Gu Furong, Han Jing, Zhang Qiang, Li Xiangyu, Wang Yue, Wu Jialing
Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China.
Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin, China.
Front Neurol. 2024 Jul 31;15:1346522. doi: 10.3389/fneur.2024.1346522. eCollection 2024.
This study aims to examine brain activity during different swallowing actions in patients with dysphagia caused by medullary infarction (MI) before and after treatment using blood oxygen level-dependent (BOLD) functional magnetic resonance imaging.
Fifteen patients were enrolled in this study. Brain activation during saliva swallowing and effortful saliva swallowing was observed using BOLD imaging in the acute phase of stroke and after 4 weeks of rehabilitation training. Differences in the activation of brain regions during saliva swallowing before and after treatment, during effortful saliva swallowing before and after treatment, and between the two swallowing actions before and after treatment were compared.
In the acute phase of stroke, only the bilateral precentral and left lingual gyrus were partially activated during saliva swallowing, and there was no obvious activation in the insula. Effortful saliva swallowing activated more brain regions than saliva swallowing before treatment, including the bilateral supplementary motor area (SMA), postcentral gyrus, and right insular cortex. The number of brain regions activated during saliva swallowing increased after treatment, including the bilateral precentral gyrus, postcentral gyrus, insula, thalamus, and SMA.
Cortical activation increases after recovery from dysphagia, and the increased activation of the postcentral gyrus might play a functional compensatory role. Effortful saliva swallowing is a more effective rehabilitation training method for patients with dysphagia caused by MI.
本研究旨在利用血氧水平依赖（BOLD）功能磁共振成像，检查延髓梗死（MI）所致吞咽困难患者在治疗前后不同吞咽动作时的脑活动。
本研究纳入了15名患者。在中风急性期和康复训练4周后，使用BOLD成像观察吞咽唾液和用力吞咽唾液时的脑激活情况。比较治疗前后吞咽唾液时脑区激活的差异、治疗前后用力吞咽唾液时脑区激活的差异以及治疗前后两种吞咽动作之间脑区激活的差异。
在中风急性期，吞咽唾液时仅双侧中央前回和左侧舌回部分激活，岛叶无明显激活。与治疗前吞咽唾液相比，用力吞咽唾液激活了更多脑区，包括双侧辅助运动区（SMA）、中央后回和右侧岛叶皮质。治疗后吞咽唾液时激活的脑区数量增加，包括双侧中央前回、中央后回、岛叶、丘脑和SMA。
吞咽困难恢复后皮质激活增加，中央后回激活增加可能起功能代偿作用。用力吞咽唾液对MI所致吞咽困难患者是一种更有效的康复训练方法。
