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Klinische Neurophysiologie 2009; 40(3): 183-193
DOI: 10.1055/s-0029-1202780
Originalia

© Georg Thieme Verlag KG Stuttgart · New York

Kortikale Repräsentation des Schluckaktes – Neues zur Physiologie und Pathophysiologie des Schluckens

Cortical Representation of Swallowing − New Aspects on the Physiology and Pathophysiology of DeglutitionI. K. Teismann1 , 2 , E. B. Ringelstein1 , R. Dziewas1
  • 1Klinik und Poliklinik für Neurologie, Universitätsklinikum Münster
  • 2Institut für Biomagnetismus und Biosignalanalyse, Universitätsklinikum Münster
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Publication History

Publication Date:
03 September 2009 (online)

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Zusammenfassung

Im Gegensatz zur seit vielen Jahren etablierten klinischen Bedeutung der neurogenen Dysphagie ist die Aufklärung der zentralen Koordination des Schluckaktes Gegenstand der aktuellen Forschung. Während sogenannte Schluckzentren des Hirnstammes den unwillkürlichen Schluckreflex steuern, kommt dem zerebralen Kortex eine entscheidende Bedeutung bei der willkürlichen Initiierung des Schluckaktes zu. Der physiologische Schluckakt wird bilateral im sensomotorischen Kortex und in mehreren weiteren kortikalen und subkortikalen Hirnregionen verarbeitet. Klinische Beobachtungen bei Schlaganfallpatienten und neue bildgebende Studien legen eine Hemisphärenspezialisierung für einzelne Phasen des Schluckaktes nahe. Dabei werden eine vorwiegend linkslateralisierte Verarbeitung der oralen Phase und eine rechtshemisphärische Lateralisation der pharyngealen Phase angenommen. Auch für pathologische und iatrogene Veränderungen konnten bereits Anpassungs- und Kompensationsmechanismen nachgewiesen werden. Läsionen des ersten Motoneurons führen zu einer Abnahme der kortikalen schluckakt-assoziierten Aktivität. Bei unilateraler Läsion, wie z. B. beim Schlaganfall, können parallel zur klinischen Erholung Reorganisationsprozesse beobachtet werden. Schädigungen jenseits des ersten Motoneurons, z. B. infolge einer bulbospinalen Muskelatrophie, resultieren typischerweise in einer Vergrößerung der kortikalen Repräsentation des Schluckaktes. Wir nehmen an, dass die bisherigen Resultate zukünftig bei der Entwicklung neuer Therapien und deren Evaluation von großem Wert sein werden.

Abstract

In spite of the long established clinical relevance of neurogenic dysphagia, clarification of the central control of deglutition is the object of ongoing research. While central swallowing pattern generators in the brainstem control the involuntary swallowing reflex, the cerebral cortex plays a decisive role in the voluntary initiation of deglutition. Physiological deglutition is processed bilaterally in the sensorimotor cortex and in several additional cortical and subcortical brain regions. Clinical observations in stroke patients and recent imaging studies suggest hemispheric specialisations for the different phases of deglutition. Predominantly left lateralised processing of the oral phase and right hemispheric lateralisation of the pharyngeal phase are assumed. Adaptation and compensation mechanisms have moreover been shown for pathological and iatrogenic changes. Lesions of the upper motor neuron result in a decrease of swallowing-related cortical activation. In the case of unilateral affection as in stroke, reorganisation processes can be observed parallel to clinical recovery. Lesions beyond the upper motor neuron, e.g., bulbospinal muscle atrophy, typically result in an increase of the cortical representation of swallowing. We assume that the hitherto existing results will be of value for the development of new therapies and their evaluation.

Schlüsselwörter

kortikale Verarbeitung - Schlucken - Dysphagie - funktionelle Bildgebung - MEG

Key words

cortical processing - swallowing - dysphagia - functional imaging - MEG

Literatur

  • 1 Amato AA, Prior TW, Barohn RJ. et al . Kennedy's disease: a clinicopathologic correlation with mutations in the androgen receptor gene.  Neurology. 1993;  43 791-794
    PubMedGoogle Scholar
  • 2 Aviv JE. Effects of aging on sensitivity of the pharyngeal and supraglottic areas.  Am J Med. 1997;  103 S74-S76
    PubMedGoogle Scholar
  • 3 Aviv JE, Martin JH, Sacco RL. et al . Supraglottic and pharyngeal sensory abnormalities in stroke patients with dysphagia.  Ann Otol Rhinol Laryngol. 1996;  105 92-97
    Google Scholar
  • 4 Boillee S, Yamanaka K, Lobsiger CS. et al . Onset and progression in inherited ALS determined by motor neurons and microglia.  Science. 2006;  312 1389-1392
    CrossrefPubMedGoogle Scholar
  • 5 Brodmann K. Brodmann's Areas.  Localisation in the Cerebral Cortex. 2005; 
    PubMedGoogle Scholar
  • 6 Broussard DL, Altschuler SM. Brainstem viscerotopic organization of afferents and efferents involved in the control of swallowing.  Am J Med. 2000;  108 ((Suppl 4a)) 79S-86S
    CrossrefPubMedGoogle Scholar
  • 7 Chee C, Arshad S, Singh S. et al . The influence of chemical gustatory stimuli and oral anaesthesia on healthy human pharyngeal swallowing.  Chem Senses. 2005;  30 393-400
    CrossrefPubMedGoogle Scholar
  • 8 Cook IJ, Dodds WJ, Dantas RO. et al . Opening mechanisms of the human upper esophageal sphincter.  Am J Physiol. 1989;  257 G748-59
    PubMedGoogle Scholar
  • 9 Daniels SK. Swallowing apraxia: a disorder of the Praxis system?.  Dysphagia. 2000;  15 159-166
    PubMedGoogle Scholar
  • 10 Daniels SK, Corey DM, Fraychinaud A. et al . Swallowing lateralization: the effects of modified dual-task interference.  Dysphagia. 2006;  21 21-27
    CrossrefPubMedGoogle Scholar
  • 11 Daniels SK, Foundas AL, Iglesia GC. et al . Lesion site in unilateral stroke patients with dysphagia.  J Stroke Cerebrovas Dis. 1996;  6 30-34
    CrossrefPubMedGoogle Scholar
  • 12 Derambure P, Defebvre L, Dujardin K. et al . Effect of aging on the spatio-temporal pattern of event-related desynchronization during a voluntary movement.  Electroencephalogr Clin Neurophysiol. 1993;  89 197-203
    PubMedGoogle Scholar
  • 13 Ding R, Logemann JA. Pneumonia in stroke patients: a retrospective study.  Dysphagia. 2000;  15 51-57
    PubMedGoogle Scholar
  • 14 Dodds WJ, Stewart ET, Logemann JA. Physiology and radiology of the normal oral and pharyngeal phases of swallowing.  Am J Roentgenol. 1990;  154 953-963
    CrossrefPubMedGoogle Scholar
  • 15 Dodds WJ, Taylor AJ, Stewart ET. et al . Tipper and dipper types of oral swallows.  Am J Roentgenol. 1989;  153 1197-1199
    PubMedGoogle Scholar
  • 16 Donner MW. Radiologic evaluation of swallowing.  Am Rev Respir Dis. 1985;  131 S20-3
    PubMedGoogle Scholar
  • 17 Downar J, Crawley AP, Mikulis DJ. et al . A multimodal cortical network for the detection of changes in the sensory environment.  Nat Neurosci. 2000;  3 277-283
    CrossrefPubMedGoogle Scholar
  • 18 Dziewas R, Soros P, Ishii R. et al . Neuroimaging evidence for cortical involvement in the preparation and in the act of swallowing.  Neuroimage. 2003;  20 135-144
    CrossrefPubMedGoogle Scholar
  • 19 Dziewas R, Soros P, Ishii R. et al . Cortical processing of esophageal sensation is related to the representation of swallowing.  Neuroreport. 2005;  16 439-443
    CrossrefPubMedGoogle Scholar
  • 20 Dziewas R, Teismann IK, Suntrup S. et al . Cortical compensation associated with dysphagia caused by selective degeneration of bulbar motor neurons.  Hum Brain Mapp. 2008; 
    PubMedGoogle Scholar
  • 21 Ertekin C, Aydogdu I, Yuceyar N. et al . Pathophysiological mechanisms of oropharyngeal dysphagia in amyotrophic lateral sclerosis.  Brain. 2000a;  123 ((Pt 1)) 125-140
    CrossrefPubMedGoogle Scholar
  • 22 Ertekin C, Kiylioglu N, Tarlaci S. et al . Effect of mucosal anaesthesia on oropharyngeal swallowing.  Neurogastroenterol Motil. 2000b;  12 567-572
    CrossrefPubMedGoogle Scholar
  • 23 Foltys H, Krings T, Meister IG. et al . Motor representation in patients rapidly recovering after stroke: a functional magnetic resonance imaging and transcranial magnetic stimulation study.  Clin Neurophysiol. 2003;  114 2404-2415
    CrossrefPubMedGoogle Scholar
  • 24 Fraser C, Power M, Hamdy S. et al . Driving plasticity in human adult motor cortex is associated with improved motor function after brain injury.  Neuron. 2002;  34 831-840
    CrossrefPubMedGoogle Scholar
  • 25 Fraser C, Rothwell J, Power M. et al . Differential changes in human pharyngoesophageal motor excitability induced by swallowing, pharyngeal stimulation, and anesthesia.  Am J Physiol Gastrointest Liver Physiol. 2003;  285 G137-44
    PubMedGoogle Scholar
  • 26 Furlong PL, Hobson AR, Aziz Q. et al . Dissociating the spatio-temporal characteristics of cortical neuronal activity associated with human volitional swallowing in the healthy adult brain.  Neuroimage. 2004;  22 1447-1455
    CrossrefPubMedGoogle Scholar
  • 27 Gow D, Hobson AR, Furlong P. et al . Characterising the central mechanisms of sensory modulation in human swallowing motor cortex.  Clin Neurophysiol. 2004;  115 2382-2390
    PubMedGoogle Scholar
  • 28 Guidetti D, Sabadini R, Ferlini A. et al . Epidemiological survey of X-linked bulbar and spinal muscular atrophy, or Kennedy disease, in the province of Reggio Emilia, Italy.  Eur J Epidemiol. 2001;  17 587-591
    CrossrefPubMedGoogle Scholar
  • 29 Hamdy S, Aziz Q, Rothwell JC. et al . Explaining oropharyngeal dysphagia after unilateral hemispheric stroke.  Lancet. 1997a;  350 686-692
    CrossrefPubMedGoogle Scholar
  • 30 Hamdy S, Aziz Q, Rothwell JC. et al . Cranial nerve modulation of human cortical swallowing motor pathways.  Am J Physiol. 1997b;  272 G802-8
    PubMedGoogle Scholar
  • 31 Hamdy S, Aziz Q, Rothwell JC. et al . Sensorimotor modulation of human cortical swallowing pathways.  J Physiol. 1998a;  506 ((Pt 3)) 857-866
    CrossrefPubMedGoogle Scholar
  • 32 Hamdy S, Aziz Q, Rothwell JC. et al . Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex.  Gastroenterology. 1998b;  115 1104-1112
    CrossrefPubMedGoogle Scholar
  • 33 Hamdy S, Aziz Q, Rothwell JC. et al . The cortical topography of human swallowing musculature in health and disease.  Nat Med. 1996;  2 1217-1224
    CrossrefPubMedGoogle Scholar
  • 34 Hamdy S, Jilani S, Price V. et al . Modulation of human swallowing behaviour by thermal and chemical stimulation in health and after brain injury.  Neurogastroenterol Motil. 2003;  15 69-77
    CrossrefPubMedGoogle Scholar
  • 35 Hamdy S, Mikulis DJ, Crawley A. et al . Cortical activation during human volitional swallowing: an event-related fMRI study.  Am J Physiol. 1999a;  277 G219-25
    PubMedGoogle Scholar
  • 36 Hamdy S, Rothwell JC. Gut feelings about recovery after stroke: the organization and reorganization of human swallowing motor cortex.  Trends Neurosci. 1998;  21 278-282
    CrossrefPubMedGoogle Scholar
  • 37 Hamdy S, Rothwell JC, Aziz Q. et al . Long-term reorganization of human motor cortex driven by short-term sensory stimulation.  Nat Neurosci. 1998c;  1 64-68
    CrossrefPubMedGoogle Scholar
  • 38 Hamdy S, Rothwell JC, Brooks DJ. et al . Identification of the cerebral loci processing human swallowing with H2(15)O PET activation.  J Neurophysiol. 1999b;  81 1917-1926
    Google Scholar
  • 39 Harris ML, Julyan P, Kulkarni B. et al . Mapping metabolic brain activation during human volitional swallowing: a positron emission tomography study using [18F]fluorodeoxyglucose.  J Cereb Blood Flow Metab. 2005;  25 520-526
    CrossrefPubMedGoogle Scholar
  • 40 Higo R, Tayama N, Nito T. Longitudinal analysis of progression of dysphagia in amyotrophic lateral sclerosis.  Auris Nasus Larynx. 2004;  31 247-254
    CrossrefPubMedGoogle Scholar
  • 41 Hillel A, Dray T, Miller R. et al . Presentation of ALS to the otolaryngologist/head and neck surgeon: getting to the neurologist.  Neurology. 1999;  53 S22-S25 , ; discussion S35–36
    PubMedGoogle Scholar
  • 42 Horner J, Massey EW, Riski JE. et al . Aspiration following stroke: clinical correlates and outcome.  Neurology. 1988;  38 1359-1362
    CrossrefPubMedGoogle Scholar
  • 43 Huckabee ML, Deecke L, Cannito MP. et al . Cortical control mechanisms in volitional swallowing: the Bereitschaftspotential.  Brain Topogr. 2003;  16 3-17
    CrossrefPubMedGoogle Scholar
  • 44 Humbert IA, Fitzgerald ME, McLaren DG. et al . Neurophysiology of swallowing: effects of age and bolus type.  Neuroimage. 2009;  44 982-991
    CrossrefPubMedGoogle Scholar
  • 45 Hutchinson S, Kobayashi M, Horkan CM. et al . Age-related differences in movement representation.  Neuroimage. 2002;  17 1720-1728
    CrossrefPubMedGoogle Scholar
  • 46 Huttunen J, Wikstrom H, Salonen O. et al . Human somatosensory cortical activation strengths: comparison between males and females and age-related changes.  Brain Res. 1999;  818 196-203
    CrossrefPubMedGoogle Scholar
  • 47 Jacob P, Kahrilas PJ, Logemann JA. et al . Upper esophageal sphincter opening and modulation during swallowing.  Gastroenterology. 1989;  97 1469-1478
    Google Scholar
  • 48 Jean A. Brain stem control of swallowing: neuronal network and cellular mechanisms.  Physiol Rev. 2001;  81 929-969
    PubMedGoogle Scholar
  • 49 Jean A, Car A, Roman C. Comparison of activity in pontine versus medullary neurones during swallowing.  Exp Brain Res. 1975;  22 211-220
    PubMedGoogle Scholar
  • 50 Jokelainen M. Amyotrophic lateral sclerosis in Finland.  II: Clinical characteristics. Acta Neurol Scand. 1977;  56 194-204
    PubMedGoogle Scholar
  • 51 Kern MK, Jaradeh S, Arndorfer RC. et al . Cerebral cortical representation of reflexive and volitional swallowing in humans.  Am J Physiol Gastrointest Liver Physiol. 2001;  280 G354-60
    PubMedGoogle Scholar
  • 52 Kew JJ, Brooks DJ, Passingham RE. et al . Cortical function in progressive lower motor neuron disorders and amyotrophic lateral sclerosis: a comparative PET study.  Neurology. 1994;  44 1101-1110
    PubMedGoogle Scholar
  • 53 Kew JJ, Leigh PN, Playford ED. et al . Cortical function in amyotrophic lateral sclerosis.  A positron emission tomography study. Brain. 1993;  116 ((Pt 3)) 655-680
    CrossrefPubMedGoogle Scholar
  • 54 Kim Y, MacCullough GH, Asp CW. Temporal measurements of pharyngeal swallowing in normal populations.  Dysphagia. 2005;  20 290-296
    CrossrefPubMedGoogle Scholar
  • 55 Konrad C, Henningsen H, Bremer J. et al . Pattern of cortical reorganization in amyotrophic lateral sclerosis: a functional magnetic resonance imaging study.  Exp Brain Res. 2002;  143 51-56
    CrossrefPubMedGoogle Scholar
  • 56 Konrad C, Jansen A, Henningsen H. et al . Subcortical reorganization in amyotrophic lateral sclerosis.  Exp Brain Res. 2006;  172 361-369
    CrossrefPubMedGoogle Scholar
  • 57 Lazzara L, Lazarus C, Logemann J. Effects of thermal stimulation on patients with swallowing disorders - A videofluoroscopic analysis.  Dysphagia. 1986;  1
    PubMedGoogle Scholar
  • 58 Leder SB, Novella S, Patwa H. Use of fiberoptic endoscopic evaluation of swallowing (FEES) in patients with amyotrophic lateral sclerosis.  Dysphagia. 2004;  19 177-181
    PubMedGoogle Scholar
  • 59 Leelamanit V, Limsakul C, Geater A. Synchronized electrical stimulation in treating pharyngeal dysphagia.  Laryngoscope. 2002;  112 2204-2210
    CrossrefPubMedGoogle Scholar
  • 60 Lehman R, Andermann F, Olivier A. et al . Seizures with onset in the sensorimotor face area: clinical patterns and results of surgical treatment in 20 patients.  Epilepsia. 1994;  35 1117-1124
    CrossrefPubMedGoogle Scholar
  • 61 Logemann J. Evaluation and treatment of swallowing disorders. San Diego CA: C.H. Press 1983
    PubMedGoogle Scholar
  • 62 Logemann JA. The need for clinical trials in dysphagia.  Dysphagia. 1998;  13 10-11
    PubMedGoogle Scholar
  • 63 Lowell SY, Poletto CJ, Knorr-Chung BR. et al . Sensory stimulation activates both motor and sensory components of the swallowing system.  Neuroimage. 2008;  42 285-295
    CrossrefPubMedGoogle Scholar
  • 64 Ludlow CL, Humbert I, Saxon K. et al . Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal Dysphagia.  Dysphagia. 2007;  22 1-10
    CrossrefPubMedGoogle Scholar
  • 65 Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months.  Stroke. 1999;  30 744-748
    CrossrefPubMedGoogle Scholar
  • 66 Mansson I, Sandberg N. Manometry of the pharynx and the esophagus in relation to laryngectomy.  JFORL J Fr Otorhinolaryngol Audiophonol Chir Maxillofac. 1974;  23 737-743
    PubMedGoogle Scholar
  • 67 Martin R, Barr A, Macintosh B. et al . Cerebral cortical processing of swallowing in older adults.  Exp Brain Res. 2006; 
    PubMedGoogle Scholar
  • 68 Martin RE, Goodyear BG, Gati JS. et al . Cerebral cortical representation of automatic and volitional swallowing in humans.  J Neurophysiol. 2001;  85 938-950
    PubMedGoogle Scholar
  • 69 Martin RE, MacIntosh BJ, Smith RC. et al . Cerebral areas processing swallowing and tongue movement are overlapping but distinct: a functional magnetic resonance imaging study.  J Neurophysiol. 2004;  92 2428-2443
    CrossrefPubMedGoogle Scholar
  • 70 Martin RE, Sessle BJ. The role of the cerebral cortex in swallowing.  Dysphagia. 1993;  8 195-202
    CrossrefPubMedGoogle Scholar
  • 71 MacDowd JM. Inhibition in attention and aging.  J Gerontol B Psychol Sci Soc Sci. 1997;  52 P265-73
    PubMedGoogle Scholar
  • 72 Miller AJ. Significance of sensory inflow to the swallowing reflex.  Brain Res. 1972;  43 147-159
    CrossrefPubMedGoogle Scholar
  • 73 Mosier K, Bereznaya I. Parallel cortical networks for volitional control of swallowing in humans.  Exp Brain Res. 2001;  140 280-289
    CrossrefPubMedGoogle Scholar
  • 74 Mosier K, Liu WC, Behin B. et al . Cortical adaptation following partial glossectomy with primary closure: implications for reconstruction of the oral tongue.  Ann Otol Rhinol Laryngol. 2005;  114 681-687
    PubMedGoogle Scholar
  • 75 Mosier K, Patel R, Liu WC. et al . Cortical representation of swallowing in normal adults: functional implications.  Laryngoscope. 1999a;  109 1417-1423
    CrossrefPubMedGoogle Scholar
  • 76 Mosier KM, Liu WC, Maldjian JA. et al . Lateralization of cortical function in swallowing: a functional MR imaging study.  Am J Neuroradiol. 1999b;  20 1520-1526
    PubMedGoogle Scholar
  • 77 Narita N, Yamamura K, Yao D. et al . Effects of functional disruption of lateral pericentral cerebral cortex on primate swallowing.  Brain Res. 1999;  824 140-145
    CrossrefPubMedGoogle Scholar
  • 78 Neumann S, Bartolome G, Buchholz D. et al . Swallowing therapy of neurologic patients: correlation of outcome with pretreatment variables and therapeutic methods.  Dysphagia. 1995;  10 1-5
    Google Scholar
  • 79 Onozuka M, Fujita M, Watanabe K. et al . Age-related changes in brain regional activity during chewing: a functional magnetic resonance imaging study.  J Dent Res. 2003;  82 657-660
    PubMedGoogle Scholar
  • 80 Pommerenke W. A study of the sensory areas eliciting the swallowing reflex.  Am J Physiol. 1927;  84 36-41
    PubMedGoogle Scholar
  • 81 Power M, Fraser C, Hobson A. et al . Changes in pharyngeal corticobulbar excitability and swallowing behavior after oral stimulation.  Am J Physiol Gastrointest Liver Physiol. 2004;  286 G45-50
    PubMedGoogle Scholar
  • 82 Power ML, Fraser CH, Hobson A. et al . Evaluating oral stimulation as a treatment for dysphagia after stroke.  Dysphagia. 2006;  21 49-55
    CrossrefPubMedGoogle Scholar
  • 83 Robbins J, Levin RL. Swallowing after unilateral stroke of the cerebral cortex: preliminary experience.  Dysphagia. 1988;  3 11-17
    CrossrefPubMedGoogle Scholar
  • 84 Robbins J, Levine RL, Maser A. et al . Swallowing after unilateral stroke of the cerebral cortex.  Arch Phys Med Rehabil. 1993;  74 1295-1300
    CrossrefPubMedGoogle Scholar
  • 85 Rosenbek JC, Robbins J, Fishback B. et al . Effects of thermal application on dysphagia after stroke.  J Speech Hear Res. 1991;  34 1257-1268
    PubMedGoogle Scholar
  • 86 Rosenbek JC, Roecker EB, Wood JL. et al . Thermal application reduces the duration of stage transition in dysphagia after stroke.  Dysphagia. 1996;  11 225-233
    CrossrefPubMedGoogle Scholar
  • 87 Satow T, Ikeda A, Yamamoto J. et al . Role of primary sensorimotor cortex and supplementary motor area in volitional swallowing: a movement-related cortical potential study.  Am J Physiol Gastrointest Liver Physiol. 2004;  287 G459-70
    CrossrefPubMedGoogle Scholar
  • 88 Schoenfeld MA, Tempelmann C, Gaul C. et al . Functional motor compensation in amyotrophic lateral sclerosis.  J Neurol. 2005;  252 944-952
    CrossrefPubMedGoogle Scholar
  • 89 Selinger M, Prescott TE, Hoffman I. Temperature acceleration in cold oral stimulation.  Dysphagia. 1994;  9 83-87
    CrossrefPubMedGoogle Scholar
  • 90 Shaw DW, Cook IJ, Gabb M. et al . Influence of normal aging on oral-pharyngeal and upper esophageal sphincter function during swallowing.  Am J Physiol. 1995;  268 G389-96
    PubMedGoogle Scholar
  • 91 Soros P, Lalone E, Smith R. et al . Functional MRI of oropharyngeal air-pulse stimulation.  Neuroscience. 2008;  153 1300-1308
    CrossrefPubMedGoogle Scholar
  • 92 Sperfeld AD, Karitzky J, Brummer D. et al . X-linked bulbospinal neuronopathy: Kennedy disease.  Arch Neurol. 2002;  59 1921-1926
    CrossrefPubMedGoogle Scholar
  • 93 Suzuki M, Asada Y, Ito J. et al . Activation of cerebellum and basal ganglia on volitional swallowing detected by functional magnetic resonance imaging.  Dysphagia. 2003;  18 71-77
    CrossrefPubMedGoogle Scholar
  • 94 Teismann IK, Dziewas R, Steinstraeter O. et al . Time-dependent hemispheric shift of the cortical control of volitional swallowing.  Hum Brain Mapp. 2007a; 
    PubMedGoogle Scholar
  • 95 Teismann IK, Steinstraeter O, Schwindt W. et al . Age-related changes in cortical swallowing processing.  Neurobiol Aging. 2008a; 
    PubMedGoogle Scholar
  • 96 Teismann IK, Steinstraeter O, Stoeckigt K. et al . Functional oropharyngeal sensory disruption interferes with the cortical control of swallowing.  BMC Neurosci. 2007b;  8 62
    CrossrefPubMedGoogle Scholar
  • 97 Teismann IK, Steinstraeter O, Warnecke T. et al . Cortical processing of swallowing in ALS patients with rapidly progressive neurogenic dysphagia.  , submitted
    PubMedGoogle Scholar
  • 98 Teismann IK, Steinstraeter O, Warnecke T. et al . Cortical recovery of swallowing function in wound botulism.  BMC Neurol. 2008b;  8 13
    CrossrefPubMedGoogle Scholar
  • 99 Traversa R, Cicinelli P, Bassi A. et al . Mapping of motor cortical reorganization after stroke. A brain stimulation study with focal magnetic pulses.  Stroke. 1997;  28 110-117
    PubMedGoogle Scholar
  • 100 Valeriani M, Ranghi F, Giaquinto S. The effects of aging on selective attention to touch: a reduced inhibitory control in elderly subjects?.  Int J Psychophysiol. 2003;  49 75-87
    CrossrefPubMedGoogle Scholar
  • 101 Van Hoesen GW. The modern concept of association cortex.  Curr Opin Neurobiol. 1993;  3 150-154
    CrossrefPubMedGoogle Scholar
  • 102 Walker AE, Robins M, Weinfeld FD. The National Survey of Stroke.  Clinical findings. Stroke. 1981;  12 I13-44
    PubMedGoogle Scholar
  • 103 Yoshikawa M, Yoshida M, Nagasaki T. et al . Aspects of swallowing in healthy dentate elderly persons older than 80 years.  J Gerontol A Biol Sci Med Sci. 2005;  60 506-509
    PubMedGoogle Scholar
  • 104 Young EC, Durant-Jones L. Developing a dysphagia program in an acute care hospital: a needs assessment.  Dysphagia. 1990;  5 159-165
    CrossrefPubMedGoogle Scholar
  • 105 Zacks R, Hasher L. Cognitive gerontology and attentional inhibition: a reply to Burke and McDowd.  J Gerontol B Psychol Sci Soc Sci. 1997;  52 P274-83
    PubMedGoogle Scholar
  • 106 Zald DH, Pardo JV. The functional neuroanatomy of voluntary swallowing.  Ann Neurol. 1999;  46 281-286
    CrossrefPubMedGoogle Scholar

Korrespondenzadresse

Dr. med. I. K. Teismann

Klinik und Poliklinik für Neurologie

Universitätsklinikum Münster

Albert-Schweitzer-Straße 33

48149 Münster

Email: i.teismann@uni-muenster.de

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