Neurogenic dysphagia: the role of the neurologist

Swallowing was originally perceived as a brainstem reflex triggered by more or less "phagetic agents" 4 : subsequently the sequence of activation of the muscles involved in deglutition was delineated 5 and the concept developed of a central pattern generator anatomically related to the nuc...

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Bibliographic Details
Published in:Journal of neurology, neurosurgery and psychiatry neurosurgery and psychiatry, 1998-05, Vol.64 (5), p.569-572
Main Authors: HUGHES, T A T, WILES, C M
Format: Article
Language:English
Subjects:
Airway management
Combined Modality Therapy
Cranial Nerve Diseases - diagnosis
Cranial Nerve Diseases - physiopathology
Cranial Nerve Diseases - rehabilitation
Deglutition - physiology
Deglutition Disorders - diagnosis
Deglutition Disorders - physiopathology
Deglutition Disorders - rehabilitation
Dysphagia
Humans
Larynx
Nutrition research
Oropharynx - innervation
Ostomy
Patient Care Team
Pulmonary Ventilation - physiology
Respiration
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Summary:Swallowing was originally perceived as a brainstem reflex triggered by more or less "phagetic agents" 4 : subsequently the sequence of activation of the muscles involved in deglutition was delineated 5 and the concept developed of a central pattern generator anatomically related to the nucleus ambiguus and the nucleus of the tractus solitarius and under various peripheral and supranuclear controls. 6-8 Clinical observations and cortical mapping using magnetic stimulation 9 10 clearly point to roles for the cerebral cortex (primary motor, inferior frontal gyrus, insula 11 ) in the modulation of the swallow whereas the frequency of dysphagia in basal ganglia and cerebellar disorders attests to involvement of these systems. Alternatively the larynx can be sectioned and closed below the true vocal cords; this leaves the option of reconnecting the larynx and trachea if subsequent recovery of the intrinsic laryngeal muscles occurs. 61 If the overall prognosis is poor it is particularly important to try and spare the patient from a debilitating series of hospital admissions for assessment and progressively elaborate interventions. 62-64 Future research Much published work on neurogenic dysphagia has been anecdotal, uncontrolled, and based on highly selected, usually small, groups of patients.
ISSN:0022-3050
1468-330X
DOI:10.1136/jnnp.64.5.569