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Wei KC, Wang TG, Hsiao MY. The Cortical and Subcortical Neural Control of Swallowing: A Narrative Review. Dysphagia 2024; 39:177-197. [PMID: 37603047 DOI: 10.1007/s00455-023-10613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
Swallowing is a sophisticated process involving the precise and timely coordination of the central and peripheral nervous systems, along with the musculatures of the oral cavity, pharynx, and airway. The role of the infratentorial neural structure, including the swallowing central pattern generator and cranial nerve nuclei, has been described in greater detail compared with both the cortical and subcortical neural structures. Nonetheless, accumulated data from analysis of swallowing performance in patients with different neurological diseases and conditions, along with results from neurophysiological studies of normal swallowing have gradually enhanced understanding of the role of cortical and subcortical neural structures in swallowing, potentially leading to the development of treatment modalities for patients suffering from dysphagia. This review article summarizes findings about the role of both cortical and subcortical neural structures in swallowing based on results from neurophysiological studies and studies of various neurological diseases. In sum, cortical regions are mainly in charge of initiation and coordination of swallowing after receiving afferent information, while subcortical structures including basal ganglia and thalamus are responsible for movement control and regulation during swallowing through the cortico-basal ganglia-thalamo-cortical loop. This article also presents how cortical and subcortical neural structures interact with each other to generate the swallowing response. In addition, we provided the updated evidence about the clinical applications and efficacy of neuromodulation techniques, including both non-invasive brain stimulation and deep brain stimulation on dysphagia.
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Affiliation(s)
- Kuo-Chang Wei
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan
| | - Ming-Yen Hsiao
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan.
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No. 7, Zhongshan South Road, Zhongzheng District, Taipei, 100, Taiwan.
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De Luca R, Gangemi A, Bonanno M, Fabio RA, Cardile D, Maggio MG, Rifici C, Vermiglio G, Di Ciuccio D, Messina A, Quartarone A, Calabrò RS. Improving Neuroplasticity through Robotic Verticalization Training in Patients with Minimally Conscious State: A Retrospective Study. Brain Sci 2024; 14:319. [PMID: 38671971 PMCID: PMC11048571 DOI: 10.3390/brainsci14040319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/17/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
In disorders of consciousness, verticalization is considered an effective type of treatment to improve motor and cognitive recovery. Our purpose is to investigate neurophysiological effects of robotic verticalization training (RVT) in patients with minimally conscious state (MCS). Thirty subjects affected by MCS due to traumatic or vascular brain injury, attending the intensive Neurorehabilitation Unit of the IRCCS Neurolesi (Messina, Italy), were included in this retrospective study. They were equally divided into two groups: the control group (CG) received traditional verticalization with a static bed and the experimental group (EG) received advanced robotic verticalization using the Erigo device. Each patient was evaluated using both clinical scales, including Levels of Cognitive Functioning (LCF) and Functional Independence Measure (FIM), and quantitative EEG pre (T0) and post each treatment (T1). The treatment lasted for eight consecutive weeks, and sessions were held three times a week, in addition to standard neurorehabilitation. In addition to a notable improvement in clinical parameters, such as functional (FIM) (p < 0.01) and cognitive (LCF) (p < 0.01) outcomes, our findings showed a significant modification in alpha and beta bands post-intervention, underscoring the promising effect of the Erigo device to influence neural plasticity and indicating a noteworthy difference between pre-post intervention. This was not observed in the CG. The observed changes in alpha and beta bands underscore the potential of the Erigo device to induce neural plasticity. The device's custom features and programming, tailored to individual patient needs, may contribute to its unique impact on brain responses.
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Affiliation(s)
- Rosaria De Luca
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Antonio Gangemi
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Rosa Angela Fabio
- Department of Economics, University of Messina, 98100 Messina, Italy;
| | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Carmela Rifici
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Giuliana Vermiglio
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Daniela Di Ciuccio
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Angela Messina
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (R.D.L.); (A.G.); (D.C.); (M.G.M.); (C.R.); (G.V.); (D.D.C.); (A.M.); (A.Q.); (R.S.C.)
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Zhang S, Liu A, Zhou Z, Huang Z, Cheng J, Chen D, Zhong Q, Yu Q, Peng Z, Hong M. Clinical features and power spectral entropy of electroencephalography in Wilson's disease with dystonia. Brain Behav 2022; 12:e2791. [PMID: 36282481 PMCID: PMC9759124 DOI: 10.1002/brb3.2791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/28/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To study the clinical features and power spectral entropy (PSE) of electroencephalography signals in Wilson's disease (WD) patients with dystonia. METHODS Several scale evaluations were performed to assess the clinical features of WD patients. Demographic information and electroencephalography signals were obtained in all subjects. RESULTS 34 WD patients with dystonia were recruited in the case group and 24 patients without dystonia were recruited in the control group. 20 healthy individuals were included in the healthy control group. The mean body mass index (BMI) in the case group was significantly lower than that in the controls (p < .05). The case group had significantly higher SAS, SDS, and Bucco-Facial-Apraxia Assessment scores (p < .05). Total BADS scores in the case group were lower than those in the control group (p < .01). Note that 94.11% of the case group presented with dysarthria and 70.59% of them suffered from dysphagia. Dysphagia was mainly related to the oral preparatory stage and oral stage. Mean power spectral entropy (PSE) values in the case group were significantly different (p < .05) from those in the control group and the healthy group across the different tasks. CONCLUSIONS The patients with dystonia were usually accompanied with low BMI, anxiety, depression, apraxia, executive dysfunction, dysarthria and dysphagia. The cortical activities of the WD patients with dystonia seemed to be more chaotic during the eyes-closed and reading tasks but lower during the swallowing stages than those in the control group.
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Affiliation(s)
- Shaoru Zhang
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Aiqun Liu
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Zhihua Zhou
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Zheng Huang
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Jing Cheng
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Danping Chen
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qizhi Zhong
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Qingyun Yu
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Zhongxing Peng
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Mingfan Hong
- Department of Neurology, The First Affiliated Hospital, Clinical Medicine College of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
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Cheng I, Takahashi K, Miller A, Hamdy S. Cerebral control of swallowing: An update on neurobehavioral evidence. J Neurol Sci 2022; 442:120434. [PMID: 36170765 DOI: 10.1016/j.jns.2022.120434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/07/2022] [Accepted: 09/18/2022] [Indexed: 01/07/2023]
Abstract
This review aims to update the current knowledge on the cerebral control of swallowing. We review data from both animal and human studies spanning across the fields of neuroanatomy, neurophysiology and neuroimaging to evaluate advancements in our understanding in the brain's role in swallowing. Studies have collectively shown that swallowing is mediated by multiple distinct cortical and subcortical regions and that lesions to these regions can result in dysphagia. These regions are functionally connected in separate groups within and between the two hemispheres. While hemispheric dominance for swallowing has been reported in most human studies, the laterality is inconsistent across individuals. Moreover, there is a shift in activation location and laterality between swallowing preparation and execution, although such activation changes are less well-defined than that for limb motor control. Finally, we discussed recent neurostimulation treatments that may be beneficial for dysphagia after brain injury through promoting the reorganization of the swallowing neural network.
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Affiliation(s)
- Ivy Cheng
- Centre for Gastrointestinal Sciences, Division of Diabetes, Gastroenterology and Endocrinology, School of Medical Sciences, University of Manchester, UK.
| | - Kazutaka Takahashi
- Department of Organismal Biology and Anatomy, University of Chicago, USA
| | - Arthur Miller
- Division of Orthodontics, Department of Orofacial, Sciences, School of Dentistry, University of California at San Francisco, USA
| | - Shaheen Hamdy
- Centre for Gastrointestinal Sciences, Division of Diabetes, Gastroenterology and Endocrinology, School of Medical Sciences, University of Manchester, UK
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Hashimoto H, Ming Khoo H, Yanagisawa T, Tani N, Oshino S, Hirata M, Kishima H. Frequency band coupling with high-frequency activities in tonic-clonic seizures shifts from θ to δ band. Clin Neurophysiol 2022; 137:122-131. [DOI: 10.1016/j.clinph.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/24/2022] [Accepted: 02/15/2022] [Indexed: 11/25/2022]
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Hashimoto H, Khoo HM, Yanagisawa T, Tani N, Oshino S, Kishima H, Hirata M. Phase-amplitude coupling between infraslow and high-frequency activities well discriminates between the preictal and interictal states. Sci Rep 2021; 11:17405. [PMID: 34465798 PMCID: PMC8408139 DOI: 10.1038/s41598-021-96479-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Infraslow activity (ISA) and high-frequency activity (HFA) are key biomarkers for studying epileptic seizures. We aimed to elucidate the relationship between ISA and HFA around seizure onset. We enrolled seven patients with drug-resistant focal epilepsy who underwent intracranial electrode placement. We comparatively analyzed the ISA, HFA, and ISA-HFA phase-amplitude coupling (PAC) in the seizure onset zone (SOZ) or non-SOZ (nSOZ) in the interictal, preictal, and ictal states. We recorded 15 seizures. HFA and ISA were larger in the ictal states than in the interictal or preictal state. During seizures, the HFA and ISA of the SOZ were larger and occurred earlier than those of nSOZ. In the preictal state, the ISA-HFA PAC of the SOZ was larger than that of the interictal state, and it began increasing at approximately 87 s before the seizure onset. The receiver-operating characteristic curve revealed that the ISA-HFA PAC of the SOZ showed the highest discrimination performance in the preictal and interictal states, with an area under the curve of 0.926. This study demonstrated the novel insight that ISA-HFA PAC increases before the onset of seizures. Our findings indicate that ISA-HFA PAC could be a useful biomarker for discriminating between the preictal and interictal states.
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Affiliation(s)
- Hiroaki Hashimoto
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan. .,Department of Neurosurgery, Otemae Hospital, Osaka, Osaka, 540-0008, Japan.
| | - Hui Ming Khoo
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Takufumi Yanagisawa
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Naoki Tani
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Satoru Oshino
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
| | - Masayuki Hirata
- Department of Neurological Diagnosis and Restoration, Graduate School of Medicine, Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0871, Japan
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