The search for the central swallowing pathway: the quest for clarity.

As the work of Dr. Martin Donner has brought a clarity to understanding swallowing, so has the work of various neuroscientists, including that of a Nobel Laureate, in providing us with a better comprehension of this complex motor pattern. Understanding the neural control of swallowing has been a process that has occurred during this century in which several investigators, primarily from Europe, Japan, Canada, and the United States, have brought their perspectives in applying particular techniques to decipher how the central and peripheral nervous system control swallowing. Swallowing represents a complex muscular response of the oral, pharyngeal, and esophageal regions which are integrated to provide an effective functional pattern that prepares and transports food while simultaneously protecting the airway. This adaptation of the upper gastrointestinal tract in mammals has been extensively studied peripherally by two methods: recording from the peripheral nerves and muscles, and stimulating peripheral nerves and their receptive fields that can induce the pharyngeal and esophageal phases of swallowing. The study of the peripheral nervous system has provided insight into the sensory receptive fields that evoke or facilitate swallowing, and has established the first serious evidence of the all-or-none sequential contraction pattern of the oropharyngeal and esophageal muscles. It has been these electromyographic studies of the muscles that has established much of the criteria for evaluating the central swallowing pathway. Five techniques have been applied to the central nervous system to study swallowing and include lesioning or destroying discrete regions to determine how swallowing is impaired or modified, electrically stimulating the central neural tissue to determine the type of effects on swallowing, recording from the central neural tissue with macro- and microelectrodes to ascertain when neurons respond in timing to the peripheral muscle activity during swallowing, applying pharmacological agents through micropipettes which could mimic or inhibit potential transmitters, and using immunochemical techniques to tag specific chemicals that could be transmitters used by the neurons in the central swallowing pathway. These various techniques have provided insight into how the central swallowing pathway is organized but the details of the central control are still in the process of being defined and will require as much effort this next century as has been previously developed over the past 90 years.