Hamdy S, Aziz Q, Rothwell J C, Crone R, Hughes D, Tallis R C, Thompson D G
Department of Gastroenterology, Hope Hospital, University of Manchester, Salford, UK.
Lancet. 1997 Sep 6;350(9079):686-92. doi: 10.1016/S0140-6736(97)02068-0.
Oropharyngeal dysphagia occurs in up to a third of patients presenting with a unilateral hemiplegic stroke, yet its neurophysiological basis remains unknown. To explore the relation between cortical motor function of swallowing and oropharyngeal dysphagia, mylohyoid, pharyngeal, and thenar electromyographic responses to stimulation of affected and unaffected hemispheres were recorded in dysphagic and non-dysphagic patients.
The 20 patients studied had unilateral hemispheric stroke confirmed by computed tomography. Eight of them had associated swallowing difficulties. Electromyographic responses were recorded after suprathreshold transcranial magneto-electric stimulation of affected and unaffected hemispheres with a figure-of-eight coil.
Stimulation of the unaffected hemisphere evoked smaller pharyngeal responses in dysphagic patients than in non-dysphagic patients (mean 64 microV, median 48, interquartile range 44-86 vs 118 microV, 81, 73-150) (p < 0.02). With stimulation of the affected hemisphere, the pharyngeal responses were smaller than for the unaffected hemisphere but similar between the two patient groups (26 microV, 0, 0-48 vs 54 microV, 0, 0-80). Dysphagic and non-dysphagic patients showed similar mylohyoid and thenar responses to stimulation of the unaffected hemisphere as well as to stimulation of the affected hemisphere-unaffected mylohyoid (269 microV, 239, 89-372 vs 239 microV, 163, 133-307), thenar (572 microV, 463, 175-638 vs 638 microV, 485, 381-764); affected mylohyoid (60 microV, 41, 0-129 vs 96 microV, 0, 0-195); thenar (259 microV, 258, 0-538 vs 451 microV, 206, 8-717).
The findings indicate that dysphagia after unilateral hemispheric stroke is related to the magnitude of pharyngeal motor representation in the unaffected hemisphere.
在单侧偏瘫性中风患者中，高达三分之一的人会出现口咽吞咽困难，但其神经生理学基础尚不清楚。为了探究吞咽的皮质运动功能与口咽吞咽困难之间的关系，我们记录了吞咽困难和非吞咽困难患者在刺激患侧和健侧半球时，下颌舌骨肌、咽部肌肉和大鱼际肌的肌电反应。
本研究的20例患者经计算机断层扫描确诊为单侧半球中风。其中8例伴有吞咽困难。使用8字形线圈对患侧和健侧半球进行阈上经颅磁电刺激后，记录肌电反应。
刺激健侧半球时，吞咽困难患者的咽部反应比非吞咽困难患者小（平均64微伏，中位数48，四分位间距44 - 86，而后者为118微伏，81，73 - 150）（p < 0.02）。刺激患侧半球时，咽部反应比刺激健侧半球时小，但两组患者之间相似（26微伏，0，0 - 48 vs 54微伏，0，0 - 80）。吞咽困难和非吞咽困难患者在刺激健侧半球以及刺激患侧半球 - 健侧下颌舌骨肌时，下颌舌骨肌和大鱼际肌的反应相似（269微伏，239，89 - 372 vs 239微伏，163，133 - 307），大鱼际肌（572微伏，463，175 - 638 vs 638微伏，485，381 - 764）；患侧下颌舌骨肌（60微伏，41，0 - 129 vs 96微伏，0，0 - 195）；大鱼际肌（259微伏，258，0 - 538 vs 451微伏，206，8 - 717）。
这些发现表明，单侧半球中风后的吞咽困难与健侧半球咽部运动代表区的大小有关。
