ABSTRACT
Swallowing difficulties are a common symptom of multiple sclerosis (MS). The early detection and treatment of dysphagia is critical to prevent complications, including poor nutrition, dehydration, and lung infections. Recently, transcranial direct current stimulation (tDCS) has been proven to be effective in ameliorating swallowing problems in stroke patients. In this pilot study, we aimed to assess safety and efficacy of transcranial direct current stimulation (tDCS) in the treatment of dysphagia in MS patients. We screened 30 patients by using the 10-item DYsphagia in MUltiple Sclerosis (DYMUS) questionnaire, and patients at risk for dysphagia underwent a clinical and fiberoptic endoscopic evaluation of swallowing (FEES). Six patients who presented with mild to moderate dysphagia underwent the experimental procedures. These consisted of 5 sessions of anodal tDCS applied in consecutive days over the right swallowing motor cortex. Patients were followed-up at 1 week, 1 month and 3 months after treatment, and changes in the Dysphagia Outcome and Severity Scale (DOSS) score between baseline and post-tDCS were assessed. Our results showed that in all patients, the tDCS treatment determined a mild but significant clinical benefit (one-point improvement in the DOSS score) lasting up to 1 month. In conclusion, our preliminary results show that anodal tDCS has therapeutic potential in the treatment of swallowing problems in patients suffering with MS. However, future double-blind, randomized, and sham-controlled studies are needed to confirm the present findings.
Subject(s)
Deglutition Disorders/etiology , Deglutition Disorders/therapy , Motor Cortex/physiology , Multiple Sclerosis/complications , Transcranial Direct Current Stimulation/methods , Adult , Electrodes , Electromyography , Evoked Potentials, Motor/physiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pilot Projects , Severity of Illness Index , Treatment OutcomeABSTRACT
On the basis of their experience of postextractive oral grafts, the authors examine all the surgical possibilities of this technique, at times using osteoinducing materials or at others semipermeable reabsorbable membrane; on other occasions an ostroinducing material associated with reabsorbable membrane is used to stimulate piloted regeneration of underlying bone tissue. Although not widely used, the post-extractive technique is presented as a fascinating reality that certainly, if used with due care, produces satisfactory and gratifying results. The authors are convinced that the contribution to simplifying surgical procedures and the reduced number of sessions that a patient has to undergo is without doubt a considerable advantage. In fact, using the postextractive technique with reabsorbable membrane the patient only undergoes a single operation. The authors have experience of three hundred post-extractive grafts with a very low failure rate (loss of seven grafts). These results can be attributed to clear rules: respect for antisepsis precautions, minimum surgery involving bone tissue, design of access flap to bone arch, positioning of fixture in correct spatial and occlusal direction, instant graft stability and perioplantar bone neoformation free of interference. The use of grafts has become a routine technique and is a valid alternative to prosthetic rehabilitation stages. It has become a true field with precise characteristics in the context of modern dentistry.
