Fostering eating after stroke (FEASt) trial for improving post-stroke dysphagia with non-invasive brain stimulation

• Published in: Scientific reports Vol. 12; no. 1; pp. 9607 - 12
• Main Authors: Kumar, Sandeep, Marchina, Sarah, Langmore, Susan, Massaro, Joseph, Palmisano, Joseph, Wang, Na, Searls, David Eric, Lioutas, Vasileios, Pisegna, Jessica, Wagner, Cynthia, Shinde, Anant, Schlaug, Gottfried
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 10.06.2022; Nature Publishing Group; Nature Portfolio
• Subjects: 631/378; 631/378/2591; Brain; Cerebral infarction; Deglutition Disorders - etiology; Deglutition Disorders - therapy; Dysphagia; Electrical stimulation of the brain; ESB; Humanities and Social Sciences; Humans; multidisciplinary; Safety; Science; Science (multidisciplinary); Seizures; Stroke; Stroke - complications; Stroke - therapy; Stroke Rehabilitation; Swallowing; Transcranial Direct Current Stimulation - adverse effects; Treatment Outcome
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-14390-9

Dysphagia is a serious stroke complication but lacks effective therapy . We investigated safety and preliminary efficacy of anodal transcranial direct current stimulation (atDCS) paired with swallowing exercises in improving post-stroke dysphagia from an acute unilateral hemispheric infarction (UHI). We conducted a double-blind, early phase-2 randomized controlled trial, in subjects (n = 42) with moderate-severe dysphagia [Penetration and Aspiration Scale (PAS) score ≥ 4], from an acute-subacute UHI. Subjects were randomized to Low-Dose, High-Dose atDCS or Sham stimulation for 5 consecutive days. Primary safety outcomes were incidence of seizures, neurological, motor, or swallowing function deterioration. Primary efficacy outcome was a change in PAS scores at day-5 of intervention. Main secondary outcome was dietary improvement at 1-month, assessed by Functional Oral Intake (FOIS) score. No differences in pre-defined safety outcomes or adjusted mean changes in PAS, FOIS scores, between groups, were observed. Post-hoc analysis demonstrated that 22 /24 subjects in the combined atDCS group had a clinically meaningful dietary improvement (FOIS score ≥ 5) compared to 8 /14 in Sham ( p  = 0.037, Fisher-exact). atDCS application in the acute-subacute stroke phase is safe but did not decrease risk of aspiration in this early phase trial. The observed dietary improvement is promising and merits further investigation.