Evidence map›Paper›PMID 24314909›Full record

Trial reportBrain stimulation

Characterizing the mechanisms of central and peripheral forms of neurostimulation in chronic dysphagic stroke patients.

Emilia Michou, Satish Mistry, Samantha Jefferson, Pippa Tyrrell, Shaheen Hamdy

Open access · bronzeAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Brain stimulation. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
47citing papers in PubMed, 6 pooled it
13.4field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

47 citing papers in PubMed, 6 syntheses or guidelines pooled it, 91 citations in OpenAlex.

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  6. Effects of non-invasive brain stimulation on post-stroke dysphagia: A systematic review and meta-analysis of randomized controlled trials.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2016
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Emilia MichouGastrointestinal Centre, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester (Part of the Manchester Academic Health Sciences Centre [MAHSC]), Salford Royal Hospital, Clinical Sciences Building, Salford M6 8HD, UK.
Satish MistryGastrointestinal Centre, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester (Part of the Manchester Academic Health Sciences Centre [MAHSC]), Salford Royal Hospital, Clinical Sciences Building, Salford M6 8HD, UK.
Samantha JeffersonGastrointestinal Centre, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester (Part of the Manchester Academic Health Sciences Centre [MAHSC]), Salford Royal Hospital, Clinical Sciences Building, Salford M6 8HD, UK.
Pippa TyrrellStroke Medicine, Institute of Cardiovascular Sciences, University of Manchester (Part of the Manchester Academic Health Sciences Centre [MAHSC]), Salford Royal Hospital Foundation Trust, Salford M6 8HD, UK.
Shaheen HamdyGastrointestinal Centre, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester (Part of the Manchester Academic Health Sciences Centre [MAHSC]), Salford Royal Hospital, Clinical Sciences Building, Salford M6 8HD, UK. Electronic address: shaheen.hamdy@manchester.ac.uk.
University of Manchester · GBSalford Royal Hospital · GBSalford Royal NHS Foundation Trust · GB

Funding

Wellcome TrustWellcome Trust WT081741MA
6 · The paper itself

Abstract

backgroundSwallowing problems following stroke may result in increased risk of aspiration pneumonia, malnutrition, and dehydration. OBJECTIVE/HYPOTHESIS: Our hypothesis was that three neurostimulation techniques would produce beneficial effects on chronic dysphagia following stroke through a common brain mechanism that would predict behavioral response.

methodsIn 18 dysphagic stroke patients (mean age: 66 ± 3 years, 3 female, time-post-stroke: 63 ± 15 weeks [±SD]), pharyngeal electromyographic responses were recorded after single-pulse transcranial magnetic stimulation (TMS) over the pharyngeal motor cortex, to measure corticobulbar excitability before, immediately, and 30 min, after real and sham applications of neurostimulation. Patients were randomized to a single session of either: pharyngeal electrical stimulation (PES), paired associative stimulation (PAS) or repetitive TMS (rTMS). Penetration-aspiration scores and bolus transfer timings were assessed before and after both real and sham interventions using videofluoroscopy.

resultsCorticobulbar excitability of pharyngeal motor cortex was beneficially modulated by PES, PAS and to a lesser extent by rTMS, with functionally relevant changes in the unaffected hemisphere. Following combining the results of real neurostimulation, an overall increase in corticobulbar excitability in the unaffected hemisphere (P = .005, F1,17 = 10.6, ANOVA) with an associated 15% reduction in aspiration (P = .005, z = -2.79) was observed compared to sham.

conclusionsIn this mechanistic study, an increase in corticobulbar excitability the unaffected projection was correlated with the improvement in swallowing safety (P = .001, rho = -.732), but modality-specific differences were observed. Paradigms providing peripheral input favored change in neurophysiological and behavioral outcome measures in chronic dysphagia patients. Further larger cohort studies of neurostimulation in chronic dysphagic stroke are imperative.

Indexed as

Electric Stimulation TherapyTranscranial Magnetic StimulationAdultAgedAged, 80 and overDeglutition DisordersElectromyographyEvoked Potentials, MotorFemaleFunctional LateralityHumansMaleMiddle AgedMotor CortexNeuronal PlasticityPharynxChronic dysphagiacPAcumulative penetration aspirationMEPMImotor cortexmotor evoked potentialsmotor thresholdMTNational Institute of Health Stroke ScaleNeurostimulationNIHSSpaired associative stimulationPASPEGpercutaneous endoscopic gastrostomyPESpharyngeal electrical stimulationPlasticityrepetitive transcranial magnetic stimulationrTMSStroke

Identifiers

PMID24314909
PMCPMC3893483
OpenAlexW2125836335

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.