Therapy of Dysphagia by Prolonged Pharyngeal Electrical Stimulation (Phagenyx) in a Patient with Brainstem Infarction

Cristina Florea, Christine Bräumann, Christine Mussger, Stefan Leis, Larissa Hauer, Johann Sellner, Stefan M Golaszewski, Cristina Florea, Christine Bräumann, Christine Mussger, Stefan Leis, Larissa Hauer, Johann Sellner, Stefan M Golaszewski

Abstract

Dysphagia after stroke impacts quality of life and is a risk factor for respiratory infections. Patients frequently require prophylactic measures including nasogastric tube or percutaneous endoscopic gastrostomy. Until recently, therapy for dysphagia was limited to training with a speech and language specialist. Intraluminal pharyngeal electrical stimulation (PES) is a new technique that stimulates the pharyngeal sensory afferents to the higher swallowing center in cortex. The clinical trials published to date involved stimulation for 10 minutes over three days. We present a case of brainstem infarction with severe dysphagia in a 53-year-old woman with preserved cognitive functions. For airway protection, she had a surgical tracheotomy. The initial swallowing training achieved slight improvements, but stagnated after three months so PES was tried. Under good PES tube tolerance, a prolonged and repeated stimulation protocol was administered, with the main purpose of relieving her of the tracheal tube. Although the swallowing improved, she stayed tube-dependent with minimal attempts with puréed food during therapy, and could not be decannulated. Further studies are required to assess the value of this promising approach for the treatment of dysphagia.

Keywords: dysphagia; ischemic stroke; pharyngeal electrical stimulation; rehabilitation; treatment.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Coronal (A) and (B) transversal T2-weighted magnetic resonance imaging (MRI) which depicts ischemic stroke in the right cerebellar hemisphere, the upper medulla oblongata and the pontomedullary junction.
Figure 2
Figure 2
Stimulation intensity and duration during the first (A) and second (B) stimulation protocol.
Figure 3
Figure 3
Stimulation intensities over time. (A) Second stimulation period with high stimulation intensities two months after the first stimulation period in the acute phase. (B) Third stimulation period with lower stimulation intensities three months after the first stimulation period. (C) Stimulation intensities of all three stimulation periods over time with decreasing stimulation intensities.

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Source: PubMed

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