Effect of acupuncture treatment on dysphagia caused by pseudobulbar paralysis after stroke: a systematic review and meta-analysis.

BACKGROUND: The efficacy of acupuncture in the treatment of dysphagia caused by pseudobulbar paralysis after stroke is lack of evidence-based medicine. Our objective was to synthesize the efficacy of acupuncture in treating dysphagia caused by pseudobulbar paralysis after stroke. METHODS: A comprehensive literature search was performed in 9 databases [PubMed, Web of Science, Embase, Cochrane, Chinese BioMedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang Data, Chinese Science and Technology Periodicals database (VIP), and Open Grey online database] to screen eligible randomized controlled studies that evaluated the effect of acupuncture in dysphagia caused by pseudobulbar paralysis after stroke. The search time limit is from establishing the database to October 1, 2020. The random-effects model was used to calculate the significant effect size. RESULTS: A total of 7 studies comprising 637 participants were included in our meta-analysis. The results showed that compared with rehabilitation, acupuncture had a significant effect on improving dysphagia caused by pseudobulbar paralysis after stroke [the significant effective size: risk ratio (RR)sig =1.51; 95% confidence interval (CI): 1.30-1.75; I2=0%]. In the subgroup analyses, the RRsig of acupuncture + rehabilitation vs. rehabilitation was 1.56 (95% CI: 1.30-1.87; I2=0%), and the RRsig of acupuncture vs. rehabilitation was 1.38 (95% CI: 1.08-1.76; I2=0.8%). DISCUSSION: Acupuncture can be used as an effective treatment for dysphagia caused by pseudobulbar paralysis after stroke. Acupuncture combined with rehabilitation therapy has better effects.

[Fire needling on dysphagia due to pseudobulbar palsy after stroke: a randomized controlled trial].

OBJECTIVE: To observe the clinical effect of fire needling on dysphagia due to pseudobulbar paralysis after stroke and to compare the difference in clinical effect between fire needling and swallowing function rehabilitation training. METHODS: A total of 76 patients with dysphagia due to pseudobulbar paralysis after stroke were randomly divided into an observation group and a control group, 38 cases in each group (1 case dropped out in the control group). The both groups were based on conventional western medication treatment. Fire needle pricking was exerted at Lianquan (CV 23), Fengchi (GB 20), Wangu (GB 12), Shuigou (GV 26), Neiguan (PC 6) and Zusanli (ST 36) without needle retaining every other day in the observation group. The control group was treated with the swallowing function rehabilitation training. In both groups, treatment for 2 weeks was as one course and 2 courses of treatment with 2-day interval were required. After treatment, swallowing scores of Fujishima Ichiro and swallow quality of life questionnaire (SWAL-QOL) scores were observed in both groups, and the clinical effect was compared. Follow-up of swallowing scores of Fujishima Ichiro in 4 weeks after treatment was completed to evaluate the clinical effect. RESULTS: The clinical effective rates after treatment and follow-up were 92.1% (35/38) and 94.7% (36/38) in the observation group, higher than 75.7% (28/37) and 83.8% (31/37) in the control group (P<0.05). After treatment, the swallowing scores of Fujishima Ichiro and SWAL-QOL scores were increased in the two groups (P<0.05), and those in the observation group were higher than the control group (P<0.05). The swallowing scores of Fujishima Ichiro were increased during follow-up in the two groups (P<0.05). CONCLUSION: Fire needling has a better effect than conventional rehabilitation training in the treatment of dysphagia due to pseudobulbar paralysis after stroke, which can obviously improve the swallowing function and quality of life in patients with dysphagia.

Thoracic Dural Arteriovenous Fistula Presenting with Isolated Pseudobulbar Palsy Mimicking Brainstem Lesion.

BACKGROUND: Spinal dural arteriovenous fistulas (DAVFs) are usually associated with neurologic dysfunction adjacent to the shunt point; however, the symptoms are uncommon far from the site of the fistula. To our knowledge, this is the first report of a patient with rapidly progressive isolated pseudobulbar palsy because of thoracic DAVF. CASE DESCRIPTION: We report a patient with thoracic DAVF presenting with remote symptoms of brainstem congestion. The patient was a 36-year-old man who presented with a sudden history of vomiting, dysphagia, and flaccid weakness in the 4 limbs. Intracranial magnetic resonance (MR) imaging at a local hospital demonstrated T2 signal hyperintensity within the medulla, and he was referred to our hospital for a suspected brainstem lesion. However, cervical MR imaging revealed a dilated and tortuous perimedullary venous plexus, and spinal angiography revealed DAVF in T5-6 with a feeding artery from the intercostal artery. After obliteration of the fistula, the progression of the disease was stopped and the symptoms improved. CONCLUSIONS: Although rare, thoracic DAVFs may present symptoms resembling brainstem infarction. Prompt surgical intervention is necessary for patients with thoracic DAVF presenting with rapidly progressive pseudobulbar palsy.

[Therapeutic effects of acupuncture combined with rehabilitation training on dysphagia in post-stroke pseudobulbar palsy].

OBJECTIVE: To compare the therapeutic effects on dysphagia in post-stroke pseudobulbar palsy between the combined treatment with acupuncture and rehabilitation training and the combined treatment with low-frequency electrical therapy and rehabilitation training and to explore its more effective therapy, using the ultrasonographic examination. METHODS: A total of 60 patients of dysphagia in post-stroke pseudobulbar palsy were randomly assigned into an observation group and a control group, 30 cases in each one. The rehabilitation treatment was provided in the two groups. Additionally, in the observation group, acupuncture was used at the three-tongue points [Shanglianquan (Extra), located in the depression between the lingual bone and the border of lower jaw, 1 cun inferior to the midline of the jaw; and the other two points, located at 0.8 cun bilateral to Shanglianquan (Extra)], bilateral Fengchi (GB 20) and Fengfu (GV 16). After arrival of qi, the last two tongue-points were stimulated with electricity, with disperse-dense wave, periodically at 2 Hz, 10 Hz and 100 Hz, at the interval of 3 s, lasting for 30 min. Bilateral Fengchi (GB 20) was stimulated with electricity, with disperse-dense wave and the same frequency as above, lasting for 30 min. In the control group, the low-frequency electrical stimulation was adopted. The electrodes were placed on the bilateral sides of the midline of the throat, 30 min each time. The treatment was for 1 month in the two groups, once a day. The scores of the standardized swallowing assessment (SSA) and the videofluoroscopy swallowing study (VFSS) were observed and the reducing rate of the hyoid-thyroid cartilage distance was determined with ultrasound quantitative measure. RESULTS: After treatment, SSA scores of the two groups were all lower than those before treatment and VFSS scores were higher than those before treatment (all P<0.05). The above scores in the observation group were better than those in the control group (both P<0.05). The reducing rates of the hyoid-thyroid cartilage distance were higher than those before treatment in the two groups (both P<0.05). The result in the observation group was higher than that in the control group (P<0.05). CONCLUSION: The treatments with acupuncture and rehabilitation training or with the low-frequency electrical therapy and rehabilitation obtain the effects on dysphagia in post-stroke pseudobulbar palsy in the patients. The effects of the combined treatment with acupuncture and rehabilitation training are better. The ultrasonographic technology effectively and quantitatively analyzes the changes in the glossopharyngeal complex in the patients of dysphagia.

[Effects of GAO's neck acupuncture on swallowing function and quality of life in patients with post-stroke pseudobulbar palsy:a randomized controlled trial].

OBJECTIVE: To observe the effects of GAO's neck acupuncture combined with swallowing rehabilitation on swallowing function and quality of life in patients with post-stroke pseudobulbar palsy. METHODS: One hundred patients were randomly assigned in to an observation group and a control group, 50 cases in each one. The patients in the control group were treated with basic pharmaceutical treatment, including neurotrophy medication and free radical scavenging medication as well as swallowing rehabilitation; the patients in the observation group, on the basis of those in the control group, were treated with GAO's neck acupuncture at Fengchi (GB 20), Yiming (EX-HN 14), Gongxue (Extra), Lianquan (CV 23), Wai Jinjin Yuye (Extra), Tunyan (Extra), Zhiqiang (Extra), Fayin (Extra), once a day, five times a week for continuous eight weeks. The Repetitive saliva-swallowing test (RSST), standardized swallowing assessment (SSA) and swallow quality-of-life questionnaire (SWAL-QOL) before and after treatment in the two groups were observed; the relationship between disease location and frequency and efficacy of GAO's neck acupuncture was explored in the observation group. RESULTS: After treatment, the RSST, SSA and SWAL-QOL were superior to those before treatment (all P<0.01), with more significant results in the observation group (all P<0.01). The total effective rate was 91.7% (44/48) in the observation group, which was superior to 75.5% (37/49) in the control group (P<0.01). The frequency of disease onset was one in 11 patients and 2 and above in 37 patients in the observation group, and the efficacy of one onset of disease was 100.0% (11/11), which was superior to two and above of onset 89.2% (33/37, P<0.01). The number of patients with disease location at cortex and subcortex was 21, while that at capsula interna and basal ganglia was 27 in the observation group, the efficacy of two was similar (P>0.05). CONCLUSIONS: GAO's neck acupuncture combined with swallowing rehabilitation could effectively improve dysphagia and quality of life in patients with post-stroke pseudobulbar palsy. No correlation of lesion locations on acupuncture efficacy is observed, while onset frequency is inversely proportional to efficacy.

Pseudobulbar Affect: What Nurses, Stroke Survivors, and Caregivers Need to Know.

Pseudobulbar affect (PBA) is a neurologic condition that can happen after a patient has had some kind of neurological insult. In this syndrome, involuntary, uncontrollable, and inappropriate emotional outbursts unrelated or out of proportion to the situation are common symptoms. This can be very frustrating and scary. Because stroke survivors and their caregivers are overloaded with information during the transition from hospital to home, information about PBA is not usually discussed. In a survey by the National Stroke Association, 53% of stroke survivors reported that they had some of the symptoms of this disorder. Even if they discussed these symptoms with their health care providers, less than half were given a diagnosis, and less than a quarter received any kind of treatment. The purpose of this article is to give nurses more information about PBA so they can share this with patients and families/significant others and encourage them to seek help if they experience these symptoms once discharged. It is hoped that increased knowledge about this condition will lead to better diagnosis and treatment and increased quality of life for stroke survivors.

Introduction to pseudobulbar affect: setting the stage for recognition and familiarity with this challenging disorder.

Pseudobulbar affect (PBA), despite its prevalence and distinctive symptoms, is widely underrecognized and undertreated. It is characterized by uncontrollable laughing or crying that can occur in an exaggerated manner or inappropriately to a given situation or stimuli. PBA is thought to center around preexisting neurological conditions, which include Parkinson disease, multiple sclerosis, amyotrophic lateral sclerosis, Alzheimer disease, traumatic brain injury, and stroke. The PBA Registry Series trial was created to measure the prevalence of PBA among patients with these underlying neurological conditions. Through greater awareness, recognition, and diagnosis, treatment for patients with PBA can be improved.

Revisión del concepto de eficacia en el tratamiento vocal de las enfermedades neurodegenerativas / Revising the concept of efficacy in the vocal therapy of neurodegenerative diseases

El tratamiento de los trastornos de la voz en las enfermedades neurodegenerativas es un tema muy controvertido, ya que no es posible esperar ni que la función se recupere totalmente, ni que las mejorías derivadas del tratamiento se mantengan a largo plazo. Es por ello que programar el tratamiento de la voz en estos trastornos implica replantearse el concepto de eficacia, ya que en estas personas no es posible conseguir logros permanentes. Sin embargo, actualmente existen estudios que demuestran resultados funcionales que permiten mantener por más tiempo una mejor calidad de vida. En este trabajo se ha revisado el estado actual de la literatura sobre el concepto de eficacia en el tratamiento de los problemas vocales de las enfermedades neurodegenerativas, analizando una serie de factores que favorecen esta eficacia y propician una mayor y más permanente disminución de la limitación funcional. Entre los factores propuestos cabe señalar la precocidad en la intervención, la jerarquización sistemática de objetivos terapéuticos y la diversificación de recursos. Asimismo se han seleccionado los protocolos de intervención para paliar los 3 tipos de déficits fonorrespiratorios más comunes en este tipo de enfermedades, esto es: la insuficiencia fonorrespiratoria, la incoordinación fonorrespiratoria y las disfunciones laríngeas. La eficacia de las tareas propuestas ha sido avalada en la literatura, bien por la medicina basada en la evidencia, bien por la opinión de expertos (AU)

Treating voice problems in neurodegenerative diseases is a controversial topic due to the lack of expectations of achieving complete functional recovery or long-lasting improvement. Therefore, when planning voice therapy in these disorders, the concept of efficacy needs to be redefined, since permanent improvements cannot be achieved in these patients. However, studies have been published that show more permanent functional benefits and improvements in quality of life of these persons. The present study was designed to review the state of the art on the vocal therapy of neurodegenerative diseases and to analyze the factors that enhance treatment efficacy and favor greater and longer-lasting reduction of functional limitations. Among the proposed factors to increase treatment efficacy are starting the intervention in the initial phases of the disorder, systematically planning the hierarchy of therapeutic targets, and implementing a multidimensional approach to different types of treatment resources. Additionally, a series of therapeutic protocols were selected to address the three main phonation deficits in neurodegenerative diseases, i.e. respiratory insufficiency, phonation incoordination and laryngeal dysfunction. All of the therapeutic strategies proposed in this study have been documented as being target efficient by either scientific evidence or expert opinion (AU)

Mielinolisis central pontina en el contexto de un trasplante hepático reducido / No disponible

No disponible

[Regulating the governor Vessel and Conception Vessel for treatment of pseudobulbar palsy after stroke].

OBJECTIVE: To compare the therapeutic effect of method for regulating the Governor Vessel and Conception Vessel as well as routine needling method. METHODS: Sixty-four cases of pseudobulbar palsy after stroke were randomly divided into an observation group and a control group, 32 cases in each group. The observation group was treated with regulating the Governor Vessel and Conception Vessel, Tiantu (CV 22) through to Danzhong (CV 17), Shanglianquan (Extra), Baihui (GV 20) through to Naohu (GV 17), Fengfu (GV 16) were selected; the control group was treated with routine needling method with acupoints Yamen (GV 15), Lianquan (CV 23), Tongli (HT 5), Guanchong (TE 1). Scores of Watian drinking water test were observed before and after treatment, and therapeutic effects of two groups were compared. RESULTS: The effective rate of 87.5% (28/32) in the observation group was superior to that of 65.6% (21/32) in the control group (P < 0.05). Scores of Watian drinking water test in both groups were significantly decreased after treatment (both P < 0.01), and the degree of the decrease in the observation group was superior to that of control group (P < 0.01). CONCLUSION: Regulating the Governor Vessel and Conception Vessel has a significant therapeutic effect for treatment of pseudobulbar palsy after stroke, and superior to that of routine needling.

[Biopercular syndrome caused by unilateral ischemia. Report of one case]. / Síndrome biopercular producido por lesión unilateral.

Biopercular syndrome is a labio-facio-pharyngeal-laryngeal-gloso-masticatory diplegia, with automatic dissociation of movements. Ischemia is the most common etiology when it occurs bilaterally in the opercular area, but it has been also described in patients with bilateral subcortical lesions. There are few cases described with unilateral lesions. We report a 76-year-old woman who developed a biopercular syndrome caused by unilateral ischemic lesion of the right middle cerebral artery confirmed by magnetic resonance imaging and cerebral SPECT.

[Amyotrophic lateral sclerosis: management of bulbar symptoms]. / Amyotrophe Lateralsklerose: Symptomatische Therapie bulbärer Symptome.

Symptomatic treatment of amyotrophic lateral sclerosis (ALS) is relevant in preventing complications and improving quality of life as long as curative therapies are still out of sight. About one third of ALS patients show disabling problems associated with dysarthria, dysphagia, sialorrhea, and a pseudobulbar affective disorder already in the early stages of ALS. A multidisciplinary approach is the cornerstone of symptomatic treatment of bulbar and pseudobulbar ALS features. Except for riluzole randomized controlled trials are lacking. Here, we review the current views with regard to epidemiology, pathophysiology, diagnosis, and practical aspects of treating bulbar and pseudobulbar symptoms.

Síndrome biopercular producido por lesión unilateral / Biopercular syndrome caused by unilateral ischemia: report of one case

Biopercular syndrome is a labio-facio-pharyngeal-laryngeal-gloso-masticatory diplegia, with automatic dissociation of movements. Ischemia is the most common etiology when it occurs bilaterally in the opercular area, but it has been also described in patients with bilateral subcortical lesions. There arefew cases described with unilateral lesions. We report a 76-year-old woman who developed a biopercular syndrome caused by unilateral ischemic lesion ofthe right middle cerebral artery confirmed by magnetic resonance imaging and cerebral SPECT.

[Observation on therapeutic effect of acupuncture at Fengchi (GB 20) at different stages on pseudobulbar palsy].

OBJECTIVE: To observe the therapeutic effect of acupuncture at different stages on pseudobulbar palsy. Methods Two hundred and forty cases of pseudobulbar palsy were divided into 4 groups according to different courses of disease, i.e. group I, the course within 10 days; group II, between 10-30 days; group III, between 1-3 months; group IV, between 3-6 months. They were treated with acupuncture at Fengchi (GB 20) for 2 courses, and then their therapeutic effects were ohserved. RESULTS: The effective rate was 100.0% in the group I, 96.7% in the group II, 83.3% in the group III and 76.7% in the group IV, with a significant difference among the 4 groups (P < 0.01). CONCLUSION: Acupuncture at Fengchi (GB 20) at any stage has therapeutic effect on pseudohulbar paisy, hut the earlier treatments, the better the therapeutic effects.

Review of pseudobulbar affect including a novel and potential therapy.

Pseudobulbar affect (PBA) is an affective disinhibition syndrome associated with various neuropathologies, which is characterized by involuntary and inappropriate outbursts of laughter and/or crying. The PBA syndrome can be socially and occupationally disabling, and it is largely unrecognized in clinical settings. Validated instruments to distinguish PBA from other disorders of affective regulation exist and could be used to improve recognition of the disorder. There is no pharmacological therapy with a Food and Drug Administration indication for PBA, although antidepressants and dopaminergic agents have been reported to show varying levels of treatment success. Recent evidence suggests that treatment with a fixed combination of dextromethorphan and the cytochrome P450 2D6 enzyme inhibitor, quinidine, can improve PBA. This review describes the clinical and neuropathological features of PBA, and presents an overview of current and future treatment approaches.