Swallowing problems – can brain stimulation help?
This research was completed on 9 December 2008
Published on 6 October 2007
Researchers working on this project estimate that each year in the UK over 40,000 people have difficulties swallowing after having a stroke.(1),(2) These difficulties lengthen sufferers’ hospital stays and put them at increased risk of complications, such as malnutrition, pneumonia and even death. The project team is investigating whether a new type of brain stimulation might boost the number of people who learn to swallow again and speed their recovery.
What's the problem and who does it affect?
Swallowing difficulties can have serious consequences
Each year in the UK, an estimated 40,000 people develop difficulties swallowing after having a stroke.(1),(2)Available treatments are controversial, with little evidence that they make any appreciable difference to someone’s recovery. Unfortunately, swallowing problems can have very serious consequences for stroke victims. They put people at risk of malnutrition, lengthen the time they have to spend in hospital and greatly increase their chances of having to go to a nursing home. Taking medication becomes problematic and many sufferers develop chest infections, particularly pneumonia. Sadly, swallowing difficulties can even increase a person’s chances of dying. If the problems persist, sufferers normally have to be fed through a tube placed in their stomach. This causes much discomfort and distress. Indeed, many regard their inability to eat and drink as being the worst aspect of having a stroke. They can feel stigmatised and become depressed. Some people remain dependent on tube feeding for the rest of their lives. Others learn how to swallow again, but their recovery is normally slow and unpredictable, taking weeks or even months. We badly need to find better treatments.
What is the project trying to achieve?
Stimulating the brain's recovery
Researchers are testing a safe and painless new technology called transcranial direct current stimulation (tDCS), which stimulates the brain using small electric currents. Ongoing trials in the USA suggest similar technologies can help stroke victims recover lost movement in their arms and hands.(3) In this study, researchers are investigating whether tDCS has the potential to help people with swallowing problems recover their ability to eat and drink again. Firstly, they are assessing how to get the best out of tDCS by varying, for example, the duration and intensity of stimulation given to healthy volunteers. Secondly, they are assessing whether tDCS has the potential to help stroke patients recover their ability to swallow. Of those patients under study, some are receiving the optimum stimulation regimen, while others are receiving sham treatment. The team is monitoring any effects on swallowing, and collecting data on death rates, diet and the incidence of respiratory infections.
What are the researchers' credentials?
|Project Leader||Dr S Hamdy PhD|
|Location||Department of GI Sciences, Medicine and Neuroscience, Hope Hospital, School of Medicine at University of Manchester|
|Grant awarded||6 July 2007|
|Start date||10 December 2007|
|End date||9 December 2008|
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The Project Leader, Dr Shaheen Hamdy, leads an expert team of clinicians who have a highly successful track record in studying the brain’s control of swallowing. They have a particular interest in how the brain recovers from a stroke, focusing on a phenomenon called cortical plasticity, which the brain uses to compensate for damage to nerve cells. The group has an international reputation, having published 142 papers in the last decade, many in premier international journals. The team has extensive, dedicated laboratory facilities and all the equipment required for this project is already in place. The researchers also benefit from many long-standing collaborations with specialists from other fields. Of particular importance to this study is a close working relationship with Dr Pippa Tyrrell, Honorary Consultant in Stroke and Clinical Senior Lecturer at the University of Manchester. Dr Tyrrell heads the North West’s Research Network for Stroke and will help recruit patients to the study.
Who stands to benefit from this research and how?
Providing essential information for large-scale trials
This is a pilot study. The goal is to find out whether it’s feasible to use tDCS to treat people who’ve developed swallowing problems after a stroke – whether tDCS has the potential to increase someone’s chances of learning how to swallow again, and to hasten or improve their recovery. If the results are promising, then researchers plan much larger clinical trials to determine, for example, the optimum frequency of treatment sessions, and provide robust evidence of any health benefits. Their work may also guide the use of tDCS to help people with other types of brain injury.
Hopes of better and faster recovery from stroke
The research group estimates that the swallowing problems suffered by stroke victims cost £200 million each year in the UK (4). With our ageing population, the cost and suffering is set to rise. Researchers believe that tDCS may be ideally suited to routine use, being pain-free, portable and suitable for delivery by specialised nurses. Their ultimate hope is that it will eventually become a gold standard treatment, changing the lives of tens of thousands of people each year.
1. Bamford J, Sandercock P, Dennis M, Burn J, and Warlow C. A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project--1981-86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 1990;53(1):16-22. 3. Gordon C, Hewer RL, and Wade DT. Dysphagia in acute stroke. Br Med J 1987;295(6595):411-4. 4. Brown JA, Lutsep, H, Weinand M and Cramer S. Motor cortex stimulation for the enhancement of recovery from stroke: a prospective, multicenter safety study. Neurosurgery 2006;58:3:464-72. 5. Smithard DG, O'Neill PA, Parks C, Morris J. Complications and outcome after acute stroke. Does dysphagia matter? Stroke 1996;27(7):1200-4.