Differential changes in human pharyngoesophageal motor excitability  induced by swallowing, pharyngeal stimulation, and anesthesia

Fraser, Christopher; Rothwell, John C.; Power, Maxine; Hobson, Anthony; Thompson, David G.; Hamdy, Shaheen

doi:10.1152/ajpgi.00399.2002

Cited by 83 publications

(86 citation statements)

References 19 publications

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“…Even though the effect of local anesthesia on the pharynx ceases after a certain amount of time, a significant decrease of ERD could be detected in our measurement indicating a relevant anesthetizing effect of lidocaine for at least 30 minutes, which is long enough to conduct intervention trials. Similar findings were described by Fraser et al who also used lidocaine as local anesthetic on the pharynx and found a decrease of sensory thresholds for at least 30 -45 minutes after application [50]. In the present study, the model was validated with MEG only but we believe it is also applicable with other functional imaging techniques, such as fMRI.…”

Section: Limitations and Methodological Considerationssupporting

confidence: 89%

Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment

et al. 2018

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Background/Aims: Performing neurophysiological and functional imaging studies in severely affected patients to investigate novel neurostimulation techniques for the treatment of neurogenic dysphagia is difficult. Therefore, basic research needs to be conducted in healthy subjects. Swallowing is a motor function highly dependent on sensory afferent input. Here we propose a virtual peripheral sensory lesion model to mimic pharyngeal sensory impairment, which is known as a major contributor to dysphagia in neurological disease. Methods: In this randomized crossover study on 11 healthy volunteers, cortical activation during pneumatic pharyngeal stimulation was measured applying magnetoencephalography in two separate sessions, with and without pharyngeal surface anesthesia. Results: Stimulation evoked bilateral event-related desynchronization (ERD) mainly in the caudolateral pericentral cortex. In comparison to the no-anesthesia condition, topical anesthesia led to a reduction of ERD in beta (13-30 Hz) and low gamma (30-60 Hz) frequency ranges (p<0.05) in sensory but also motor cortical areas. Conclusions: Withdrawal of sensory afferent information by topical anesthesia leads to reduced response to pneumatic pharyngeal stimulation in a distributed cortical sensorimotor network in healthy subjects. The proposed paradigm may serve to investigate the effect of neuromodulatory treatments specifically on pharyngeal sensory impairment as relevant cause of neurogenic dysphagia.

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Section: Limitations and Methodological Considerationssupporting

confidence: 89%

Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment

et al. 2018

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“…Using MEPs as an outcome measure in swallowing-related interventions Since MEPs are a commonly used outcome measure in swallowing-related intervention studies in healthy subjects (Abdul Wahab et al 2010;Doeltgen et al 2010;Fraser et al 2003), it is important to consider the characteristics of a desirable result following intervention. Rehabilitation-related studies consider increased MEP magnitude to be a positive outcome following therapy (Hamdy et al 1997) and an absent or decreased MEP magnitude a negative predictor for motor improvement (Koski et al 2004;Piron et al 2005).…”

Section: Discussionmentioning

confidence: 99%

Age and gender effects on submental motor-evoked potentials

Sella

Jones

Huckabee

2014

AGE

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It is not known whether there are ageand/or gender-related differences in magnitude of motor-evoked potentials (MEPs) of the submental muscles. Knowledge of this is important in investigations of neurophysiological aspects of swallowing. Forty healthy participants (20 males, 20 females; 20 young [21-35 years], 20 old [53-88 years]) were recruited. Surface electromyography (EMG) electrodes were placed at midline underlying the submental muscle group. Age-and genderrelated differences were evaluated in two neurophysiologic measures of swallowing: MEPs stimulated by single-pulse transcranial magnetic stimulation (TMS) over the motor cortex and surface electromyography (sEMG) recorded from the same submental muscle group during non-stimulated swallows. The older participants had larger MEPs during saliva swallowing than the young participants (p = 0.04, d=0.86). Conversely, the older participants had lower amplitude submental EMG activity during nonstimulated swallows (p=0.045, d=0.67). Gender had no significant effect on MEP magnitude and on submental activity during saliva swallowing. There were no effects of age or gender on MEP latencies. These findings suggest deterioration in muscle function with age in a sample of healthy adults presenting with functional swallowing. We speculate that muscular decline is partially ameliorated by increased cortical activity-i.e., increased submental MEPs-so as to preserve swallowing function in healthy older subjects. These findings emphasize the need for different reference points for evaluation of submental MEPs of different age groups.

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“…Equally it is possible that the additional swallowing activity causes some fatigue of the cortical swallowing system, which provoked a level of inhibition in cortical excitability reducing any long-term effect. Considering the effect of swallowing solutions, previous reports have shown that there is an immediate increase in excitability without long-term changes when applying either room temperature 36 or cold water (4-6°C) 22,37 on pharyngeal cortex. Thus, it would appear that cold water swallowing alone is not a strong inducer of cortical excitation despite cold stimulation being an established method of the rehabilitation for dysphagia patient.…”

Section: Changes In the Corticobulbar Neural Circuitmentioning

confidence: 99%

Exploring the effects of synchronous pharyngeal electrical stimulation with swallowing carbonated water on cortical excitability in the human pharyngeal motor system

Magara

Michou

Raginis-Zborowska

et al. 2016

Neurogastroenterology Motil

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Key Points• Excitation of human pharyngeal motor cortex can be induced by pharyngeal electrical stimulation (PES) and swallowing carbonated water (CW). This study was undertaken to investigate the effect of synchronously combining PES with swallowing CW.• Pharyngeal cortical and brainstem excitation was investigated using transcranial or transcutaneous magnetic stimulation (TMS).• PES was most effective at inducing excitation in the pharyngeal motor cortex. Combination of PES and CW were less effective in producing cortical excitability but induced transient excitation in the brainstem. Our data indicate the PES may be more advantageous than combined swallowing stimuli for driving cortical changes in the swallowing system which may be useful in dysphagia rehabilitation. AbstractBackground Previous reports have revealed that excitation of human pharyngeal motor cortex can be induced by pharyngeal electrical stimulation (PES) and swallowing carbonated water (CW). This study investigated whether combining PES with swallowing (of still water, SW or CW) can potentiate this excitation in either cortical and/or brain stem areas assessed with transcranial and transcutaneous magnetic stimulation (TMS). Methods Fourteen healthy volunteers participated and were intubated with an intraluminal catheter to record pharyngeal electromyography and deliver PES. Each participant underwent baseline corticopharyngeal, hand and craniobulbar motor-evoked potential (MEP) measurements. Subjects were then randomized to receive each of four 10-min interventions (PES only, Sham-PES+CW, PES+CW, and PES+SW). Corticobulbar, craniobulbar and hand MEPs were then remeasured for up to 60 min and data analyzed using ANOVA and post hoc t-tests. Key Results A two-way rmANOVA for Interventions 9 Time-point showed a significant corticopharyngeal interaction (p = 0.010). One-way ANOVA with post hoc t-tests indicated significant cortical changes with PES only at 45 (p = 0.038) and 60 min (p = 0.023) and ShamPES+CW immediately (p = 0.008) but not with PES+CW or PES+SW. By contrast, there were immediate craniobulbar amplitude changes only with PES+CW (p = 0.020) which were not sustained. Conclusions & Inferences We conclude that only PES produced long-term changes in corticopharyngeal excitability whereas combination stimuli were less effective. Our data suggest that PES alone rather than in combination, may be better for the patients who have difficulty in performing voluntary swallows.

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Differential changes in human pharyngoesophageal motor excitability induced by swallowing, pharyngeal stimulation, and anesthesia

Cited by 83 publications

References 19 publications

Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment

Introducing a Virtual Lesion Model of Dysphagia Resulting from Pharyngeal Sensory Impairment

Age and gender effects on submental motor-evoked potentials

Exploring the effects of synchronous pharyngeal electrical stimulation with swallowing carbonated water on cortical excitability in the human pharyngeal motor system

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