Hamdy S, Aziz Q, Rothwell J C, Power M, Singh K D, Nicholson D A, Tallis R C, Thompson D G
Department of Gastroenterology, Hope Hospital, University of Manchester, Salford, UK.
Gastroenterology. 1998 Nov;115(5):1104-12. doi: 10.1016/s0016-5085(98)70081-2.
BACKGROUND & AIMS: The aim of this study was to determine the mechanism for recovery of swallowing after dysphagic stroke.
Twenty-eight patients who had a unilateral hemispheric stroke were studied 1 week and 1 and 3 months after the stroke by videofluoroscopy. Pharyngeal and thenar electromyographic responses to magnetic stimulation of multiple sites over both hemispheres were recorded, and motor representations were correlated with swallowing recovery.
Dysphagia was initially present in 71% of patients and in 46% and 41% of the patients at 1 and 3 months, respectively. Cortical representation of the pharynx was smaller in the affected hemisphere (5 +/- 1 sites) than the unaffected hemisphere (13 +/- 1 sites; P </= 0.001). Nondysphagic and persistently dysphagic patients showed little change in pharyngeal representation in either hemisphere at 1 and 3 months compared with presentation, but dysphagic patients who recovered had an increased pharyngeal representation in the unaffected hemisphere at 1 and 3 months (15 +/- 2 and 17 +/- 3 vs. 9 +/- 2 sites; P </= 0.02) without change in the affected hemisphere. In contrast, thenar representation increased in the affected hemisphere but not the unaffected hemisphere at 1 and 3 months (P </= 0.01).
Return of swallowing after dysphagic stroke is associated with increased pharyngeal representation in the unaffected hemisphere, suggesting a role for intact hemisphere reorganization in recovery.
本研究旨在确定吞咽困难性卒中后吞咽恢复的机制。
对28例单侧半球卒中患者在卒中后1周、1个月和3个月进行视频透视检查。记录双侧半球多个部位磁刺激时的咽部和鱼际肌肌电图反应，并将运动表征与吞咽恢复情况相关联。
71%的患者最初存在吞咽困难，在1个月和3个月时，分别有46%和41%的患者存在吞咽困难。患侧半球咽部的皮质表征（5±1个部位）比未患侧半球（13±1个部位；P≤0.001）小。与初始表现相比，非吞咽困难和持续吞咽困难的患者在1个月和3个月时，双侧半球的咽部表征几乎没有变化，但恢复的吞咽困难患者在1个月和3个月时，未患侧半球的咽部表征增加（分别为15±2和17±3个部位，而初始为9±2个部位；P≤0.02），患侧半球无变化。相比之下，在1个月和3个月时，患侧半球的鱼际肌表征增加，而未患侧半球未增加（P≤0.01）。
吞咽困难性卒中后吞咽功能的恢复与未患侧半球咽部表征增加有关，提示完整半球重组在恢复过程中起作用。
