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Innovative Treatments for Neurogenic Dysphagia

I

IRCCS National Neurological Institute "C. Mondino" Foundation

Status

Completed

Conditions

Stroke, Complication
Parkinson's Disease

Treatments

Other: NMES + swallowing therapy
Other: Sham tDCS
Other: Bihemispheric anodal tDCS
Other: Unilateral anodal tDCS
Other: Sham NMES + swallowing therapy

Study type

Interventional

Funder types

Other

Identifiers

NCT07152899
Neu-Dysphagia

Details and patient eligibility

About

This study aims to evaluate different non-invasive and neuromuscular stimulation treatments for neurogenic dysphagia in post-stroke and Parkinson's disease patients. The study is divided into three sub-studies:

  1. Unilateral, bihemispheric, or sham transcranial Direct Current Stimulation (tDCS) in post-stroke dysphagia (patients ≥2 weeks from onset).
  2. Bihemispheric or sham tDCS in Parkinson's disease-related dysphagia.
  3. Neuromuscular stimulation therapy in post-stroke and Parkinson's disease dysphagia.

Full description

Neurogenic dysphagia, commonly seen in post-stroke and Parkinson's disease patients, significantly impacts quality of life. Despite emerging treatments, there remains a lack of consensus on the best approaches for these conditions. This study evaluates three different innovative therapeutic interventions and their efficacy in improving swallowing function:

Sub-study 1: Evaluates the effects of unilateral, bihemispheric, or sham tDCS applied to the swallowing motor cortex in post-stroke patients with dysphagia.

Sub-study 2: Evaluates the effects of bihemispheric or sham tDCS in Parkinson's disease patients with dysphagia.

Sub-study 3: Examines the effects of neuromuscular electrical stimulation (NMES) therapy on swallowing function in both post-stroke and Parkinson's disease patients.

Each intervention was administered over a 6-week period with outcome measures assessed at baseline and post-treatment. All treatments were applied in conjunction with a personalized and intensive speech therapy program.

This study aims to provide valuable insights into the effectiveness of tDCS and NMES as adjuncts to traditional swallowing therapy. By targeting mechanisms of brain plasticity and neuromuscular function, the study could improve treatment strategies for neurogenic dysphagia in stroke and Parkinson's disease patients. Ultimately, the findings could contribute to evidence-based guidelines for managing dysphagia in these populations.

This interventional study recruited a total of 110 participants: 70 patients with post-stroke dysphagia and 40 patients with Parkinson's disease-related dysphagia. Participants were consecutively enrolled from collaborating institutions.

Following informed consent, participants underwent a standardized evaluation protocol consisting of clinical and neurophysiological assessments. Swallowing function was assessed using the Dysphagia Outcome and Severity Scale (DOSS) as the primary outcome measure. Secondary outcomes include the Penetration-Aspiration Scale (PAS), Mann Assessment of Swallowing Ability (MASA), Swallowing Quality of Life Questionnaire (SWAL-QOL), and Motor Evoked Potentials (MEPs) of tongue musculature in a subgroup of participants.

All stimulation interventions (tDCS or NMES) were delivered by trained clinicians according to standardized protocols. Each session was accompanied by a personalized intensive speech and swallowing therapy session, administered by certified speech-language pathologists.

Enrollment

110 patients

Sex

All

Ages

18 to 85 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Adults aged 18-85 years
  • Diagnosis of post-stroke or Parkinson's disease-related dysphagia
  • Dysphagia duration ≥ 2 weeks for post-stroke patients and ≥ 6 months for Parkinson's disease patients
  • Ability to undergo rehabilitation therapy
  • Written informed consent obtained

Exclusion criteria

  • Severe dysphagia requiring Percutaneous Endoscopic Gastrostomy (PEG) feeding for more than 1 year
  • Non-neurogenic causes of dysphagia
  • Contraindications to tDCS or NMES
  • Cognitive impairment affecting compliance with treatment

Trial design

Primary purpose

Treatment

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

Double Blind

110 participants in 7 patient groups, including a placebo group

Unilateral anodal tDCS
Experimental group
Description:
In post-stroke dysphagia
Treatment:
Other: Unilateral anodal tDCS
Bihemispheric anodal tDCS
Experimental group
Description:
In post-stroke dysphagia
Treatment:
Other: Bihemispheric anodal tDCS
Sham tDCS
Placebo Comparator group
Description:
In post-stroke dysphagia
Treatment:
Other: Sham tDCS
Anodal tDCS in both hemispheres
Experimental group
Description:
In Parkinson's disease dysphagia
Treatment:
Other: Bihemispheric anodal tDCS
Placebo tDCS
Placebo Comparator group
Description:
In Parkinson's disease dysphagia
Treatment:
Other: Sham tDCS
NMES + swallowing therapy
Experimental group
Description:
In patients with post-stroke dysphagia and Parkinson's disease dysphagia
Treatment:
Other: NMES + swallowing therapy
Sham NMES + swallowing therapy
Placebo Comparator group
Description:
In patients with post-stroke dysphagia and Parkinson's disease dysphagia
Treatment:
Other: Sham NMES + swallowing therapy

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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