Ertekin C, Aydogdu I, Yüceyar N, Tarlaci S, Kiylioglu N, Pehlivan M, Celebi G
Department of Clinical Neurophysiology, Medical School Hospital, Ege University Bornova, Izmir, Turkey.
Electroencephalogr Clin Neurophysiol. 1998 Aug;109(4):331-40. doi: 10.1016/s0924-980x(98)00027-7.
Swallowing mechanisms and neurogenic dysphagia have not been systematically studied by the EMG technique. It is desirable to evaluate neurogenic dysphagia for diagnostic and possibly for therapeutic purposes using electrophysiological methods.
The following methods were described: mechanical upward/downward movements of the larynx were detected using a piezoelectric sensor, while submental integrated EMG activity was recorded during dry and wet swallowing. The EMG activity of cricopharyngeal muscle of the upper oesophageal sphincter was also recorded in some normal subjects and patients. Piecemeal deglutition and the dysphagia limit were determined in all patients to detect dysphagia objectively. In this study 75 normal subjects and 177 neurological patients with various degrees of dysphagia were investigated.
Voluntarily triggered oropharyngeal swallowing was commonly pathological in the majority of patients, with or without overt dysphagia. The dysphagia limit appeared to be an objective measure of the degree of dysphagia in more than 90% of patients. Pathophysiological mechanisms were different in at least three groups of patients with neurogenic dysphagia. In the group of patients with muscular disorders, laryngeal elevators were involved while the CP-sphincter was intact. The second group included patients with the clinical signs of corticobulbar fibre involvement such as amyotrophic lateral sclerosis and pseudobulbar palsy. In these patients, there was incoordination between paretic laryngeal elevators and hyperreflexic CP-sphincter. In the third group (patients with Parkinson's disease), the swallowing reflex was delayed and prolonged.
EMG methods described in the present study are very useful for the diagnosis of neurogenic dysphagia, objectively and quickly. They are important to understand the physiological mechanisms for deglutition and its disorders.
吞咽机制和神经源性吞咽困难尚未通过肌电图技术进行系统研究。期望使用电生理方法评估神经源性吞咽困难以用于诊断，可能也用于治疗目的。
描述了以下方法：使用压电传感器检测喉部的机械向上/向下运动，同时在干咽和湿咽过程中记录颏下肌的积分肌电图活动。在一些正常受试者和患者中也记录了食管上括约肌环咽肌的肌电图活动。确定所有患者的分次吞咽和吞咽困难极限以客观检测吞咽困难。在本研究中，对75名正常受试者和177名患有不同程度吞咽困难的神经科患者进行了调查。
在大多数患者中，无论有无明显吞咽困难，自主触发的口咽吞咽通常都是病理性的。吞咽困难极限似乎是超过90%患者吞咽困难程度的客观指标。至少三组神经源性吞咽困难患者的病理生理机制不同。在肌肉疾病患者组中，喉部提升肌受累而环咽括约肌完整。第二组包括具有皮质延髓纤维受累临床体征的患者，如肌萎缩侧索硬化症和假性延髓麻痹。在这些患者中，麻痹的喉部提升肌和反射亢进的环咽括约肌之间存在不协调。在第三组（帕金森病患者）中，吞咽反射延迟且延长。
本研究中描述的肌电图方法对于神经源性吞咽困难的诊断非常有用，客观且快速。它们对于理解吞咽及其障碍的生理机制很重要。
