Characteristics of Cricopharyngeal Dysphagia After Ischemic Stroke
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Objective To evaluate the characteristics of cricopharyngeal dysfunction (CPD), the frequency, and correlation with a brain lesion in patients with first-ever ischemic stroke, and to provide basic data for developing a therapeutic protocol for dysphagia management. Methods We retrospectively reviewed the medical records of a series of subjects post-stroke who underwent a videofluoroscopic swallowing study (VFSS) from January 2009 to December 2015. VFSS images were recorded on videotape and analyzed. CPD was defined as the retention of more than 25% of residue in the pyriform sinus after swallowing. The location of the brain lesion was assessed using magnetic resonance imaging. Results Among the 262 dysphagic patients with first-ever ischemic stroke, 15 (5.7%) showed CPD on the VFSS. Patients with an infratentorial lesion had a significantly higher proportion of CPD than those with a supratentorial lesion (p=0.003), and lateral medullary infarction was identified as the single independent predictor of CPD (multivariable analysis: odds ratio=19.417; confidence interval, 5.560–67.804; p<0.0001). Compared to patients without CPD, those with CPD had a significantly prolonged pharyngeal transit time, lower laryngeal elevation, and a higher pharyngeal constriction ratio and functional dysphagia scale score. Conclusion Overall, the results support the notion that an impaired upper esopharyngeal opening is likely related to the specific locations of brain lesions. The association of CPD with lateral medullary infarction can be explained based on the regulation of the pharyngolaryngeal motor system by the motor neurons present in the dorsal nucleus ambiguus. Overall, the results reveal the relation between CPD and the problems in the pharyngeal phase as well as the severity of dysphagia.
Abstract
Objective To evaluate the characteristics of cricopharyngeal dysfunction (CPD), the frequency, and correlation with a brain lesion in patients with first-ever ischemic stroke, and to provide basic data for developing a therapeutic protocol for dysphagia management. Methods We retrospectively reviewed the medical records of a series of subjects post-stroke who underwent a videofluoroscopic swallowing study (VFSS) from January 2009 to December 2015. VFSS images were recorded on videotape and analyzed. CPD was defined as the retention of more than 25% of residue in the pyriform sinus after swallowing. The location of the brain lesion was assessed using magnetic resonance imaging. Results Among the 262 dysphagic patients with first-ever ischemic stroke, 15 (5.7%) showed CPD on the VFSS. Patients with an infratentorial lesion had a significantly higher proportion of CPD than those with a supratentorial lesion (p=0.003), and lateral medullary infarction was identified as the single independent predictor of CPD (multivariable analysis: odds ratio=19.417; confidence interval, 5.560–67.804; p<0.0001). Compared to patients without CPD, those with CPD had a significantly prolonged pharyngeal transit time, lower laryngeal elevation, and a higher pharyngeal constriction ratio and functional dysphagia scale score. Conclusion Overall, the results support the notion that an impaired upper esopharyngeal opening is likely related to the specific locations of brain lesions. The association of CPD with lateral medullary infarction can be explained based on the regulation of the pharyngolaryngeal motor system by the motor neurons present in the dorsal nucleus ambiguus. Overall, the results reveal the relation between CPD and the problems in the pharyngeal phase as well as the severity of dysphagia.
참고문헌 (32)
- Gonzalez-Fernandez M, "Dysphagia in stroke and neurologic disease", Phys Med Rehabil Clin N Am, 19, pp.867~888 (2008)[DOI]
- Baredes S, "The frequency of cricopharyngeal dysfunction on videofluoroscopic swallowing studies in patients with dysphagia", Am J Otolaryngol, 18, pp.185~189 (1997)[DOI]
- Lang IM, "Brain stem control of the phases of swallowing", Dysphagia, 24, pp.333~348 (2009)[DOI]
- Dou Z, "The effect of different catheter balloon dilatation modes on cricopharyngeal dysfunction in patients with dysphagia", Dysphagia, 27, pp.514~520 (2012)[DOI]
- Kocdor P, "Cricopharyngeal dysfunction: a systematic review comparing outcomes of dilatation, botulinum toxin injection, and myotomy", Laryngoscope, 126, pp.135~141 (2016)[DOI]
- Wan P, "Dysphagia post subcortical and supratentorial stroke", J Stroke Cerebrovasc Dis, 25, pp.74~82 (2016)[DOI]
- Fager SK, "Braddom's physical medicine and rehabilitation", pp.53~69 (2016), Elsevier
- Logemann JA, "Evaluation and treatment of swallowing disorders" (1995), Pro-Ed
- Kuhn MA, "Management of cricopharyngeus muscle dysfunction", Otolaryngol Clin North Am, 46, pp.1087~1099 (2013)[DOI]
- Lee SY, "Botulinum toxin injection for dysphagia: a blinded retrospective videofluoroscopic swallowing study analysis", Am J Phys Med Rehabil, 88, pp.491~494 (2009)[DOI]
- Kahrilas PJ, "Pharyngeal clearance during swallowing: a combined manometric and videofluoroscopic study", Gastroenterology, 103, pp.128~136 (1992)[DOI]
- Shaker R, "Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening", Gastroenterology, 122, pp.1314~1321 (2002)[DOI]
- Robbins J, "The effects of lingual exercise in stroke patients with dysphagia", Arch Phys Med Rehabil, 88, pp.150~158 (2007)[DOI]
- Steele CM, "The influence of orolingual pressure on the timing of pharyngeal pressure events", Dysphagia, 22, pp.30~36 (2007)[DOI]
- 이청기, "뇌졸증 환자에서 뇌 병변 위치에 따른 연하곤란의 양상", Annals of Rehabilitation Medicine, 25(2), pp.193~201 (2001), 대한재활의학회
- Bian RX, "Impaired opening of the upper esophageal sphincter in patients with medullary infarctions", Dysphagia, 24, pp.238~245 (2009)[DOI]
- Steinhagen V, "Swallowing disturbance pattern relates to brain lesion location in acute stroke patients", Stroke, 40, pp.1903~1906 (2009)[DOI]
- Han TR, "Quantifying swallowing function after stroke: a functional dysphagia scale based on videofluoroscopic studies", Arch Phys Med Rehabil, 82, pp.677~682 (2001)[DOI]
- Rademaker AW, "Oropharyngeal swallow efficiency as a representative measure of swallowing function", J Speech Hear Res, 37, pp.314~325 (1994)[DOI]
- Leonard RJ, "Structural displacements in normal swallowing: a videofluoroscopic study", Dysphagia, 15, pp.146~152 (2000)[DOI]
- Alfonsi E, "Electrophysiologic patterns of oral-pharyngeal swallowing in parkinsonian syndromes", Neurology, 68, pp.583~589 (2007)[DOI]
- Ali GN, "Mechanisms of oral-pharyngeal dysphagia in patients with Parkinson's disease", Gastroenterology, 110, pp.383~392 (1996)[DOI]
- Mu L, "Altered pharyngeal muscles in Parkinson disease", J Neuropathol Exp Neurol, 71, pp.520~530 (2012)[DOI]
- Ertekin C, "Pathophysiological mechanisms of oropharyngeal dysphagia in amyotrophic lateral sclerosis", Brain, 123, pp.125~140 (2000)[DOI]
- Martin RE, "The role of the cerebral cortex in swallowing", Dysphagia, 8, pp.195~202 (1993)[DOI]
- Ertekin C, "Cricopharyngeal sphincter muscle responses to transcranial magnetic stimulation in normal subjects and in patients with dysphagia", Clin Neurophysiol, 112, pp.86~94 (2001)[DOI]
- Valdez DT, "Swallowing and upper esophageal sphincter contraction with transcranial magnetic-induced electrical stimulation", Am J Physiol, 264(2), pp.G213~G219 (1993)
- Kahrilas PJ, "Upper esophageal sphincter function during deglutition", Gastroenterology, 95, pp.52~62 (1988)[DOI]
- Ertekin C, "Mechanisms of dysphagia in suprabulbar palsy with lacunar infarct", Stroke, 31, pp.1370~1376 (2000)[DOI]
- Perlman AL, "Electromyographic activity from human laryngeal, pharyngeal, and submental muscles during swallowing", J Appl Physiol (1985), 86, pp.1663~1669 (1999)[DOI]
- Venker-van Haagen AJ, "Continuous electromyographic recordings of pharyngeal muscle activity in normal and previously denervated muscles in dogs", Am J Vet Res, 50, pp.1725~1728 (1989)
- Arenaz Bua B, "Treatment of cricopharyngeal dysfunction: a comparative pilot study", BMC Res Notes, 8, pp.301~ (2015)[DOI]