Effect of medullary lesions on coordination of deglutition

Doty, Robert W.; Richmond, W.; Storey, Arthur T.

doi:10.1016/0014-4886(67)90125-2

Cited by 156 publications

(76 citation statements)

References 7 publications

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“…In both these muscles, the interval between the peaks of activity was of the order of 220 -260 ms, which approximates to the duration of suckling cycles (200 -250 ms) previously described in the intact conscious animal (German et al 1997;. Similarly, two peaks of geniohyoid activity are found in the swallows of cerebrally intact primates (Doty et al 1967).…”

Section: Swallow Emg Profiles In the Intact Conscious And The Decerebmentioning

confidence: 80%

Integration of the Reflex Pharyngeal Swallow Into Rhythmic Oral Activity in a Neurologically Intact Pig Model

German¹,

Crompton²,

Thexton³

2009

Journal of Neurophysiology

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Section: Swallow Emg Profiles In the Intact Conscious And The Decerebmentioning

confidence: 80%

Integration of the Reflex Pharyngeal Swallow Into Rhythmic Oral Activity in a Neurologically Intact Pig Model

German¹,

Crompton²,

Thexton³

2009

Journal of Neurophysiology

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“…7,28 -30 These 2 regions are represented on both sides of the brain stem and are interconnected extensively so that either side can coordinate the pharyngeal and esophageal phases of swallowing. 31,32 Consequently, these dual swallowing centers on both sides of the medullary region and their extensive connections are important in understanding the nature of dysphagia in WS. LMI should primarily affect the NTS and, in particular, the NA and their vicinity in the medulla oblongata unilaterally.…”

Section: Discussionmentioning

confidence: 99%

Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome)

Aydoğdu

Ertekin

Tarlacı

et al. 2001

Stroke

130

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Background and Purpose-We have investigated the pathophysiological mechanisms of dysphagia in Wallenberg's syndrome (WS) that are due to lateral medullary infarction (LMI). Methods-Twenty patients with WS were evaluated by means of clinical and electrophysiological methods that measured the oropharyngeal phase of voluntarily initiated swallowing. For comparison, 22 patients with unilateral hemispheric infarction were investigated during the acute stage of stroke, and 4 patients with unilateral peripheral 9th and 10th cranial nerve palsies were studied. Age-matched 30 healthy control subjects were also included in the study. Results-It was found that dysphagia was clinically more severe in WS patients than in the patients in the other groups.The pharyngeal phase of swallowing was predominantly impaired, whereas in patients with hemispheric stroke, dysphagia was related only to the delay of triggering of the voluntarily induced swallowing. In WS patients, the swallowing reflex was extremely slow in spite of the unilateral involvement due to LMI, whereas the pharyngeal phase of reflex swallowing remained within normal limits in patients with unilateral hemispheric stroke and patients with unilateral peripheral 9th and 10th cranial nerve palsies. Conclusions-Although in WS the lesion due to LMI is unilateral, its effect on oropharyngeal swallowing is bilateral. In LMI, primarily the premotor neurons in the nucleus ambiguus and their connections seem to be affected. Consequently, a disruption and/or disconnection of their linkage to swallowing-related cranial motor neuron pools bilaterally and to the contralateral nucleus ambiguus could produce the swallowing disorders in WS. However, the remaining intact ipsilateral premotor neurons and the contralateral center in the medulla oblongata may eventually begin to operate and overcome the severity and long-term persistence of dysphagia.

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“…The neural mechanism by which deglutition resets the respiratory oscillator is not known. Deglutition can be induced in animals by electrical stimulation of the anterolateral prefrontal cortex (Sumi, 1969) or by stimulation of superior laryngeal nerve (SLN) afferents (Doty & Bosma, 1956;Miller, 1972), which project to the nucleus tractus solitarii (NTS) and reticular formation (Doty, Richmond & Storey, 1956;Sumi, 1969;Car, 1973). There is evidence that corticofugal and SLN inputs converge on the NTS, which appears to serve as the initial integrative site to potentiate other medullary sites (such as the nucleus ambiguus) involved in the generation of deglutition.…”

Section: Discussionmentioning

confidence: 99%

Respiratory phase resetting and airflow changes induced by swallowing in humans.

Paydarfar

Gilbert

Poppel

et al. 1995

The Journal of Physiology

186

163

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1. Relationships between the timing of respiration and deglutition were studied in thirty awake healthy subjects at rest. Deglutition was monitored by submental electromyography, pharyngeal manometry and videofluoroscopy. Respiration was recorded by measurement of oronasal airflow and chest wall movement. Three types of deglutition were studied: injected bolus swallows, spontaneous swallows, and visually cued swallows of boluses previously placed in the mouth. 2. The effect of each swallow on respiratory rhythm was characterized by measurement of cophase, defined as the interval between the onset of deglutitive submental EMG activity to the onset of subsequent rescheduled inspirations. Cophase was determined for swallows initiated at different phases of the respiratory cycle. In all subjects deglutition caused phase resetting of respiratory rhythm. Cophase was largest for swallows initiated near the inspiratory-expiratory (I-E) transition and smallest for swallows initiated near the expiratory-inspiratory (E-I) transition. The pattern of respiratory resetting by deglutition was topologically classified as type 0. This pattern was shown for swallows induced by bolus injection or visual cue, and for spontaneous swallows. 3. The incidence of spontaneous deglutition was influenced by the position of the swallow in the respiratory cycle. Few spontaneous swallows were initiated near the E-I transition whereas most occurred from late inspiration to mid-expiration. 4. Deglutition caused an abrupt decrease in airflow leading to an interval of apnoea, followed by a period of expiration. The duration of deglutition apnoea for spontaneous swallows was shorter than that for 5 ml bolus swallows, and was unaffected by the respiratory phase of swallow initiation. The period of expiration after swallowing was longest for swallows initiated at the I-E transition, and shortest for E-I swallows. 5. The intervals between bolus injection and the onset of deglutition apnoea, and the timing of swallowing events, were not significantly altered by the phase in the respiratory cycle at which swallowing was exhibited. 6. To quantify the relationship between bolus flow and respiration, we determined the latencies between cessation of inspiratory airflow and arrival of the bolus at the larynx (a.), and between laryngeal bolus departure and resumption of inspiratory airflow (a). Both values were dependent upon the respiratory phase of swallowing. The lowest values for a and a were found for early-inspiratory and late-expiratory swallows, respectively. 7. We conclude that swallowing causes respiratory phase resetting with a pattern that is characteristic of the strong perturbations of an attractor-cycle oscillator. The threshold for initiation of swallowing in awake subjects is influenced by, but not strongly coupled to, the phase of respiration. We propose that respiratory timing, in addition to anatomical barriers within the upper airway, influences the vulnerability for aspiration during deglutition. Swallows initiated near the E-I transiti...

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Effect of medullary lesions on coordination of deglutition

Cited by 156 publications

References 7 publications

Integration of the Reflex Pharyngeal Swallow Into Rhythmic Oral Activity in a Neurologically Intact Pig Model

Integration of the Reflex Pharyngeal Swallow Into Rhythmic Oral Activity in a Neurologically Intact Pig Model

Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome)

Respiratory phase resetting and airflow changes induced by swallowing in humans.

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