Abstract
ObjectiveCurrent 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.MethodsIn 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.ResultsSwallowing 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).ConclusionsFunctional 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.
Highlights
Functional swallowing disorders including functional oropharyngeal dysphagia, globus pharyngis, phagophobia and heartburn have not been well studied
There was a trend towards longer duration of the preparatory oral swallow phase (M0–M1) in psychogenic dysphagia patients (p,0.1)
Patients had focal reduction of event-related desynchronization (ERD) in the left medial primary sensory cortex (Brodmann Area (BA) 1–3) and right medial primary sensorimotor cortex and adjacent supplementary motor area (SMA, BA 1–4, 6), whereas a prominent increase of ERD was observed in the right insula, dorsolateral prefrontal cortex (DLPFC), caudolateral motor and premotor cortex (PMC) and inferolateral parietal lobe (IPL) (BA 1–4, 6, 9, 13, 40, 43, 44, 45) as compared to healthy subjects. In this pilot study we investigated for the first time the cortical swallowing processing in patients with functional dysphagia compared to matched control subjects
Summary
Functional swallowing disorders including functional oropharyngeal dysphagia, globus pharyngis, phagophobia and heartburn have not been well studied. According to Galmiche et al (2006) [5] diagnostic criteria for functional esophageal disorders must include all of the following: (1) Sense of solid and/or liquid foods sticking, lodging, or passing abnormally through the esophagus; (2) absence of evidence that gastroesophageal reflux causes the symptom and (3) absence of esophageal motility disorders. These criteria must be fulfilled for three months, with symptom onset at least six months before the diagnosis is made. Similar criteria can be applied, except that functional symptom perception is located in the oral cavity or pharynx instead of the esophagus
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
