Restoration of normal swallowing function in Wallenberg syndrome by repetitive transcranial magnetic stimulation and surgery

摘要

Oropharyngeal dysphagia is common in patients with Wallenberg syndrome. Although the functional outcome is good for most patients, the risk of inhalation pneumonia is high. Nevertheless, some patients exhibit permanent and chronic oropharyngeal dysphagia with pharyngeal residue and bronchial aspiration. In such cases, the central pattern generator for swallowing may be affected. We report 2 cases for which we proposed a novel strategy based on repetitive transcranial magnetic stimulation (TMS), electrical stimulation and surgery. Currently, therapeutic possibilities for oropharyngeal dysphagia include speech-language therapy and gastrostomy. New perspectives include cortical modulation involving peripheral electrical stimulation and cortical magnetic stimulation. Several studies have assessed the efficacy of stimulation techniques on brainstem stroke. In one, repetitive TMS (rTMS) was successfully applied to the motor area of both hemispheres in patients with acute lateral medullary infarction. However, patients also often present paralyzed hemi-pharynx with pharyngo-esophageal dys-synergia, for which surgery could be useful.