Transcranial direct current stimulation treatment in chronic after-stroke dysphagia: A clinical case.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that has shown positive effects in a variety of motor diseases including dysphagia. However, its clinical application and underlying microstructural effects are still being researched. We tested whether tDCS applied together with swallowing training could benefit a treatment-resistent patient with dysphagia after a stroke.

METHOD: The clinical case was a 64 year old male who suffered from a left medial cerebellum stroke lesion leading to severe dysphagia. The treatment consisted of a traditional swallowing rehabilitation treatment, which served as a baseline measure, followed by an intervention adding tDCS (anodal/left M1/16 sessions/20 min/1mA). The variables measured were (1) clinical symptoms of dysphagia, (2) quality of life and (3) microstructural changes with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI).

RESULTS: Results showed (1) a slight reduction of the clinical symptoms, (2) an improvement in the quality of life domains of communication, fatigue and sleep and (3) an enhancement of the connectivity and increase of the number of fibers of the injured left medium cerebellum peduncle.

CONCLUSIONS: These results support the use of tDCS as a coadjuvant neurorehabilitation tool in cases which are resistant to traditional motor rehabilitation.