Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015:2015:429053.
doi: 10.1155/2015/429053. Epub 2015 Nov 24.

Pharyngeal Electrical Stimulation for Treatment of Poststroke Dysphagia: Individual Patient Data Meta-Analysis of Randomised Controlled Trials

Polly Scutt  1 , Han S Lee  1 , Shaheen Hamdy  2 , Philip M Bath  1
Affiliations
Review

Pharyngeal Electrical Stimulation for Treatment of Poststroke Dysphagia: Individual Patient Data Meta-Analysis of Randomised Controlled Trials

Polly Scutt et al. Stroke Res Treat. 2015.

Abstract

Background. Dysphagia after stroke is common, associated independently with poor outcome, and has limited treatment options. Pharyngeal electrical stimulation (PES) is a novel treatment being evaluated for treatment of poststroke dysphagia. Methods. We searched electronically for randomised controlled trials of PES in dysphagic patients within 3 months of stroke. Individual patient data were analysed using regression, adjusted for trial, age, severity, and baseline score. The coprimary outcomes were radiological aspiration (penetration aspiration score, PAS) and clinical dysphagia (dysphagia severity rating scale, DSRS) at 2 weeks; secondary outcomes included functional outcome, death, and length of stay in hospital. Results. Three completed trials were identified: 73 patients, age 72 (12) years, severity (NIHSS) 11 (6), DSRS 6.7 (4.3), mean PAS 4.3 (1.8). Compared with no/sham stimulation, PES was associated with lower PAS, 3.4 (1.7) versus 4.1 (1.7), mean difference -0.9 (p = 0.020), and lower DSRS, 3.5 (3.8) versus 4.9 (4.4), mean difference -1.7 (p = 0.040). Length of stay in hospital tended to be shorter: 50.2 (25.3) versus 71.2 (60.4) days (p = 0.11). Functional outcome and death did not differ between treatment groups. Conclusions. PES was associated with less radiological aspiration and clinical dysphagia and possibly reduced length of stay in hospital across three small trials.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Box and whisker plot of change in penetration aspiration score from baseline to two weeks, by source trial. Comparison of pharyngeal electrical stimulation (PES) versus no PES by multiple linear regression with adjustment, overall mean difference −0.9 (95% confidence interval −1.7, −0.1; p = 0.020); no difference between trials (p = 0.89).
Figure 2
Figure 2
Mean penetration aspiration score, in subgroups: Age (≤70, >70), sex (female, male), stroke syndrome (non-TACS, TACS), stroke severity (NIHSS ≤10, >10), stroke type (IS, ICH); DSRS (≤7, >7), mean PAS (≤4, >4), number PAS >3 (0, >0), trial (1, 2, and 3), treatment current (<10, 10–20, and >20 mA), sensitivity current (<8, 8–12, and >12 mA), treatment-sensitivity current (<3.5, ≥3.5 mA). Interaction tests adjusted for trial, age, and baseline NIHSS and PAS.
Figure 3
Figure 3
Box and whisker plot of change in dysphagia severity rating scale (DSRS) from baseline to two weeks, by source trial. Comparison of pharyngeal electrical stimulation (PES) versus no PES by multiple linear regression with adjustment, overall mean difference −1.7 (95% confidence interval −3.2, −0.1; p = 0.040); no difference between trials (p = 0.18).
See this image and copyright information in PMC

References

    1. Smithard D. G., Smeeton N. C., Wolfe C. D. A. Long-term outcome after stroke: does dysphagia matter? Age and Ageing. 2007;36(1):90–94. doi: 10.1093/ageing/afl149. - DOI - PubMed
    1. Martino R., Foley N., Bhogal S., Diamant N., Speechley M., Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756–2763. doi: 10.1161/01.str.0000190056.76543.eb. - DOI - PubMed
    1. Falsetti P., Acciai C., Palilla R., et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. Journal of Stroke & Cerebrovascular Diseases. 2009;18(5):329–335. doi: 10.1016/j.jstrokecerebrovasdis.2009.01.009. - DOI - PubMed
    1. Geeganage C., Beavan J., Ellender S., Bath P. M. W. Interventions for dysphagia and nutritional support in acute and subacute stroke. The Cochrane Database of Systematic Reviews. 2012;10 doi: 10.1002/14651858.CD000323.pub2.CD000323 - DOI - PubMed
    1. Hamdy S., Aziz Q., Rothwell J. C., et al. The cortical topography of human swallowing musculature in health and disease. Nature Medicine. 1996;2(11):1217–1224. doi: 10.1038/nm1196-1217. - DOI - PubMed