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Am J Physiol Gastrointest Liver Physiol 286: G45-G50, 2004. First published August 28, 2003; doi:10.1152/ajpgi.00114.2003
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NEUROREGULATION AND MOTILITY

Changes in pharyngeal corticobulbar excitability and swallowing behavior after oral stimulation

M. Power,1 C. Fraser,1 A. Hobson,1 J. C. Rothwell,2 S. Mistry,1 D. A. Nicholson,3 D. G. Thompson,1 and S. Hamdy1

Departments of 1GI Science and 3Radiology, University of Manchester, Hope Hospital, Salford M6 8HD; and 2Sobell Department of Neurophysiology, Institute of Neurology, London WC1N 3BG, United Kingdom

Submitted 12 March 2003 ; accepted in final form 18 August 2003

Faucial pillar (FP) stimulation is commonly used in swallowing rehabilitation, yet its physiological basis remains uncertain. We investigated the effects of intraoral FP stimulation on human corticobulbar excitability and swallowing behavior, to explore the possibility of a central mechanism for functional change. In 10 healthy subjects, corticobulbar projections to pharynx were investigated with transcranial magnetic stimulation, via intraluminal electrodes, before and up to 1 h after 10 min of electrical FP stimulation with three frequencies (0.2, 1, and 5 Hz) or sham and peripheral (median nerve) stimulation. In a second study, swallowing behavior was assessed with videofluoroscopy before and after FP stimulation. FP stimulation at 5 Hz inhibited the corticobulbar projection (-14 ± 6%, P < 0.02) and lengthened swallow response time (+114 ± 24%, P = 0.02). By comparison, FP stimulation at 0.2 Hz facilitated this projection (+60 ± 28%, P < 0.04), without enhancing swallowing behavior. Neither 1-Hz, sham, nor median nerve stimulation altered excitability. Thus changes in corticobulbar excitability to FP stimulation are frequency dependent with implications for the treatment for neurogenic swallowing dysfunction.

cortical plasticity; deglutition; faucial pillars; oropharynx; transcranial magnetic stimulation; videofluoroscopy


Address for reprint requests and other correspondence: S. Hamdy, MRC Clinician Scientist, Dept. of GI Sciences, Univ. of Manchester, Hope Hospital, Salford M6 8HD, UK (E-mail: shamdy{at}fs1.ho.man.ac.uk).




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Evidence-Based Systematic Review: Effects of Neuromuscular Electrical Stimulation on Swallowing and Neural Activation
Am J Speech Lang Pathol, November 1, 2009; 18(4): 361 - 375.
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