经颅直流电刺激对吞咽失用症及皮质兴奋性的作用

目的:探讨经颅直流电刺激治疗吞咽失用症及其与大脑皮质兴奋性变化的关系。方法:采用A-B实验设计,对2例吞咽失用症患者采用经皮电刺激配合手法训练3周前后、经颅直流电刺激治疗3周后评估舌运动、口面失用及进食能力。利用脑电非线性分析观察1例吞咽失用症患者,经颅直流电刺激治疗前后安静闭眼、反射性和自主性吞咽状态下的大脑皮质电活动,记录6名健康者脑电图作为对照。结果:经皮电刺激配合手法训练后,患者吞咽能力均没有任何改善;经颅直流电刺激治疗后,患者自主性与无意识状态下舌运动均明显改善,口面失用评分由10分恢复到34—36分,均拔除鼻饲管。经颅直流电刺激治疗前,1例患者自主性吞咽时患侧中央、颞顶区皮质兴奋性明显低于反射性吞咽,经颅直流电刺激治疗后,自主性吞咽时脑区皮质兴奋性与反射性吞咽没有明显差异。结论:经颅直流电刺激为吞咽失用症提供了一种有效治疗手段,吞咽失用症的恢复可能与吞咽皮质兴奋性提高密切相关。

Effects of transcranial direct current stimulation on swallowing apraxia and cortical excitability

Objective:To investigate the effects of transcranial direct current stimulation(tDCS) on swallowing apraxia and changes of cortical excitability.Method:Two patients with swallowing apraxia were enrolled in an A-B experiment design:Lingual movement,buccofacial apraxia and feeding were evaluated before and after 3 weeks of surface electrical stimulation combined with swallowing maneuvers(A).The same assessments were evaluated before and after 3 weeks of tDCS(B).EEG nonlinear index approximate entropy(ApEn) was calculated in 1 patient and 6 healthy subjects.EEG was recorded under eyes closed,reflexive swallowing and volitional swallowing conditions.Result:After phase A,there was no improvement in lingual movement,buccofacial apraxia and feeding.After phase B,lingual movements improved significantly,buccofacial apraxia scores increased from 10 to 34—36,nasogastric tubes were removed in all patients.Compared with healthy subjects,before tDCS cortical excitabilities of 1 patient’s affected central-parietal and post-temporal regions were suppressed in volitional swallowing task,and the excitabilities were significantly lower than that in reflexive swallowing task;while after tDCS there was no significant difference between volitional and reflexive swallowing task.Conclusion:tDCS may provide an effective treatment for promoting recovery of swallowing apraxia,and the recovery may be related to elevated excitability of swallowing cortex.