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COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 6  |  Page : 1467--1468

Poststroke Dysphagia- Does Electrophysiology Help in Evaluation and Monitoring?

Soumya Sundaram, PN Sylaja 
 Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India

Correspondence Address:
Dr. P N Sylaja
Department of Neurology, Comprehensive Stroke Care Program, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011, Kerala
India




How to cite this article:
Sundaram S, Sylaja P N. Poststroke Dysphagia- Does Electrophysiology Help in Evaluation and Monitoring?.Neurol India 2019;67:1467-1468


How to cite this URL:
Sundaram S, Sylaja P N. Poststroke Dysphagia- Does Electrophysiology Help in Evaluation and Monitoring?. Neurol India [serial online] 2019 [cited 2020 Jun 2 ];67:1467-1468
Available from: http://www.neurologyindia.com/text.asp?2019/67/6/1467/273612


Full Text



Poststroke dysphagia (PSD) predisposes patients to aspiration pneumonia and malnutrition. It has a deleterious impact on morbidity and mortality, prolonging hospital stay, and adding to treatment costs.[1] While large-scale clinical trials have led to giant strides in the management of acute stroke, the evaluation and management of PSD has not received similar attention.

This issue of the journal features a novel study by Umay et al. exploring the electrophysiological techniques in the evaluation of PSD. In this research article, electrical stimulation of facial, trigeminal, and hypoglossal nerves was used for determining the oral phase of swallowing and electroneuromyography (EMNG) records from submental electrodes and laryngeal piezoelectric sensors for recording pharyngeal phase of swallowing. The authors had prospectively evaluated 51 patients with PSD and compared them with a similar number of age–gender-matched healthy individuals. The swallowing parameters, such as duration of swallowing reflex, triggering time of swallowing reflex, and total oropharyngeal phase, were significantly prolonged in patients with stroke when compared with the healthy controls. After four weeks of intensive dysphagia intervention, a significant but incomplete improvement was observed when compared with the baseline. The motor action potential (MAP) amplitudes from masseter, orbicularis oris, and intrinsic tongue muscles were significantly lower than the healthy group, which also improved after four weeks. This study has shown that the electrophysiological swallowing intervals and MAPs assessment from the muscles involved in the oral phase of deglutition can objectively assess and monitor PSD.[2] Stroke-related sarcopenia characterized by muscle degradation and atrophy can also affect the cranial musculature and hence, the reduction in MAPs from these tested muscles.[3]

Clinical bedside assessment, videofluoroscopy swallow study (VFSS), and fibre optic endoscopic evaluation of swallowing (FEES) are the investigative modalities routinely used for the diagnosis and monitoring of dysphagia in stroke units; however, each one has its merits and demerits. The cortical reorganisation assessed by transcranial magnetic stimulation (TMS), functional neuroimaging, and magnetic encephalography (MEG) was found to correlate with the recovery of dysphagia, but it had limited applicability outside research settings.[4] Electrophysiological evaluation can provide an objective alternative technique for outcome assessment in various interventions in the management of dysphagia, such as postural and swallow techniques and neurostimulation using TMS, pharyngeal electrical stimulation (PES), or neuromuscular electric stimulation (NMES).

In the current study, a less explored electrophysiological approach for the evaluation of cranial nerves participating in the oral phase of swallowing was used. Oropharyngeal swallow assessment using a laryngeal sensor in different conditions of neurogenic dysphagia, including stroke, has been examined previously.[5] A combination of these two approaches has been used for the first time in this study. It has shown to be a reliable modality for objectively assessing dysphagia, but a correlation with bedside swallow assessment and FESS scoring was not available.

Electrophysiological evaluation of dysphagia is a promising technique as it is noninvasive and devoid of any complications and radiation exposure. However, in clinical practice, to incorporate these methods into the evaluation and follow-up of PSD, further evidence regarding clinical utility and comparison with the existing diagnostic modalities are essential.

References

1Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: Incidence, diagnosis, and pulmonary complications. Stroke 2005;36:2756-63.
2Umay EK, Yilmaz V, Gundogdu I, Ozturk E, Gurcay E, Karaahmet O, et al. What happens to swallowing muscles after stroke?: A prospective randomized controlled electrophysiological study. Neurol India 2019;67:1459-66.
3Scherbakov N, von Haehling S, Anker SD, Dirnagl U, Doehner W. Stroke induced sarcopenia: Muscle wasting and disability after stroke. Int J Cardiol 2013;170:89-94.
4Cohen DL, Roffe C, Beavan J, Blackett B, Fairfield CA, Hamdy S, et al. Post-stroke dysphagia: A review and design considerations for future trials. Int J Stroke 2016;11:399-411.
5Ertekin C, Aydogdu I, Tarlaci S, Turman AB, Kiylioglu N. Mechanisms of dysphagia in suprabulbar palsy with lacunar infarct. Stroke 2000;31:1370-6.