不断发展的神经性吞咽困难新疗法。

IF 13 1区 医学 Q1 PHARMACOLOGY & PHARMACY Drugs Pub Date : 2024-08-01 Epub Date: 2024-07-02 DOI:10.1007/s40265-024-02064-x
Ayodele Sasegbon, Ivy Cheng, Bendix Labeit, Sriramya Lapa, Nathalie Rommel, Shaheen Hamdy
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引用次数: 0

摘要

尽管吞咽是一项经常执行的日常功能,但它却非常复杂。为了实现安全吞咽,头部、颈部和胸部的肌肉需要以协调的模式收缩,并由中枢神经系统多层次的多个吞咽中枢控制,包括中脑、大脑皮层和小脑以及五条颅神经。吞咽困难或吞咽困难是由一系列病理过程和疾病引起的,这些病理过程和疾病会干扰吞咽感觉运动通路的各个阶段。一旦出现吞咽困难,死亡率、发病率、住院时间和生活质量都会增加。目前治疗吞咽困难的方法,如改变食物和液体的质地和稠度以及教患者进行康复训练,多年来大致未变,就质地改变而言,其效果并不确定。不过,新的药物治疗和神经调节治疗方法正在获得证据支持。关于药物疗法,大多数研究都集中在辣椒素方面,研究表明辣椒素能够改善中风后吞咽困难患者的吞咽功能。另外,在神经调控领域,三种非侵入性脑部刺激技术:重复经颅磁刺激(rTMS)、经颅直流电刺激(TDCS)和咽部电刺激(PES)也有越来越多的积极证据。如果这些新兴疗法中的部分或全部实现了它们的承诺,那么与吞咽困难相关的患者预后可能会得到改善。本文介绍了我们目前对基于新药物和神经调控的神经源性口咽吞咽困难治疗方法的了解情况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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New and Evolving Treatments for Neurologic Dysphagia.

Despite swallowing being a frequently performed daily function, it is highly complex. For a safe swallow to occur, muscles within the head, neck, and thorax need to contract in a concerted pattern, controlled by several swallowing centers at multiple levels of the central nervous system, including the midbrain, cerebral cortex, and cerebellum in addition to five cranial nerves. Dysphagia, or difficulty swallowing, is caused by a long list of pathologic processes and diseases, which can interfere with various stages along the swallowing sensorimotor pathway. When present, dysphagia leads to increased mortality, morbidity, hospital length of stay, and reduced quality of life. Current dysphagia management approaches, such as altering the texture and consistency of foods and fluids and teaching patients rehabilitative exercises, have been broadly unchanged for many years and, in the case of texture modification, are of uncertain effectiveness. However, evidence is emerging in support of new medication-based and neuromodulatory treatment approaches. Regarding medication-based therapies, most research has focused on capsaicinoids, which studies have shown are able to improve swallowing in patients with post-stroke dysphagia. Separately, albeit convergently, in the field of neuromodulation, there is a growing and positive evidential base behind three non-invasive brain stimulation techniques: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (TDCS), and pharyngeal electrical stimulation (PES). Should some or all of these emerging therapies fulfill their promise, dysphagia-related patient outcomes may be improved. This paper describes the current state of our understanding regarding new medication and neuromodulation-based neurogenic oropharyngeal dysphagia treatments.

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来源期刊
Drugs
Drugs 医学-毒理学
CiteScore
22.70
自引率
0.90%
发文量
134
审稿时长
3-8 weeks
期刊介绍: Drugs is a journal that aims to enhance pharmacotherapy by publishing review and original research articles on key aspects of clinical pharmacology and therapeutics. The journal includes: Leading/current opinion articles providing an overview of contentious or emerging issues. Definitive reviews of drugs and drug classes, and their place in disease management. Therapy in Practice articles including recommendations for specific clinical situations. High-quality, well designed, original clinical research. Adis Drug Evaluations reviewing the properties and place in therapy of both newer and established drugs. AdisInsight Reports summarising development at first global approval. Moreover, the journal offers additional digital features such as animated abstracts, video abstracts, instructional videos, and podcasts to increase visibility and educational value. Plain language summaries accompany articles to assist readers with some knowledge of the field in understanding important medical advances.
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