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NEUROREGULATION AND MOTILITY

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

¹Department of Gastrointestinal Science, University of Manchester, Hope Hospital, Salford M6 8HD; and ²The Sobell Department of Neurophysiology, Institute of Neurology, London WC1N 3BG, England

Submitted 17 September 2002 ; accepted in final form 18 February 2003

We investigated the effects of water swallowing, pharyngeal stimulation, and oropharyngeal anesthesia on corticobulbar and craniobulbar projections to human swallowing musculature. Changes in pathway excitability were measured via electromyography from swallowed intraluminal pharyngeal and esophageal electrodes to motor cerebral and trigeminal nerve magnetic stimulation. After both water swallowing and pharyngeal stimulation, pharyngoesophageal corticobulbar excitability increased (swallowing: pharynx = 59 ± 12%, P < 0.001; esophagus = 45 ± 20%, P < 0.05; pharyngeal stimulation: pharynx = 76 ± 19%, P < 0.001; esophagus = 45 ± 23%, P = 0.05), being early with swallowing but late with stimulation. By comparison, craniobulbar excitability increased early after swallowing but remained unaffected by pharyngeal stimulation. After anesthesia, both corticobulbar (pharynx =–24 ± 10%, P < 0.05; esophagus = –28 ± 7%, P < 0.01) and craniobulbar excitability showed a late decrease. Thus swallowing induces transient early facilitation of corticobulbar and craniobulbar projections, whereas electrical stimulation promotes delayed facilitation mainly in cortex. With removal of input, both corticobulbar and craniobulbar projections show delayed inhibition, implying a reduction in motoneuron and/or cortical activity.

deelutition; motor cortex; plasticity; sensation

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