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The effects of unilateral and bilateral cerebellar rTMS on human pharyngeal motor cortical activity and swallowing behavior.
Exp Brain Res. 2020 Aug; 238(7-8):1719-1733.EB

Abstract

The cerebellum is recognised to bilaterally modulate sensorimotor function and has recently been shown to play a role in swallowing. Unilateral cerebellar repetitive trans-cranial magnetic stimulation (rTMS) excites corticobulbar motor pathways to the pharynx but the effects of bilateral versus unilateral cerebellar rTMS on these pathways are unknown. In this three-part cross-over study, healthy participants (n = 13) were randomly allocated to receive unilateral or bilateral 10 Hz cerebellar rTMS. Participants were intubated with pharyngeal electromyography and/or manometry catheters for motor evoked potentials (MEPs) and pressure recordings. In part 1 of the study, single pulse TMS was used to measure baseline motor cortical pharyngeal MEP (PMEP) and hemispheric cerebellar MEP (CMEP) amplitudes, before cerebellar rTMS was administered. Repeat measures of PMEP amplitude were performed at 15-min intervals for an hour post unilateral and bilateral rTMS. Thereafter, in two further studies, a cortical 'virtual lesion' (V/L) was applied prior to cerebellar rTMS with pre and post PMEPs (part 2) and measurements of swallowing accuracy (part 3) using a behavioural task. Compared to baseline, unilateral and bilateral cerebellar rTMS provoked increases in pharyngeal cortical excitation (P = 0.028, 0.0005, respectively). Bilateral rTMS was significantly more effective than unilateral in causing cortical excitation (P = 0.0005) and in reversing the suppressive neurological (P = 0.0005) and behavioural (P = 0.0005) effects of a cortical V/L. Our findings suggest bilateral cerebellar rTMS has greater facilitatory effects on corticobulbar motor pathways to the pharynx than unilateral stimulation with the potential to be a more effective clinical therapy if its effects are reproduced in populations with neurogenic dysphagia.

Authors+Show Affiliations

Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Clinical Sciences Building, Eccles Old Road, Salford, M6 8HD, UK.Division of Cardiovascular Sciences, Manchester Centre for Clinical Neurosciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Salford Royal Hospital, Manchester Academic Health Sciences Centre (MAHSC), Salford, UK.Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK. Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK.Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK.Gastrointestinal (GI) Sciences, Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Clinical Sciences Building, Eccles Old Road, Salford, M6 8HD, UK. shaheen.hamdy@manchester.ac.uk.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

32232540

Citation

Sasegbon, Ayodele, et al. "The Effects of Unilateral and Bilateral Cerebellar rTMS On Human Pharyngeal Motor Cortical Activity and Swallowing Behavior." Experimental Brain Research, vol. 238, no. 7-8, 2020, pp. 1719-1733.
Sasegbon A, Smith CJ, Bath P, et al. The effects of unilateral and bilateral cerebellar rTMS on human pharyngeal motor cortical activity and swallowing behavior. Exp Brain Res. 2020;238(7-8):1719-1733.
Sasegbon, A., Smith, C. J., Bath, P., Rothwell, J., & Hamdy, S. (2020). The effects of unilateral and bilateral cerebellar rTMS on human pharyngeal motor cortical activity and swallowing behavior. Experimental Brain Research, 238(7-8), 1719-1733. https://doi.org/10.1007/s00221-020-05787-x
Sasegbon A, et al. The Effects of Unilateral and Bilateral Cerebellar rTMS On Human Pharyngeal Motor Cortical Activity and Swallowing Behavior. Exp Brain Res. 2020;238(7-8):1719-1733. PubMed PMID: 32232540.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of unilateral and bilateral cerebellar rTMS on human pharyngeal motor cortical activity and swallowing behavior. AU - Sasegbon,Ayodele, AU - Smith,Craig J, AU - Bath,Philip, AU - Rothwell,John, AU - Hamdy,Shaheen, Y1 - 2020/03/30/ PY - 2020/01/23/received PY - 2020/03/16/accepted PY - 2020/4/2/pubmed PY - 2021/6/30/medline PY - 2020/4/2/entrez KW - Bilateral KW - Cerebellar KW - Cerebellum KW - rTMS SP - 1719 EP - 1733 JF - Experimental brain research JO - Exp Brain Res VL - 238 IS - 7-8 N2 - The cerebellum is recognised to bilaterally modulate sensorimotor function and has recently been shown to play a role in swallowing. Unilateral cerebellar repetitive trans-cranial magnetic stimulation (rTMS) excites corticobulbar motor pathways to the pharynx but the effects of bilateral versus unilateral cerebellar rTMS on these pathways are unknown. In this three-part cross-over study, healthy participants (n = 13) were randomly allocated to receive unilateral or bilateral 10 Hz cerebellar rTMS. Participants were intubated with pharyngeal electromyography and/or manometry catheters for motor evoked potentials (MEPs) and pressure recordings. In part 1 of the study, single pulse TMS was used to measure baseline motor cortical pharyngeal MEP (PMEP) and hemispheric cerebellar MEP (CMEP) amplitudes, before cerebellar rTMS was administered. Repeat measures of PMEP amplitude were performed at 15-min intervals for an hour post unilateral and bilateral rTMS. Thereafter, in two further studies, a cortical 'virtual lesion' (V/L) was applied prior to cerebellar rTMS with pre and post PMEPs (part 2) and measurements of swallowing accuracy (part 3) using a behavioural task. Compared to baseline, unilateral and bilateral cerebellar rTMS provoked increases in pharyngeal cortical excitation (P = 0.028, 0.0005, respectively). Bilateral rTMS was significantly more effective than unilateral in causing cortical excitation (P = 0.0005) and in reversing the suppressive neurological (P = 0.0005) and behavioural (P = 0.0005) effects of a cortical V/L. Our findings suggest bilateral cerebellar rTMS has greater facilitatory effects on corticobulbar motor pathways to the pharynx than unilateral stimulation with the potential to be a more effective clinical therapy if its effects are reproduced in populations with neurogenic dysphagia. SN - 1432-1106 UR - https://www.unboundmedicine.com/medline/citation/32232540/The_effects_of_unilateral_and_bilateral_cerebellar_rTMS_on_human_pharyngeal_motor_cortical_activity_and_swallowing_behavior_ L2 - https://dx.doi.org/10.1007/s00221-020-05787-x DB - PRIME DP - Unbound Medicine ER -