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Abstract

Because no detailed information exists regarding the topographic representation of swallowing musculature on the human cerebral cortex in health or disease, we used transcranial magnetic stimulation to study the cortical topography of human oral, pharyngeal and esophageal musculature in 20 healthy individuals and the topography of pharyngeal musculature in two stroke patients, one with and one without dysphagia. Our results demonstrate that swallowing musculature is discretely and somatotopically represented on the motor and premotor cortex of both hemispheres but displays interhemispheric asymmetry, independent of handedness. Following stroke, dysphagia appeared to be associated with smaller pharyngeal representation on the intact hemisphere, which increases in size with recovery of swallowing.

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Most cited references 21

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NON-INVASIVE MAGNETIC STIMULATION OF HUMAN MOTOR CORTEX

A.T. Barker, R Jalinous, I.L. Freeston (1985)

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The natural history and functional consequences of dysphagia after hemispheric stroke.

D Barer (1989)

Data from 357 conscious stroke patients taking part in an acute intervention trial and assessed within 48 hours of the onset of symptoms, were used to investigate the prevalence and natural history of swallowing problems. Nearly 30% of patients with single-hemisphere strokes were initially found to have difficulty swallowing a mouthful of water, but in most of those who survived, the deficit had resolved by the end of the first week. Strong correlations were found between dysphagia and speech impairment (comprehension and expression) and with facial weakness, but there was no association with the side of the stroke. After controlling for other markers of overall stroke severity such as conscious level, urinary continence, white blood cell count and strength in the affected limbs, swallowing impairment still showed a significant inverse correlation with functional ability at 1 and 6 months. These results indicate that, even if dysphagia itself is not responsible for much excess mortality in acute stroke, it might still lead to complications which hamper functional recovery.

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Dysphagia in acute stroke.

C. Gordon, R L Hewer, D Wade (1987)

A prospective study was undertaken to define the incidence, duration, and consequences of dysphagia in an unselected group of 91 consecutive patients who had suffered acute stroke. The site of the present lesion and of any previous stroke was determined clinically and was confirmed by computed tomography of the brain or necropsy in 40 cases. Of 41 patients who had dysphagia on admission, 37 had had a stroke in one cerebral hemisphere. Only seven patients showed evidence of lesions in both hemispheres. Nineteen of 22 patients who survived a stroke in a hemisphere regained their ability to swallow within 14 days. Dysphagia in patients who had had a stroke in a cerebral hemisphere was associated in this study with a higher incidence of chest infections, dehydration, and death.

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PubMed ID:: 8898748

DOI:: 10.1038/nm1196-1217

ScienceOpen disciplines: Chemistry

Keywords: Adolescent,Adult,Aged,Brain Mapping,Cerebrovascular Disorders,physiopathology,Deglutition,physiology,Electromyography,Esophagus,Female,Hemiplegia,Humans,Magnetic Resonance Imaging,Male,Middle Aged,Motor Cortex,Muscle, Smooth,Pharynx,Prefrontal Cortex,Reproducibility of Results,Signal Transduction,Tomography Scanners, X-Ray Computed,Twins, Monozygotic

The cortical topography of human swallowing musculature in health and disease.

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Most cited references 21

NON-INVASIVE MAGNETIC STIMULATION OF HUMAN MOTOR CORTEX

The natural history and functional consequences of dysphagia after hemispheric stroke.

Dysphagia in acute stroke.

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