Dysfunction of bulbar central pattern generator in ALS patients with dysphagia during sequential deglutition.
OBJECTIVE
The aim of this study is to investigate a probable dysfunction of the central pattern generator (CPG) in dysphagic patients with ALS.


METHODS
We investigated 58 patients with ALS, 23 patients with PD, and 33 normal subjects. The laryngeal movements and EMG of the submental muscles were recorded during sequential water swallowing (SWS) of 100ml of water. The coordination of SWS and respiration was also studied in some normal cases and ALS patients.


RESULTS
Normal subjects could complete the SWS optimally within 10s using 7 swallows, while in dysphagic ALS patients, the total duration and the number of swallows were significantly increased. The novel finding was that the regularity and rhythmicity of the swallowing pattern during SWS was disorganized to irregular and arhythmic pattern in 43% of the ALS patients. The duration and speed of swallowing were the most sensitive parameters for the disturbed oropharyngeal motility during SWS.


CONCLUSIONS
The corticobulbar control of swallowing is insufficient in ALS, and the swallowing CPG cannot work very well to produce segmental muscle activation and sequential swallowing. CPG dysfunction can result in irregular and arhythmical sequential swallowing in ALS patients with bulbar plus pseudobulbar types.


CONCLUSIONS
The arhythmical SWS pattern can be considered as a kind of dysfunction of CPG in human ALS cases with dysphagia.
Department of Neurology, Ege University Medical School Hospital, Bornova, Izmir 35100, Turkey. ibrahim.aydogdu@ege.edu.tr
Ibrahim
I
Aydogdu
Zeynep
Z
Tanriverdi
Cumhur
C
Ertekin
D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D001931:Brain Mapping; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology*; D004569:Electroencephalography / Q000379:methods; D004576:Electromyography / Q000379:methods; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology; D012119:Respiration; D018709:Statistics, Nonparametric