title: Brain imaging correlates of recovered swallowing after dysphagic stroke: A fMRI and DWI study.
abstract: Neurogenic dysphagia frequently occurs after stroke and deglutitive aspiration is one of the main reasons for subacute death after stroke. Although promising therapeutic interventions for neurogenic dysphagia are being developed, the functional neuroanatomy of recovered swallowing in this population remains uncertain. Here, we investigated 18 patients post-stroke who recovered from dysphagia using an event related functional magnetic resonance imaging (fMRI) study of swallowing. Patients were characterized by initial dysphagia score (mild to severe), lesion mapping, white matter fractional anisotropy (FA) of the pyramidal tracts, and swallowing performance measurement during fMRI scanning. Eighteen age matched healthy participants served as a control group. Overall, patients showed decreased fMRI-activation in the entire swallowing network apart from an increase of activation in the contralesional primary somatosensory cortex (S1). Moreover, fMRI activation in contralesional S1 correlated with initial dysphagia score. Finally, when lesions of the pyramidal tract were more severe, recovered swallowing appeared to be associated with asymmetric activation of the ipsilesional anterior cerebellum. Taken together, our data support a role for increased contralesional somatosensory resources and ipsilesional anterior cerebellum feed forward loops for recovered swallowing after dysphagia following stroke.
authors.affiliation: Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University Medicine, University of Greifswald, Germany.
authors.forename: Paul Glad
authors.initials: PG
authors.lastname: Mihai
authors.affiliation: BDH-Klinik Greifswald, Neurorehabilitation Centre and Spinal Cord Injury Unit, University of Greifswald, Germany.
authors.forename: Mareile
authors.initials: M
authors.lastname: Otto
authors.affiliation: Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University Medicine, University of Greifswald, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Domin
authors.affiliation: BDH-Klinik Greifswald, Neurorehabilitation Centre and Spinal Cord Injury Unit, University of Greifswald, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Platz
authors.affiliation: Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, University of Manchester, UK.
authors.forename: Shaheen
authors.initials: S
authors.lastname: Hamdy
authors.affiliation: Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University Medicine, University of Greifswald, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Lotze
mesh_terms: D000328:Adult; D000368:Aged; D016880:Anisotropy; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D001931:Brain Mapping; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013003:Somatosensory Cortex / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D020521:Stroke / Q000150:complications*; D066127:White Matter / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology
keywords: Dysphagia; Neurorehabilitation; Recovery; Stroke; Swallowing