Pharyngeal electrical stimulation for the treatment of dysphagia in Wallenberg syndrome: A FEES-based case analysis

Swallowing is regulated by cortical networks and the caudal brainstem. Damage to central pattern generators, commonly seen after stroke, can result in severe dysphagia with limited treatment options. Pharyngeal electrical stimulation (PES) presents a promising therapy as it may enhance sensory input to impaired brainstem networks by targeting pharyngeal sensory afferents, the primary site of dysfunction in brainstem infarction. This single-case study reports on a 78-year-old woman with a confirmed left-sided infarction in the dorsolateral medulla oblongata, resulting in severe dysphagia. PES was delivered 2 days after the onset of symptoms using the Phagenyx® system via a nasogastric catheter. The stimulation was applied at 5 Hz for 10 min daily over 4 days. The initial fiberoptic endoscopic evaluation of swallowing (FEES) showed severe dysphagia with saliva aspiration. Assessment revealed a Penetration-Aspiration-Scale (PAS) score of 8 for half a tablespoon of ice chips, alongside a score of 3 on Murray's Secretion Scale (MSS) and 7 on the New Zealand Secretion Scale (NZSS). No other consistencies were tested. After 4 consecutive days of stimulation followed by a 48-h period without stimulation, follow-up FEES revealed normal swallowing frequency and adequate saliva control, with a score of 0 on MSS. The patient safely swallowed all tested consistencies, scoring 1 on the PAS. On the NZSS, both fluids and solids scored 0. With pudding, residue in the pyriform fossae resulted in a score of 1. PES appears to be a targeted and effective approach for the treatment of severe dysphagia after brainstem stroke.