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Guanyabens N, Tomsen N, Palomeras E, Mundet L, Clavé P, Ortega O. Neurophysiological characterization of oropharyngeal dysphagia in older patients. Clin Neurophysiol 2024; 162:129-140. [PMID: 38615499 DOI: 10.1016/j.clinph.2024.03.030] [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: 11/16/2023] [Revised: 03/09/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To characterize swallowing biomechanics and neurophysiology in older patients with oropharyngeal dysphagia (OD). METHODS Observational study in 12 young healthy volunteers (HV), 9 older HV (OHV) and 12 older patients with OD with no previous diseases causing OD (OOD). Swallowing biomechanics were measured by videofluoroscopy, neurophysiology with pharyngeal sensory (pSEP) and motor evoked-potentials (pMEP) to intrapharyngeal electrical and transcranial magnetic stimulation (TMS), respectively, and salivary neuropeptides with enzyme-linked immunosorbent assay (ELISA). RESULTS 83.3% of OOD patients had unsafe swallows (Penetration-Aspiration scale = 4.3 ± 2.1; p < 0.0001) with delayed time to laryngeal vestibule closure (362.5 ± 73.3 ms; p < 0.0001) compared to both HV groups. OOD patients had: (a) higher pharyngeal sensory threshold (p = 0.009) and delayed pSEP P1 and N2 latencies (p < 0.05 vs HV) to electrical stimulus; and (b) higher pharyngeal motor thresholds to TMS in both hemispheres (p < 0.05) and delayed pMEPs latencies (right, p < 0.0001 HV vs OHV/OOD; left, p < 0.0001 HV vs OHV/OOD). CONCLUSIONS OOD patients have unsafe swallow and delayed swallowing biomechanics, pharyngeal hypoesthesia with disrupted conduction of pharyngeal sensory inputs, and reduced excitability and delayed cortical motor response. SIGNIFICANCE These findings suggest new elements in the pathophysiology of aging-associated OD and herald new and more specific neurorehabilitation treatments for these patients.
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Affiliation(s)
- Nicolau Guanyabens
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Neurology Department, Hospital de Mataró, Barcelona, Spain
| | - Noemí Tomsen
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Lluís Mundet
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain.
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery, Hospital de Mataró, Universitat Autónoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Kent RD. The Feel of Speech: Multisystem and Polymodal Somatosensation in Speech Production. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1424-1460. [PMID: 38593006 DOI: 10.1044/2024_jslhr-23-00575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE The oral structures such as the tongue and lips have remarkable somatosensory capacities, but understanding the roles of somatosensation in speech production requires a more comprehensive knowledge of somatosensation in the speech production system in its entirety, including the respiratory, laryngeal, and supralaryngeal subsystems. This review was conducted to summarize the system-wide somatosensory information available for speech production. METHOD The search was conducted with PubMed/Medline and Google Scholar for articles published until November 2023. Numerous search terms were used in conducting the review, which covered the topics of psychophysics, basic and clinical behavioral research, neuroanatomy, and neuroscience. RESULTS AND CONCLUSIONS The current understanding of speech somatosensation rests primarily on the two pillars of psychophysics and neuroscience. The confluence of polymodal afferent streams supports the development, maintenance, and refinement of speech production. Receptors are both canonical and noncanonical, with the latter occurring especially in the muscles innervated by the facial nerve. Somatosensory representation in the cortex is disproportionately large and provides for sensory interactions. Speech somatosensory function is robust over the lifespan, with possible declines in advanced aging. The understanding of somatosensation in speech disorders is largely disconnected from research and theory on speech production. A speech somatoscape is proposed as the generalized, system-wide sensation of speech production, with implications for speech development, speech motor control, and speech disorders.
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Labeit B, Muhle P, von Itter J, Slavik J, Wollbrink A, Sporns P, Rusche T, Ruck T, Hüsing-Kabar A, Gellner R, Gross J, Wirth R, Claus I, Warnecke T, Dziewas R, Suntrup-Krueger S. Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults. Front Aging Neurosci 2022; 14:912691. [PMID: 35966778 PMCID: PMC9366332 DOI: 10.3389/fnagi.2022.912691] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Background “Presbyphagia” refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity. Materials and methods 64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule. Results 32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model. Conclusions Swallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia.
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Affiliation(s)
- Bendix Labeit
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
- *Correspondence: Bendix Labeit,
| | - Paul Muhle
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Jonas von Itter
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Janna Slavik
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Peter Sporns
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Rusche
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Ruck
- Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Anna Hüsing-Kabar
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Reinhold Gellner
- Medical Clinic B (Gastroenterology, Hepatology, Endocrinology and Clinical Infectiology), University Hospital Münster, Münster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Herne, Germany
| | - Inga Claus
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Hospital Osnabrück, Osnabrück, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology, Institute of Translational Neurology, University Hospital Münster, Münster, Germany
- Institute for Biomagnetism and Biosignal Analysis, University Hospital Münster, Münster, Germany
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Muhle P, Labeit B, Wollbrink A, Claus I, Warnecke T, Wolters CH, Gross J, Dziewas R, Suntrup-Krueger S. Targeting the sensory feedback within the swallowing network-Reversing artificially induced pharyngolaryngeal hypesthesia by central and peripheral stimulation strategies. Hum Brain Mapp 2020; 42:427-438. [PMID: 33068056 PMCID: PMC7776007 DOI: 10.1002/hbm.25233] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/21/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Pharyngolaryngeal hypesthesia is a major reason for dysphagia in various neurological diseases. Emerging neuromodulation devices have shown potential to foster dysphagia rehabilitation, but the optimal treatment strategy is unknown. Because functional imaging studies are difficult to conduct in severely ill patients, we induced a virtual sensory lesion in healthy volunteers and evaluated the effects of central and peripheral neurostimulation techniques. In a sham-controlled intervention study with crossover design on 10 participants, we tested the potential of (peripheral) pharyngeal electrical stimulation (PES) and (central) transcranial direct current stimulation (tDCS) to revert the effects of lidocaine-induced pharyngolaryngeal hypesthesia on central sensorimotor processing. Changes were observed during pharyngeal air-pulse stimulation and voluntary swallowing applying magnetoencephalography before and after the interventions. PES induced a significant (p < .05) increase of activation during swallowing in the bihemispheric sensorimotor network in alpha and low gamma frequency ranges, peaking in the right premotor and left primary sensory area, respectively. With pneumatic stimulation, significant activation increase was found after PES in high gamma peaking in the left premotor area. Significant changes of brain activation after tDCS could neither be detected for pneumatic stimulation nor for swallowing. Due to the peripheral cause of dysphagia in this model, PES was able to revert the detrimental effects of reduced sensory input on central processing, whereas tDCS was not. Results may have implications for therapeutic decisions in the clinical context.
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Affiliation(s)
- Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
| | - Bendix Labeit
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
| | - Andreas Wollbrink
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Tobias Warnecke
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Carsten H Wolters
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
| | - Joachim Gross
- Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany.,Institute for Biomagnetism and Biosignalanalysis, University Hospital Muenster, Muenster, Germany
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Neurophysiological and Biomechanical Evaluation of the Mechanisms Which Impair Safety of Swallow in Chronic Post-stroke Patients. Transl Stroke Res 2019; 11:16-28. [DOI: 10.1007/s12975-019-00701-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/06/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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Easterling C. Management and Treatment of Patients with Dysphagia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0196-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marian T, Schröder JB, Muhle P, Claus I, Riecker A, Warnecke T, Suntrup-Krueger S, Dziewas R. Pharyngolaryngeal Sensory Deficits in Patients with Middle Cerebral Artery Infarction: Lateralization and Relation to Overall Dysphagia Severity. Cerebrovasc Dis Extra 2017; 7:130-139. [PMID: 28972945 PMCID: PMC5730110 DOI: 10.1159/000479483] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/06/2017] [Indexed: 12/16/2022] Open
Abstract
Background Dysphagia is a frequent and dangerous complication of acute stroke. Apart from a well-timed oropharyngeal muscular contraction pattern, sensory feedback is of utmost importance for safe and efficient swallowing. In the present study, we therefore analyzed the relation between pharyngolaryngeal sensory deficits and post-stroke dysphagia (PSD) severity in a cohort of acute stroke patients with middle cerebral artery (MCA) infarction. Methods Eighty-four first-ever MCA stroke patients (41 left, 43 right) were included in this trial. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardized protocol within 96 h after stroke onset. PSD was classified according to the 6-point fiberoptic endoscopic dysphagia severity scale. Pharyngolaryngeal sensation was semi-quantitatively evaluated by a FEES-based touch technique. Results PSD severity was closely related to the pharyngolaryngeal sensory deficit. With regards to lateralization of the sensory deficit, there was a slight but significant preponderance of sensory loss contralateral to the side of stroke. Apart from that, right hemispheric stroke patients were found to present with a more severe PSD. Conclusions This study provides evidence that an intact sensory feedback is of utmost importance to perform nonimpaired swallowing and highlights the key role of disturbed pharyngeal and laryngeal afferents in the pathophysiology of PSD.
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Affiliation(s)
- Thomas Marian
- Department of Neurology, University Hospital Münster, Münster, Germany
| | | | - Paul Muhle
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Inga Claus
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Axel Riecker
- Neurological/Neurosurgical Rehabilitation Clinic, RehaNova, Cologne, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, Münster, Germany
| | | | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Münster, Germany
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Cabib C, Ortega O, Vilardell N, Mundet L, Clavé P, Rofes L. Chronic post-stroke oropharyngeal dysphagia is associated with impaired cortical activation to pharyngeal sensory inputs. Eur J Neurol 2017; 24:1355-1362. [DOI: 10.1111/ene.13392] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 07/04/2017] [Indexed: 11/28/2022]
Affiliation(s)
- C. Cabib
- Laboratorio de Fisiología Digestiva; Hospital de Mataró; Mataró
| | - O. Ortega
- Laboratorio de Fisiología Digestiva; Hospital de Mataró; Mataró
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd); Hospital de Mataró; Mataró
| | - N. Vilardell
- Laboratorio de Fisiología Digestiva; Hospital de Mataró; Mataró
| | - L. Mundet
- Laboratorio de Fisiología Digestiva; Hospital de Mataró; Mataró
| | - P. Clavé
- Laboratorio de Fisiología Digestiva; Hospital de Mataró; Mataró
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd); Hospital de Mataró; Mataró
- Fundación Instituto de Investigación en Ciencias de la Salud; Hospital Universitario Germans Trias i Pujol; Badalona Spain
| | - L. Rofes
- Laboratorio de Fisiología Digestiva; Hospital de Mataró; Mataró
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd); Hospital de Mataró; Mataró
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Rofes L, Ortega O, Vilardell N, Mundet L, Clavé P. Spatiotemporal characteristics of the pharyngeal event-related potential in healthy subjects and older patients with oropharyngeal dysfunction. Neurogastroenterol Motil 2017; 29. [PMID: 27485487 DOI: 10.1111/nmo.12916] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/06/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Oropharyngeal dysphagia (OD) is a highly prevalent symptom in older people. Appropriate oropharyngeal sensory feedback is essential for safe and efficient swallowing. However, pharyngeal sensitivity decreases with advancing age and could play a fundamental role in the physiopathology of swallowing dysfunction associated with aging. We aimed to characterize pharyngeal sensitivity and cortical response to a pharyngeal electrical stimulus in healthy volunteers (HV) and older patients with and without OD. METHODS Eight young HV, eight older HV without OD, and 14 older patients with OD were studied by electroencephalography through 32 scalp electrodes. Pharyngeal event-related potentials (ERP) were assessed following electrical stimulation of the pharynx. Sensory and tolerance thresholds to the electrical stimulus and latency, amplitude, and scalp current density of each ERP component were analyzed and compared. An ERP source localization study was also performed using the sLORETA software. KEY RESULTS Older participants (with and without OD) presented an increased sensory threshold to pharyngeal electrical stimulation (10.2 ± 1.7 mA and 11.5 ± 1.9 mA respectively), compared with young HV (6.0 ± 1.2 mA). The cortical activation of older HV in response to pharyngeal electrical stimulus was reduced compared with young HV (N2 amplitude: 0.22 ± 0.79 vs -3.10 ± 0.59, P<.05). Older patients with OD also presented disturbances to the pharyngo-cortical connection together with disrupted pattern of cortical activation. CONCLUSIONS AND INFERENCES Older people present a decline in pharyngeal sensory function, more severe in older patients with OD. This sensory impairment might be a critical pathophysiological element and a potential target for treatment of swallowing dysfunction in older patients.
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Affiliation(s)
- L Rofes
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital de Mataró, Mataró, Spain
| | - O Ortega
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Mataró, Spain
| | - N Vilardell
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Mataró, Spain
| | - L Mundet
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Mataró, Spain
| | - P Clavé
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas (CIBERehd), Hospital de Mataró, Mataró, Spain.,Gastrointestinal Physiology Laboratory, Hospital de Mataró, Mataró, Spain
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Cabib C, Ortega O, Kumru H, Palomeras E, Vilardell N, Alvarez-Berdugo D, Muriana D, Rofes L, Terré R, Mearin F, Clavé P. Neurorehabilitation strategies for poststroke oropharyngeal dysphagia: from compensation to the recovery of swallowing function. Ann N Y Acad Sci 2016; 1380:121-138. [DOI: 10.1111/nyas.13135] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/11/2016] [Accepted: 05/19/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Christopher Cabib
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
| | - Omar Ortega
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - Hatice Kumru
- Fundación Institut Guttmann; Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona; Badalona Spain
| | - Ernest Palomeras
- Neurology Department, Hospital de Mataró; Universitat Autònoma de Barcelona; Mataró Spain
| | - Natalia Vilardell
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
| | - Daniel Alvarez-Berdugo
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - Desirée Muriana
- Neurology Department, Hospital de Mataró; Universitat Autònoma de Barcelona; Mataró Spain
| | - Laia Rofes
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - Rosa Terré
- Fundación Institut Guttmann; Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona; Badalona Spain
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation; Barcelona Spain
| | - Fermín Mearin
- Fundación Institut Guttmann; Institut Universitari de Neurorehabilitació, Universitat Autonoma de Barcelona; Badalona Spain
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation; Barcelona Spain
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Department of Surgery; Hospital de Mataró, Universitat Autònoma de Barcelona; Mataró Spain
- Centro de Investigación Biomedica en Red de enfermedades hepáticas y digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
- Health Sciences Research Institute of the Germans Trias i Pujol Foundation; Barcelona Spain
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Miyaji H, Hironaga N, Umezaki T, Hagiwara K, Shigeto H, Sawatsubashi M, Tobimatsu S, Komune S. Neuromagnetic detection of the laryngeal area: Sensory-evoked fields to air-puff stimulation. Neuroimage 2013; 88:162-9. [PMID: 24246493 DOI: 10.1016/j.neuroimage.2013.11.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 10/16/2013] [Accepted: 11/04/2013] [Indexed: 10/26/2022] Open
Abstract
The sensory projections from the oral cavity, pharynx, and larynx are crucial in assuring safe deglutition, coughing, breathing, and voice production/speaking. Although several studies using neuroimaging techniques have demonstrated cortical activation related to pharyngeal and laryngeal functions, little is known regarding sensory projections from the laryngeal area to the somatosensory cortex. The purpose of this study was to establish the cortical activity evoked by somatic air-puff stimulation at the laryngeal mucosa using magnetoencephalography. Twelve healthy volunteers were trained to inhibit swallowing in response to air stimuli delivered to the larynx. Minimum norm estimates was performed on the laryngeal somatosensory evoked fields (LSEFs) to best differentiate the target activations from non-task-related activations. Evoked magnetic fields were recorded with acceptable reproducibility in the left hemisphere, with a peak latency of approximately 100ms in 10 subjects. Peak activation was estimated at the caudolateral region of the primary somatosensory area (S1). These results establish the ability to detect LSEFs with an acceptable reproducibility within a single subject and among subjects. These results also suggest the existence of laryngeal somatic afferent input to the caudolateral region of S1 in human. Our findings indicate that further investigation in this area is needed, and should focus on laryngeal lateralization, swallowing, and speech processing.
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Affiliation(s)
- Hideaki Miyaji
- Department of Otorhinolaryngology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan; Department of Otorhinolaryngology, Yuaikai Oda Regional Medical Center, Japan.
| | - Naruhito Hironaga
- Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Toshiro Umezaki
- Department of Otorhinolaryngology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Koichi Hagiwara
- Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hiroshi Shigeto
- Division of Epilepsy and Sleep Center, Fukuoka Sanno Hospital, Japan
| | - Motohiro Sawatsubashi
- Department of Otorhinolaryngology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Shozo Tobimatsu
- Department of Clinical Neurophysiology, Neurological Institute, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Shizuo Komune
- Department of Otorhinolaryngology, Faculty of Medicine, Graduate School of Medical Sciences, Kyushu University, Japan
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Wheeler-Hegland K, Pitts T, Davenport PW. Peak morphology and scalp topography of the pharyngeal sensory-evoked potential. Dysphagia 2010; 26:287-94. [PMID: 20890713 DOI: 10.1007/s00455-010-9308-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 09/02/2010] [Indexed: 10/19/2022]
Abstract
The initiation of the pharyngeal stage of swallowing is dependent upon sensory input to the brainstem and cortex. The event-related evoked potential provides a measure of neuronal electrical activity as it relates to a specific stimulus. Air-puff stimulation to the posterior pharyngeal wall produces a sensory-evoked potential (PSEP) waveform. The goal of this study was to characterize the scalp topography and morphology for the component peaks of the PSEP waveform. Twenty-five healthy men and women served as research participants. PSEPs were measured via a 32-electrode cap (10-20 system) connected to SynAmps2 Neuroscan EEG System. Air puffs were delivered directly to the oropharynx using a thin polyethylene tube connected to a flexible laryngoscope. The PSEP waveform is characterized by four early- and mid-latency component peaks: an early positivity (P1) and negativity (N1), followed by a mid-latency positivity (P2) and negativity (N2). The early positive peak P1 is localized bilaterally to the lateral parietal scalp, the N1 medially in the frontoparietal region, and the P2 and N2 with diffuse scalp locations. Somatosensory and premotor regions are possible anatomical correlates of peak locations. Based on the latencies of the peaks, they are likely analogous to somatosensory- and respiratory-related evoked potential peaks.
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Affiliation(s)
- Karen Wheeler-Hegland
- Department of Physiological Sciences, University of Florida, Box 100144, Gainesville, FL 32610, USA.
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