KEY POINTS: Neurostimulation is a rapidly emerging approach to swallowing rehabilitation, but cerebellar stimulation has not been explored as a treatment. Such proposed therapies for post- @entity64 have required confirmation of physiological effects and optimisation of parameters in healthy @entity1 prior to translational progression into @entity1 groups. There is strong evidence for a role of the cerebellum in swallowing physiology, but this relationship has been under-explored. Recently, single pulses of cerebellar magnetic stimulation have been shown to directly evoke responses from pharyngeal musculature and produce short-term enhancement of cortico-pharyngeal motor evoked potentials, suggesting the feasibility of a cerebellar approach to neurostimulation in the swallowing system. We therefore examined multiple parameters of repetitive cerebellar magnetic stimulation and have described the optimal settings to provoke longer-lasting changes in swallowing neurophysiology. Based on evidence from the post- @entity64 neurostimulation literature, these changes may have a therapeutic potential for swallowing rehabilitation. ABSTRACT: Brain neurostimulation has been shown to modulate cortical swallowing neurophysiology in post- @entity64 with therapeutic effects which are critically dependent on the stimulation parameters. Cerebellar neurostimulation is, however, a novel, unexplored approach to modulation of swallowing pathways as a prelude to therapy for @entity1282 . Here, we randomised healthy @entity1 subjects (n  =  17) to receive one of @entity76 (rTMS) interventions (Sham, 1  Hz, 5  Hz, 10  Hz and 20  Hz) on separate visits to our laboratory. Additionally, a subset of subjects randomly received each of three different durations (50, 250, 500 pulses) of optimal frequency versus sham cerebellar rTMS. Prior to interventions subjects underwent MRI-guided single-pulse transcranial magnetic stimulation (TMS) to co-localise pharyngeal and thenar representation in the cortex and cerebellum (midline and hemispheric) before acquisition of baseline motor evoked potential (MEP) recordings from each site as a measure of excitability. Post-interventional MEPs were recorded for an hour and compared to sham using repeated measures ANOVA. Only 10  Hz cerebellar rTMS increased cortico-pharyngeal MEP amplitudes (mean bilateral increase 52%, P  =  0.007) with effects lasting 30  min post-intervention with an optimal train length of 250 pulses (P  =  0.019). These optimised parameters of cerebellar rTMS can produce sustained increases in corticobulbar excitability and may have clinical translation in future studies of @entity1282 .

High-frequency focal repetitive cerebellar stimulation induces prolonged increases in XXXX pharyngeal motor cortex excitability.

@entity1 :: ('9606', 'Species') :: ['humans', 'human', 'patient'] @entity64 :: ('MESH:D020521', 'Disease') :: ['stroke dysphagia'] @entity76 :: ('MESH:D002526', 'Disease') :: ['five cerebellar repetitive TMS'] @entity1282 :: ('MESH:D003680', 'Disease') :: ['neurogenic dysphagia', 'dysphagia']
@entity1 :: (9606,Species) :: ['human']
