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Differences in swallow physiology in patients with left and right hemispheric strokes.

ABSTRACT: BACKGROUND:We sought to determine the impact of lesion lateralization and lesion volume on swallow impairment on group-level by comparing patients with left and right hemisphere strokes and on patient-level by analyzing patients individually. METHODS:We performed a retrospective, observational, cross-sectional study of 46 patients with unilateral (22 left, 24 right), acute, first-ever, ischemic strokes who received a diffusion weighted MRI (DW-MRI) and modified barium swallow study (MBSS) during their acute hospital stay. We determined lesion side on the DW-MRI and measured swallow physiology using the Modified Barium Swallow Impairment Profile (MBSImP™©), Penetration-Aspiration Scale (PAS), swallow timing, distance, area, and speed measures. We performed Pearson's Chi-Square and Wilcoxon Rank-Sum tests to compare patients with left and right hemisphere strokes, and Pearson or Spearman correlation, simple logistic regression, linear, and logistic multivariable regression modeling to assess the relationship between variables. RESULTS:At the group-level, there were no differences in MBSImP oral swallow impairment scores between patients with left and right hemisphere stroke. In adjusted analyses, patients with right hemisphere strokes showed significantly worse MBSImP pharyngeal total scores (p?=?0.02), worse MBSImP component specific scores for laryngeal vestibular closure (Bonferroni adjusted alpha p???0.0029), and worse PAS scores (p?=?0.03). Patients with right hemisphere strokes showed worse timing, distance, area, and speed measures. Lesion volume was significantly associated with MBSImP pharyngeal residue (p?=?0.03) and pharyngeal total scores (p?=?0.04). At the patient-level, 24% of patients (4 left, 7 right) showed opposite patterns of MBSImP oral and pharyngeal swallow impairment than seen at group-level. CONCLUSION:Our study showed differences in swallow physiology between patients with right and left unilateral strokes with patients with right hemisphere strokes showing worse pharyngeal impairment. Lesion lateralization seems to be a valuable marker for the severity of swallowing impairment at the group-level but less informative at the patient-level.

SUBMITTER: Wilmskoetter J

PROVIDER: S-EPMC6070395 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Differences in swallow physiology in patients with left and right hemispheric strokes.

Wilmskoetter Janina J Martin-Harris Bonnie B Pearson William G WG Bonilha Leonardo L Elm Jordan J JJ Horn Janet J Bonilha Heather S HS

Physiology & behavior 20180511

<h4>Background</h4>We sought to determine the impact of lesion lateralization and lesion volume on swallow impairment on group-level by comparing patients with left and right hemisphere strokes and on patient-level by analyzing patients individually.<h4>Methods</h4>We performed a retrospective, observational, cross-sectional study of 46 patients with unilateral (22 left, 24 right), acute, first-ever, ischemic strokes who received a diffusion weighted MRI (DW-MRI) and modified barium swallow stud ...[more]

PMID: 29758228

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Project description:Hemispheric asymmetries, i.e., differences between the two halves of the brain, have extensively been studied with respect to both structure and function. Commonly employed pairwise comparisons between left and right are suitable for finding differences between the hemispheres, but they come with several caveats when assessing multiple asymmetries. What is more, they are not designed for identifying the characterizing features of each hemisphere. Here, we present a novel data-driven framework-based on machine learning-based classification-for identifying the characterizing features that underlie hemispheric differences. Using voxel-based morphometry data from two different samples (n = 226, n = 216), we separated the hemispheres along the midline and used two different pipelines: First, for investigating global differences, we embedded the hemispheres into a two-dimensional space and applied a classifier to assess if the hemispheres are distinguishable in their low-dimensional representation. Second, to investigate which voxels show systematic hemispheric differences, we employed two classification approaches promoting feature selection in high dimensions. The two hemispheres were accurately classifiable in both their low-dimensional (accuracies: dataset 1 = 0.838; dataset 2 = 0.850) and high-dimensional (accuracies: dataset 1 = 0.966; dataset 2 = 0.959) representations. In low dimensions, classification of the right hemisphere showed higher precision (dataset 1 = 0.862; dataset 2 = 0.894) compared to the left hemisphere (dataset 1 = 0.818; dataset 2 = 0.816). A feature selection algorithm in the high-dimensional analysis identified voxels that most contribute to accurate classification. In addition, the map of contributing voxels showed a better overlap with moderate to highly lateralized voxels, whereas conventional t test with threshold-free cluster enhancement best resembled the LQ map at lower thresholds. Both the low- and high-dimensional classifiers were capable of identifying the hemispheres in subsamples of the datasets, such as males, females, right-handed, or non-right-handed participants. Our study indicates that hemisphere classification is capable of identifying the hemisphere in their low- and high-dimensional representation as well as delineating brain asymmetries. The concept of hemisphere classifiability thus allows a change in perspective, from asking what differs between the hemispheres towards focusing on the features needed to identify the left and right hemispheres. Taking this perspective on hemispheric differences may contribute to our understanding of what makes each hemisphere special.

Project description:ObjectivesApraxia is a common syndrome of left hemispheric stroke. A parieto-premotor-prefrontal network has been associated with apraxia, in which the left inferior parietal lobe (IPL-L) plays a major role. We hypothesized that transcranial continuous theta burst stimulation (cTBS) over the right inferior parietal lobe (IPL-R) improves gesturing by reducing its inhibition on the contralateral IPL in left hemispheric stroke patients. It was assumed that this effect is independent of lesion volume and that transcallosal connectivity is predictive for gestural effect after stimulation.Materials and methodsNineteen stroke patients were recruited. Lesion volume and fractional anisotropy of the corpus callosum were acquired with structural magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI). Each patient had pseudorandomised sessions with sham or with stimulation over the IPL-R or over the right inferior frontal gyrus IFG-R. Gesturing was assessed in a double-blinded manner before and after each session. We tested the effects of stimulation on gesture performance using a linear mixed-effects model.ResultsPairwise treatment contrasts showed, that, compared to sham, the behavioral effect was higher after stimulation over IPL-R (12.08, 95% CI 6.04 - 18.13, p < 0.001). This treatment effect was approximately twice as high as the contrasts for IFG-R vs. sham (6.25, 95% CI -0.20 - 12.70, p = 0.058) and IPL-R vs. IFG-R vs. sham (5.83, 95% CI -0.49 - 12.15, p = 0.071). Furthermore, higher fractional anisotropy in the splenium (connecting the left and right IPL) were associated with higher behavioral effect. Relative lesion volume did not affect the changes after sham or stimulation over IPL-R or IFG-R.ConclusionOne single session of cTBS over the IPL-R improved gesturing after left hemispheric stroke. Denser microstructure in the corpus callosum correlated with favorable gestural response. We therefore propose the indirect transcallosal modulation of the IPL-L as a promising model of restoring interhemispheric balance, which may be useful in rehabilitation of apraxia.

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Differences in swallow physiology in patients with left and right hemispheric strokes.

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Differences in swallow physiology in patients with left and right hemispheric strokes.

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