Neurophysiology of swallowing.

UNLABELLED: Swallowing is a complex motor event that is difficult to investigate in man by neurophysiological experiments. For this reason, the characteristics of the brain stem pathways have been studied in experimental animals. However, the sequential and orderly activation of the swallowing muscles with the monitoring of the laryngeal excursion can be recorded during deglutition. Although influenced by the sensory and cortical inputs, the sequential muscle activation does not alter from the perioral muscles caudally to the cricopharyngeal sphincter muscle. This is one evidence for the existence of the central pattern generator for human swallowing. The brain stem swallowing network includes the nucleus tractus solitarius and nucleus ambiguus with the reticular formation linking synaptically to cranial motoneuron pools bilaterally. Under normal function, the brain stem swallowing network receives descending inputs from the cerebral cortex. The cortex may trigger deglutition and modulate the brain stem sequential activity. The voluntarily initiated pharyngeal swallow involves several cortical and subcortical pathways. The interactions of regions above the brain stem and the brain stem swallowing network is, at present, not fully understood, particularly in humans. Functional neuroimaging methods were recently introduced into the human swallowing research. It has been shown that volitional swallowing is represented in the multiple cortical regions bilaterally but asymmetrically. Cortical organisation of swallowing can be continuously changed by the continual modulatory ascending sensory input with descending motor output. SIGNIFICANCE: Dysphagia is a severe symptom complex that can be life threatening in a considerable number of patients. Three-fourths of oropharyngeal dysphagia is caused by neurological diseases. Thus, the responsibility of the clinical neurologist and neurophysiologist in the care for the dysphagic patients is twofold. First, we should be more acquainted with the physiology of swallowing and its disorders, in order to care for the dysphagic patients successfully. Second, we need to evaluate the dysphagic problems objectively using practical electromyography methods for the patients' management. Cortical and subcortical functional imaging studies are also important to accumulate more data in order to get more information and in turn to develop new and effective treatment strategies for dysphagic patients.