Repetitive transcranial magnetic stimulation demonstration

Testing hi-tech way to treat swallowing problems

Researchers are testing new hi-tech methods to help people with swallowing problems after a stroke or Parkinson’s disease.

Swallowing problems are common and can be devastating for patients. With a poor swallow, food or drink can pass into the lungs and cause respiratory problems which can progress to a more serious complication, aspiration pneumonia. This can result in patients having to be admitted to hospital or needing a longer hospital stay and more care on discharge.

Currently swallowing difficulties can be treated by exercises to strengthen the muscles involved in swallowing or changing food consistency to thick liquids or pureed food. Sometimes, however, problems are so severe that a patient needs to be fed through a tube.

The new methods being tested at Salford Royal (part of the Northern Care Alliance NHS Group) and The University of Manchester include repetitive transcranial magnetic stimulation (rTMS), a non-invasive form of brain stimulation. This uses rapidly changing magnetic fields to stimulate areas of the brain. It’s a quick and painless treatment that’s been shown to have a beneficial effect on swallowing problems (also known as dysphagia) when targeted on the cortical area of the brain – the outer layer responsible for most information processing.

Scientists are testing rTMS on people with Parkinson’s disease, a neurological condition with symptoms which include stiff and inflexible muscles. The team believes that rTMS or pharyngeal (throat) electrical stimulation could benefit those with swallowing problems due to Parkinson’s disease. They are recruiting 60 people with Parkinson’s disease to test this.

They are also testing a new method of rTMS, which targets on the cerebellum instead of the cortical area. This part of the brain is at the base of the skull and is thought to be important to muscle activity during the process of swallowing.

Dr Ivy Cheng is one of the team developing the research at Salford Royal. She added: “We have looked at the effects of cerebellar rTMS in healthy volunteers over the past four years which showed it has potential as a treatment. We have also tested cerebellar rTMS on one stroke patient, focusing the treatment on the undamaged side of the brain, and had really promising results. The lady had had severe dysphagia but was able to swallow more safely after a single treatment. She also continued to improve after she was discharged from hospital, so that five months after leaving she was able to eat and drink normally.

“Now we want to find out what the most effective dose of the treatment is so we are comparing a higher frequency of rTMS twice a day for five days with a lower frequency once daily for three days.

“The treatment itself takes only 30 seconds and isn’t painful at all but the effects appear to be long-lasting.”

The team aim to test the treatment on 48 patients.

The projects are funded by the charity Parkinson’s UK and Medical Research Council.