Читать книгу The Esophagus - Группа авторов - Страница 118

Voluntary control of swallowing initiation resides in the dorsolateral and anterolateral regions of the sensory‐motor frontal cortex in primates, with bilateral representation, although one side, usually the left, is dominant [45–47]. Connections to the brainstem SPG and direct pathways to the motor neurons both exist. Cortical stroke on the dominant side results in dysphagia, recovery from which is associated with enhancement of cortical representation on the non‐dominant side [48]. Transcranial magnetic stimulation (TMS) of these cortical regions has demonstrated somatotopic organization serving different pharyngeal musculature and the upper striated muscle esophagus [49]. TMS directed at the cortex can stimulate swallowing in animals but not in humans [50].

Other cortical and supramedullary areas (cerebellum, nuclei in the pons, hypothalamus, basal ganglia) are also active during swallowing, as evident from neuroimaging in humans and neurophysiologic studies in animals. Generally, these areas control feeding behavior, mastication, and respiration, or accept peripheral afferent sensory input to modify swallowing at one or more central levels [51–54]. Consequently, strokes in many cortical areas and disorders like Parkinson’s disease can impact swallowing at many peripheral levels, including the esophagus [55, 56]. Therapeutic interventions directed at one or more of the central areas, such as TMS activation of the sensory feedback pathways, can be of value [57].