経頭蓋直流電気刺激で嚥下機能改善

経頭蓋直流電気刺激が脳卒中患者の嚥下機能を改善するという論文を紹介しています。浜松リハ病院からの報告です。

Takashi Shigematsu, Ichiro Fujishima, Kikuo Ohno. Transcranial Direct Current Stimulation Improves Swallowing Function in Stroke Patients. Neurorehabil Neural Repair February 7, 2013, doi: 10.1177/1545968312474116

脳卒中後1カ月以上経過した嚥下障害患者20人を対象としています。10人に実際の経頭蓋直流電気刺激を病変側の嚥下運動皮質に行い、他の10人にはシャム（偽）の刺激を行っています。両群とも通常の嚥下リハを行っています。

結果ですが、経頭蓋直流電気刺激直後、1か月後とも介入群で有意に嚥下機能が改善しました。すべての嚥下障害患者に経頭蓋直流電気刺激を行う必要はないと思いますが、中重度の嚥下障害患者には、嚥下リハを組み合わせることでとても興味深い治療法の1つになりそうです。

Abstract
Background. Poststroke dysphagia can persist, leading to many complications. Objective. We investigated whether noninvasive brain stimulation to the pharyngeal motor cortex combined with intensive swallowing therapy can improve dysphagia. Methods. A total of 20 patients who had dysphagia for at least 1 month after stroke were randomly assigned to receive 10 sessions lasting 20 minutes each of either 1-mA anodal transcranial direct current stimulation (tDCS) or a sham procedure to the ipsilesional pharyngeal motor cortex, along with simultaneous conventional swallowing therapies. We evaluated swallowing function with the Dysphagia Outcome and Severity Scale (DOSS) before, immediately after, and 1 month after the last session. Results. Anodal tDCS resulted in an improvement of 1.4 points in DOSS (P = .006) immediately after the last session and 2.8 points (P = .004) 1 month after the last session. The sham tDCS group improved 0.5 points (P = .059) after the last session and 1.2 points (P = .026) 1 month after the final session. The improvements in the anodal tDCS group were significantly greater than those in the sham tDCS group (P = .029 after the last session, and P = .007 1 month after the last session). Conclusions. Anodal tDCS to the ipsilesional hemisphere and simultaneous peripheral sensorimotor activities significantly improved swallowing function as assessed by the DOSS.