A New Therapeutic Approach for Dystussia and Atussia in Neurogenic Dysphagia: Effect of Aerosolized Capsaicin on Peak Cough Flow.

Swallowing and cough are crucial components of airway protection. In patients with neurogenic dysphagia (ND), there is a high prevalence of dystussia (impaired cough) and atussia (absence of cough). As a result, the ability to detect and remove aspirated material from the airway decreases, exacerbating the sequelae associated with ND, including aspiration pneumonia, a leading cause of mortality in ND. This controlled intervention study aimed to quantify the cough response to aerosolized capsaicin (AC) in patients with ND and assess the potential of AC as a therapeutic tool in treating ND-related dystussia and atussia. Furthermore, we propose a novel application method that enables AC treatment to be performed at home. Spirometry was used to measure peak cough flow (PCF) of voluntary cough (cough on command) and reflexive cough (cough secondary to pharyngeal exposure to AC) in 30 subjects with and 30 without ND. The capsaicin aerosol was generated by adding 1-10 drops of liquid cayenne extract (1.5-2% capsaicin) to 100 mL carbonated water (0.00075-0.001% to 0.0075-0.01% capsaicin). Voluntary PCF in the ND group was significantly lower than in the control group (p < 0.001), while there was no significant difference in reflexive PCF (p = 0.225). Within the ND group, reflexive PCF was significantly higher than voluntary PCF (p = 0.001), while in healthy controls, reflexive PCF was significantly lower (p < 0.001). The data show that AC increased the tracheobronchial clearance efficacy in ND patients with dystussia and atussia, as it enabled subjects to access their individual cough potential, which is present, but inaccessible, due to neurological disorder.

Neurogenic dysphagia in traditional Chinese medicine.

BACKGROUND: Neurogenic dysphagia is the difficulty in swallowing caused by neurological diseases, which is a very common symptom in neurological disorders. In this paper, we try to summarize the opinions in the pathophysiology and therapy of dysphagia in ancient China (before AD 1840) through the records in the literatures from all the dynasties. METHODS: We searched the databases including Chinese Medical Classics, China National Knowledge Infrastructure, Wanfang Data, MEDLINE, and ISI Proceedings until July 2020, with the search terms "dysphagia" and "difficulty in swallowing" in English and their Chinese equivalents. RESULTS AND CONCLUSIONS: The concept of neurogenic dysphagia was first described as Hou Bi in the Yellow Emperor's Internal Classic, which is the first Chinese medical classic and the origin of traditional Chinese medicine (TCM) theory. In the different eras, the pathogenesis of neurogenic dysphagia was explained mainly by three theories in TCM, that is, the wind-phlegm blocking collaterals, the deficiency of liver and kidney-essence, and the Qi-stagnation with static blood. In addition to the TCM prescriptions, acupuncture is characteristic treatment and seems to be effective. However, the evidences of efficacy and safety from clinical trials are still required.

[Acupoint selection rules of neurogenic dysphagia treated with acupuncture and moxibustion in ancient times].

Acupoint selection rules of neurogenic dysphagia treated with acupuncture and moxibustion from pre-Qin to late Qing Dynasty in Chinese Medical Classics were analyzed based on data mining. The literature regarding acupuncture and moxibustion for neurogenic dysphagia was searched and screened according to the inclusion and exclusion criteria in Chinese Medical Classics (5th Edition), the prescriptions were extracted according to the principle of acupoint extraction.The SPSS 21.0 and Clementine 12.0 were used to perform the cluster analysis and association rule analysis.A total of 191 acupuncture and moxibustion prescriptions were screened and extracted，including 45 acupoints. The top 5 acupoints of acupuncture and moxibustion for neurogenic dysphagia in frequency were Jiache (ST 6), Dicang (ST 4), Lieque (LU 7), Lianquan (CV 23), Shuigou (GV 26). The most involved meridians were the stomach meridian, the governor vessel and the conception vessel. The main acupoints were distributed in the scalp face neck and upper limbs. The most frequently used specific acupoints was crossing points,next was eight confluence points. There were 11 acupoint combinations with strong association according to the association rule analysis, and the top one acupoint combination was Hegu (LI 4)-Jiache (ST 6). There were 9 acupoint cluster groups according to the cluster analysis. Hegu (LI 4), Jiache (ST 6), Dicang (ST 4), Shuigou (GV 26) and Chengjiang (CV 24) were core acupoints for neurogenic dysphagia treated with acupuncture and moxibustion in ancient times, besides，selecting proximal and distal acupoints and selecting acupoints according to symptoms were emphasized.

Acupoint selection rules of neurogenic dysphagia treated with acupuncture and moxibustion in ancient times / 中国针灸

Acupoint selection rules of neurogenic dysphagia treated with acupuncture and moxibustion from pre-Qin to late Qing Dynasty in were analyzed based on data mining. The literature regarding acupuncture and moxibustion for neurogenic dysphagia was searched and screened according to the inclusion and exclusion criteria in (5th Edition), the prescriptions were extracted according to the principle of acupoint extraction.The SPSS 21.0 and Clementine 12.0 were used to perform the cluster analysis and association rule analysis.A total of 191 acupuncture and moxibustion prescriptions were screened and extracted，including 45 acupoints. The top 5 acupoints of acupuncture and moxibustion for neurogenic dysphagia in frequency were Jiache (ST 6), Dicang (ST 4), Lieque (LU 7), Lianquan (CV 23), Shuigou (GV 26). The most involved meridians were the stomach meridian, the governor vessel and the conception vessel. The main acupoints were distributed in the scalp face neck and upper limbs. The most frequently used specific acupoints was crossing points,next was eight confluence points. There were 11 acupoint combinations with strong association according to the association rule analysis, and the top one acupoint combination was Hegu (LI 4)-Jiache (ST 6). There were 9 acupoint cluster groups according to the cluster analysis. Hegu (LI 4), Jiache (ST 6), Dicang (ST 4), Shuigou (GV 26) and Chengjiang (CV 24) were core acupoints for neurogenic dysphagia treated with acupuncture and moxibustion in ancient times, besides，selecting proximal and distal acupoints and selecting acupoints according to symptoms were emphasized.

Is non-invasive neuromuscular electrical stimulation effective in severe chronic neurogenic dysphagia? Reporton a post-traumatic brain injury patient.

BACKGROUND: Neurogenic dysphagia is a difficulty in swallowing induced by nervous system disease. It often causes serious complications, which are preventable if dysphagia is properly managed. There is growing debate concerning the usefulness of non-invasive neuromuscular electrical stimulation (NMES) in treating swallowing dysfunction. OBJECTIVE: Aim of this study was to assess the effectiveness of Vitalstim© device, and to investigate the neurophysiological mechanisms underlying functional recovery. METHODS: A 34-year-old man, affected by severe chronic dysphagia following traumatic brain injury, underwent two different intensive rehabilitation trainings, including either conventional rehabilitation alone or coupled to Vitalstim training. We evaluated patient swallowing function in two separate sessions (i.e. before and after the two trainings) by means of ad hoc swallowing function scales and electrophysiological parameters (rapid paired associative stimulation). The overall Vitalstim program was articulated in 6 weekly sessions for 6 weeks. RESULTS: The patient did not report any side-effect either during or following both the intensive rehabilitation trainings. We observed an important improvement in swallowing function only after Vitalstim training. In fact, the patient was eventually able to safely eat even solid food. CONCLUSIONS: This is the first report objectively suggesting (by means of rPAS) a correlation between the brain neuroplastic changes induced by Vitalstim and the swallowing function improvement. It is hypothesizable that Vitalstim may have targeted cortical (and maybe subcortical) brain areas that are recruited during the highly coordinated function of swallowing, and it may have thus potentiated the well-known neuroplastic changes induced by repetitive and intensive swallowing exercises, probably thanks to metaplasticity phenomena.

Natural capsaicinoids improve swallow response in older patients with oropharyngeal dysphagia.

OBJECTIVE: There is no pharmacological treatment for oropharyngeal dysphagia (OD). The aim of this study was to compare the therapeutic effect of stimulation of oropharyngeal transient receptor potential vanilloid type 1 (TRPV1) with that of thickeners in older patients with OD. DESIGN: A clinical videofluoroscopic non-randomised study was performed to assess the signs of safety and efficacy of swallow and the swallow response in (1) 33 patients with OD (75.94 ± 1.88 years) while swallowing 5, 10 and 20 ml of liquid (20.4 mPa.s), nectar (274.4 mPa.s), and pudding (3930 mPa.s) boluses; (2) 33 patients with OD (73.94 ± 2.23 years) while swallowing 5, 10 and 20 ml nectar boluses, and two series of nectar boluses with 150 µM capsaicinoids and (3) 8 older controls (76.88 ± 1.51 years) while swallowing 5, 10 and 20 ml nectar boluses. RESULTS: Increasing bolus viscosity reduced the prevalence of laryngeal penetrations by 72.03% (p < 0.05), increased pharyngeal residue by 41.37% (p < 0.05), delayed the upper esophageal sphincter opening time and the larynx movement and did not affect the laryngeal vestibule closure time and maximal hyoid displacement. Treatment with capsaicinoids reduced both, penetrations by 50.% (p < 0.05) and pharyngeal residue by 50.% (p < 0.05), and shortened the time of laryngeal vestibule closure (p < 0.001), upper esophageal sphincter opening (p < 0.05) and maximal hyoid and laryngeal displacement. CONCLUSION: Stimulation of TRPV1 by capsaicinoids strongly improved safety and efficacy of swallow and shortened the swallow response in older patients with OD. Stimulation of TRPV1 might become a pharmacologic strategy to treat OD.