title: Altered cortical swallowing processing in patients with functional dysphagia: a preliminary study.
abstract: OBJECTIVE
  Current neuroimaging research on functional disturbances provides growing evidence for objective neuronal correlates of allegedly psychogenic symptoms, thereby shifting the disease concept from a psychological towards a neurobiological model. Functional dysphagia is such a rare condition, whose pathogenetic mechanism is largely unknown. In the absence of any organic reason for a patient's persistent swallowing complaints, sensorimotor processing abnormalities involving central neural pathways constitute a potential etiology.
  
  
  METHODS
  In this pilot study we measured cortical swallow-related activation in 5 patients diagnosed with functional dysphagia and a matched group of healthy subjects applying magnetoencephalography. Source localization of cortical activation was done with synthetic aperture magnetometry. To test for significant differences in cortical swallowing processing between groups, a non-parametric permutation test was afterwards performed on individual source localization maps.
  
  
  RESULTS
  Swallowing task performance was comparable between groups. In relation to control subjects, in whom activation was symmetrically distributed in rostro-medial parts of the sensorimotor cortices of both hemispheres, patients showed prominent activation of the right insula, dorsolateral prefrontal cortex and lateral premotor, motor as well as inferolateral parietal cortex. Furthermore, activation was markedly reduced in the left medial primary sensory cortex as well as right medial sensorimotor cortex and adjacent supplementary motor area (p<0.01).
  
  
  CONCLUSIONS
  Functional dysphagia--a condition with assumed normal brain function--seems to be associated with distinctive changes of the swallow-related cortical activation pattern. Alterations may reflect exaggerated activation of a widely distributed vigilance, self-monitoring and salience rating network that interferes with down-stream deglutition sensorimotor control.
authors.affiliation: Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany ; Department of Neurology, University of Muenster, Muenster, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Suntrup
authors.affiliation: Department of Neurology, University of Muenster, Muenster, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Teismann
authors.affiliation: Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wollbrink
authors.affiliation: Department of Neurology, University of Muenster, Muenster, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Warnecke
authors.affiliation: Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Winkels
authors.affiliation: Institute for Biomagnetism and Biosignalanalysis, University of Muenster, Muenster, Germany.
authors.forename: Christo
authors.initials: C
authors.lastname: Pantev
authors.affiliation: Department of Neurology, University of Muenster, Muenster, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Dziewas
mesh_terms: D001931:Brain Mapping / Q000379:methods*; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D015225:Magnetoencephalography; D060306:Magnetometry; D010865:Pilot Projects