title: Changes in pharyngeal corticobulbar excitability and swallowing behavior after oral stimulation.
abstract: Faucial pillar (FP) stimulation is commonly used in swallowing rehabilitation, yet its physiological basis remains uncertain. We investigated the effects of intraoral FP stimulation on human corticobulbar excitability and swallowing behavior, to explore the possibility of a central mechanism for functional change. In 10 healthy subjects, corticobulbar projections to pharynx were investigated with transcranial magnetic stimulation, via intraluminal electrodes, before and up to 1 h after 10 min of electrical FP stimulation with three frequencies (0.2, 1, and 5 Hz) or sham and peripheral (median nerve) stimulation. In a second study, swallowing behavior was assessed with videofluoroscopy before and after FP stimulation. FP stimulation at 5 Hz inhibited the corticobulbar projection (-14 +/- 6%, P < 0.02) and lengthened swallow response time (+114 +/- 24%, P = 0.02). By comparison, FP stimulation at 0.2 Hz facilitated this projection (+60 +/- 28%, P < 0.04), without enhancing swallowing behavior. Neither 1-Hz, sham, nor median nerve stimulation altered excitability. Thus changes in corticobulbar excitability to FP stimulation are frequency dependent with implications for the treatment for neurogenic swallowing dysfunction.
authors.affiliation: Department of GI Science, University of Manchester, Hope Hospital, Salford M6 8HD, UK.
authors.forename: M
authors.initials: M
authors.lastname: Power
authors.forename: C
authors.initials: C
authors.lastname: Fraser
authors.forename: A
authors.initials: A
authors.lastname: Hobson
authors.forename: J C
authors.initials: JC
authors.lastname: Rothwell
authors.forename: S
authors.initials: S
authors.lastname: Mistry
authors.forename: D A
authors.initials: DA
authors.lastname: Nicholson
authors.forename: D G
authors.initials: DG
authors.lastname: Thompson
authors.forename: S
authors.initials: S
authors.lastname: Hamdy
mesh_terms: D000328:Adult; D002540:Cerebral Cortex / Q000502:physiology*; D003679:Deglutition / Q000502:physiology*; D004558:Electric Stimulation; D004574:Electromagnetic Fields; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000502:physiology; D008875:Middle Aged; D010614:Pharynx / Q000502:physiology*; D012684:Sensory Thresholds / Q000502:physiology; D013116:Spinal Cord / Q000502:physiology*