Feb 15; 592(4):695-709.JP

Abstract

The human cortical swallowing system exhibits bilateral but functionally asymmetric representation in health and disease as evidenced by both focal cortical inhibition (pre-conditioning with 1 Hz repetitive transcranial magnetic stimulation; rTMS) and unilateral stroke, where disruption of the stronger (dominant) pharyngeal projection alters swallowing neurophysiology and behaviour. Moreover, excitatory neurostimulation protocols capable of reversing the disruptive effects of focal cortical inhibition have demonstrated therapeutic promise in post-stroke dysphagia when applied contralaterally. In healthy participants (n = 15, 8 males, mean age (±SEM) 35 ± 9 years), optimal parameters of transcranial direct current stimulation (tDCS) (anodal, 1.5 mA, 10 min) were applied contralaterally after 1 Hz rTMS pre-conditioning to the strongest pharyngeal projection. Swallowing neurophysiology was assessed in both hemispheres by intraluminal recordings of pharyngeal motor-evoked responses (PMEPs) to single-pulse TMS as a measure of cortical excitability. Swallowing behaviour was examined using a pressure-based reaction time protocol. Measurements were made before and for up to 60 min post intervention. Subjects were randomised to active or sham tDCS after 1 Hz rTMS on separate days and data were compared using repeated measures ANOVA. Active tDCS increased PMEPs bilaterally (F1,14 = 7.4, P = 0.017) reversing the inhibitory effects of 1 Hz rTMS in the pre-conditioned hemisphere (F1,14 = 10.1, P = 0.007). Active tDCS also enhanced swallowing behaviour, increasing the number of correctly timed challenge swallows compared to sham (F1,14 = 6.3, P = 0.025). Thus, tDCS to the contralateral pharyngeal motor cortex reverses the neurophysiological and behavioural effects of focal cortical inhibition on swallowing in healthy individuals and has therapeutic potential for dysphagia rehabilitation.

Authors+Show Affiliations

Gastrointestinal Centre, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Salford Royal NHS Foundation Trust, Salford M6 8HD, UK. shaheen.hamdy@manchester.ac.uk.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24247983

Citation

Vasant, Dipesh H., et al. "Transcranial Direct Current Stimulation Reverses Neurophysiological and Behavioural Effects of Focal Inhibition of Human Pharyngeal Motor Cortex On Swallowing." The Journal of Physiology, vol. 592, no. 4, 2014, pp. 695-709.
Vasant DH, Mistry S, Michou E, et al. Transcranial direct current stimulation reverses neurophysiological and behavioural effects of focal inhibition of human pharyngeal motor cortex on swallowing. J Physiol. 2014;592(4):695-709.
Vasant, D. H., Mistry, S., Michou, E., Jefferson, S., Rothwell, J. C., & Hamdy, S. (2014). Transcranial direct current stimulation reverses neurophysiological and behavioural effects of focal inhibition of human pharyngeal motor cortex on swallowing. The Journal of Physiology, 592(4), 695-709. https://doi.org/10.1113/jphysiol.2013.263475
Vasant DH, et al. Transcranial Direct Current Stimulation Reverses Neurophysiological and Behavioural Effects of Focal Inhibition of Human Pharyngeal Motor Cortex On Swallowing. J Physiol. 2014 Feb 15;592(4):695-709. PubMed PMID: 24247983.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transcranial direct current stimulation reverses neurophysiological and behavioural effects of focal inhibition of human pharyngeal motor cortex on swallowing. AU - Vasant,Dipesh H, AU - Mistry,Satish, AU - Michou,Emilia, AU - Jefferson,Samantha, AU - Rothwell,John C, AU - Hamdy,Shaheen, Y1 - 2013/11/18/ PY - 2013/11/20/entrez PY - 2013/11/20/pubmed PY - 2014/10/21/medline SP - 695 EP - 709 JF - The Journal of physiology JO - J Physiol VL - 592 IS - 4 N2 - The human cortical swallowing system exhibits bilateral but functionally asymmetric representation in health and disease as evidenced by both focal cortical inhibition (pre-conditioning with 1 Hz repetitive transcranial magnetic stimulation; rTMS) and unilateral stroke, where disruption of the stronger (dominant) pharyngeal projection alters swallowing neurophysiology and behaviour. Moreover, excitatory neurostimulation protocols capable of reversing the disruptive effects of focal cortical inhibition have demonstrated therapeutic promise in post-stroke dysphagia when applied contralaterally. In healthy participants (n = 15, 8 males, mean age (±SEM) 35 ± 9 years), optimal parameters of transcranial direct current stimulation (tDCS) (anodal, 1.5 mA, 10 min) were applied contralaterally after 1 Hz rTMS pre-conditioning to the strongest pharyngeal projection. Swallowing neurophysiology was assessed in both hemispheres by intraluminal recordings of pharyngeal motor-evoked responses (PMEPs) to single-pulse TMS as a measure of cortical excitability. Swallowing behaviour was examined using a pressure-based reaction time protocol. Measurements were made before and for up to 60 min post intervention. Subjects were randomised to active or sham tDCS after 1 Hz rTMS on separate days and data were compared using repeated measures ANOVA. Active tDCS increased PMEPs bilaterally (F1,14 = 7.4, P = 0.017) reversing the inhibitory effects of 1 Hz rTMS in the pre-conditioned hemisphere (F1,14 = 10.1, P = 0.007). Active tDCS also enhanced swallowing behaviour, increasing the number of correctly timed challenge swallows compared to sham (F1,14 = 6.3, P = 0.025). Thus, tDCS to the contralateral pharyngeal motor cortex reverses the neurophysiological and behavioural effects of focal cortical inhibition on swallowing in healthy individuals and has therapeutic potential for dysphagia rehabilitation. SN - 1469-7793 UR - https://www.unboundmedicine.com/medline/citation/24247983/Transcranial_direct_current_stimulation_reverses_neurophysiological_and_behavioural_effects_of_focal_inhibition_of_human_pharyngeal_motor_cortex_on_swallowing_ L2 - https://doi.org/10.1113/jphysiol.2013.263475 DB - PRIME DP - Unbound Medicine ER -