Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex

Research output: Contribution to journalArticlepeer-review

  • External authors:
  • Q. Aziz
  • J. C. Rothwell
  • M. Power
  • K. D. Singh
  • D. A. Nicholson
  • R. C. Tallis
  • D. G. Thompson

Abstract

Background and Aims: The aim of this study was to determine the mechanism for recovery of swallowing after dysphagic stroke. Methods: Twenty- eight patients who had a unilateral hemispheric stroke were studied 1 week and 1 and 3 months after the stroke by videofluoroscopy. Pharyngeal and thenar electromyographic responses to magnetic stimulation of multiple sites over both hemispheres were recorded, and motor representations were correlated with swallowing recovery. Results: Dysphagia was initially present in 71% of patients and in 46% and 41% of the patients at 1 and 3 months, respectively. Cortical representation of the pharynx was smaller in the affected hemisphere (5 ± 1 sites) than the unaffected hemisphere (13 ± 1 sites; P ≤ 0.001). Nondysphagic and persistently dysphagic patients showed little change in pharyngeal representation in either hemisphere at 1 and 3 months compared with presentation, but dysphagic patients who recovered had an increased pharyngeal representation in the unaffected hemisphere at 1 and 3 months (15 ± 2 and 17 ± 3 vs. 9 ± 2 sites; P ≤ 0.02) without change in the affected hemisphere. In contrast, thenar representation increased in the affected hemisphere but not the unaffected hemisphere at 1 and 3 months (P ≤ 0.01). Conclusions: Return of swallowing after dysphagic stroke is associated with increased pharyngeal representation in the unaffected hemisphere, suggesting a role for intact hemisphere reorganization in recovery.

Bibliographical metadata

Original languageEnglish
Pages (from-to)1104-1112
Number of pages8
JournalGastroenterology
Volume115
Issue number5
DOIs
Publication statusPublished - 1998

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