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Sensorimotor modulation of human cortical swallowing pathways

S Hamdy1, Q Aziz, J C Rothwell

  • 1University of Manchester Gastroenterology Unit, Hope Hospital, London, UK.

The Journal of Physiology
|March 21, 1998
PubMed
Summary

Cortical motor pathways to the pharynx and esophagus interact and are modulated by sensory feedback. This interaction influences swallowing control, with specific sensory inputs affecting pathway excitability.

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Area of Science:

  • Neuroscience
  • Motor Control
  • Gastroenterology

Background:

  • Transcranial magnetic stimulation (TMS) activates bilateral cortical projections to the pharynx and esophagus.
  • Understanding the interaction between hemispheres and sensory modulation of these pathways is crucial for swallowing function.

Purpose of the Study:

  • To investigate the interaction between cortical pathways from each hemisphere projecting to the pharynx and esophagus.
  • To explore how afferent feedback from the face, pharynx, and esophagus modulates these cortical pathways.

Main Methods:

  • Bilateral TMS with varying interstimulus intervals (ISIs) to assess spatial summation and transcallosal inhibition.
  • Conditioning cortical responses with single stimuli to the vagus or supraorbital nerves.
  • Applying single electrical stimuli or trains of stimuli to the pharynx or esophagus to modulate cortically evoked responses.

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Main Results:

  • Spatial summation of responses occurred at a 1 ms ISI, indicating shared cortical efferent targets.
  • Cortical responses were facilitated and onset latency reduced when timed with late reflex responses from vagus or supraorbital nerve stimulation.
  • Pharyngeal and esophageal stimulation trains decreased response latencies in a site-specific manner, suggesting modulation at brainstem and cortical levels.

Conclusions:

  • Cortical swallowing motor pathways from each hemisphere interact.
  • Sensory input from the pharynx and esophagus modulates pathway excitability in a site-specific manner.
  • This modulation involves a mixture of excitation and inhibition at brainstem and cortical levels, influencing swallowing control.