Objective: Our study used a combined approach based on non-invasive neuromodulation and speech therapy to improve dysphagia in PD patients.

Background: Dysphagia is one of the most disabling and under-recognized symptoms in Parkinson’s Disease, even in the first stages of the illness [1]. Pharmacological therapies provided conflicting results, sometimes worsening both esophageal and gastric motility, whereas Deep Brain Stimulation (DBS) could reduce dysphagia for some food consistencies and limited to the oral phase only [2].

Method: 18 patients were enrolled from February 2022 to December 2024 (seven women, mean age ± SD = 62.5 ± 5.4 years; baseline OFF UPDRS-III score = 25.6 ± 3.5). They had a “`Dysphagia Outcome and Severity Scale” (DOSS) score between 2 and 6 (mean±SD = 4.25 ± 1.54). Participants underwent anodal transcranial Direct Current Stimulation (tDCS; anodes on C3-C4, cathode over the right shoulder; 20’ duration, 2.0 mA intensity for two consecutive weeks) combined with speech therapy (45’, after tDCS, 6 consecutive weeks). They were clinically and neurophysiologically evaluated before treatment (T0), two weeks later (T1), after the whole treatment (T2), and 6 weeks after (T3). Outcome measures included: Bed-Side Examination of swallowing (BSE); penetration-aspiration scale (PAS) score; quality-of-life (QOL) questionnaire (SWAL-QOL); Mann assessment of swallowing ability (MASA); ASHA-NOMS scale; Motor Evoked Potentials (MEPs) derived from the tongue muscles. Ten patients underwent “real” tDCS stimulation, while the others received “sham” treatment. Changes among different time-points were assessed by using Friedman test, whereas differences between the sham and anodal tDCS were evaluated with Kruskal-Wallis analysis.

Results: both MASA (T0: 163.5 ± 3.7; T3: 175.6 ± 5.7; p = 0.011) and SWAL-CARE (T0: 46.7 ± 6.0; T3: 79.8 ± 4.2; p = 0.0015) scores significantly improved over time, paralleled by an increase of MEP amplitudes (T0: 2.7 ± 1.3 mV; T3: 3.8 ± 1.3; p = 0.035). When sham and anodal stimulation were compared, patients enrolled in the “real stimulation” group showed a significant improvement in MASA, SWAL-CARE and SWAL-QOL scores (p = 0.048; p = 0.023; p = 0.039).

Conclusion: Our study proved a significant improvement of dysphagia in PD patients by using a novel approach, combining for the first time bi-motor tDCS [3] and conventional speech therapy.

References: [1] Cosentino G, Avenali M, Schindler A, Pizzorni N, Montomoli C, Abbruzzese G, Antonini A, Barbiera F, Benazzo M, Benarroch EE, Bertino G, Cereda E, Clavè P, Cortelli P, Eleopra R, Ferrari C, Hamdy S, Huckabee ML, Lopiano L, Marchese Ragona R, Masiero S, Michou E, Occhini A, Pacchetti C, Pfeiffer RF, Restivo DA, Rondanelli M, Ruoppolo G, Sandrini G, Schapira AHV, Stocchi F, Tolosa E, Valentino F, Zamboni M, Zangaglia R, Zappia M, Tassorelli C, Alfonsi E. A multinational consensus on dysphagia in Parkinson’s disease: screening, diagnosis and prognostic value. J Neurol. 2022;269(3):1335-1352. doi: 10.1007/s00415-021-10739-8.
[2] Troche MS, Brandimore AE, Foote KD, Okun MS. Swallowing and deep brain stimulation in Parkinson’s disease: a systematic review. Parkinsonism Relat Disord. 2013;19(9):783-8. doi: 10.1016/j.parkreldis.2013.05.001.
[3] Guidetti M, Maria Bianchi A, Parazzini M, Maiorana N, Bonato M, Ferrara R, Libelli G, Montemagno K, Ferrucci R, Priori A, Bocci T. Monopolar tDCS might affect brainstem reflexes: A computational and neurophysiological study. Clin Neurophysiol. 2023;155:44-54. doi: 10.1016/j.clinph.2023.08.011.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/an-innovative-approach-combining-transcranial-direct-current-stimulation-and-speech-therapy-for-the-treatment-of-dysphagia-in-parkinsons-disease/