Case Report: Event-Related Desynchronization Observed During Volitional Swallow by Electroencephalography Recordings in ALS Patients With Dysphagia.
Case Report: Event-Related Desynchronization Observed During Volitional Swallow by Electroencephalography Recordings in ALS Patients With Dysphagia.
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DOI：
10.3389/fnbeh.2022.798375
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发表时间：
2022
影响因子：
3
通讯作者：
Kansaku K
中科院分区：
文献类型：
--
作者：
Ogawa A;Koganemaru S;Takahashi T;Takemura Y;Irisawa H;Matsuhashi M;Mima T;Mizushima T;Kansaku K
吞咽困难是肌萎缩侧索硬化症（ALS）患者影响日常生活的严重残疾。它是由延髓运动神经元和投射到口咽区的皮质运动神经元的变性引起的。先前的报告显示，ALS吞咽困难患者内侧感觉运动区的事件相关去极化（ERD）减少。在退化过程中，大脑重组也可能在感觉运动皮层以外的其他区域被诱导。此外，患有吞咽困难的ALS患者通常表现出较长的吞咽持续时间。然而，还没有关于这些患者在长时间吞咽期间其他皮质区域的大脑活动和大脑活动的时间过程的报告。在这份病例报告中，我们调查了两名ALS患者在意志性吞咽过程中使用脑电图（EEG）在β（15-25 Hz）频段的ERD和皮质肌相干性（CMC）的分布和时间过程。病例1（71岁男性）在评估前2年确诊。他的第一个症状是右手肌肉无力; 5个月后，吞咽困难发展并加重。由于他的饮食摄入量减少，他被给予植入式静脉输液港。病例2（64岁女性）在评估前1年诊断。她的第一个症状是开口鼻音和构音障碍; 3个月后，吞咽困难发展并加重。她接受了经皮内镜胃造口术。在自主吞咽期间进行EEG记录，并计算ERD。病例1和病例2的平均吞咽持续时间分别为7.6 ± 3.0 s和8.3 ± 2.9 s。病例1的显著ERD位于前额叶和运动前区，从吞咽开始后几秒钟持续到吞咽结束。ERD仅在病例2吞咽开始时位于外侧感觉运动区。在两种情况下均未观察到CMC。这些结果表明，皮层运动输出的补偿过程可能取决于个体患者，并应根据ALS吞咽困难患者的个性，开发一种新的治疗方法，使用ERD。
Dysphagia is a severe disability affecting daily life in patients with amyotrophic lateral sclerosis (ALS). It is caused by degeneration of both the bulbar motor neurons and cortical motoneurons projecting to the oropharyngeal areas. A previous report showed decreased event-related desynchronization (ERD) in the medial sensorimotor areas in ALS dysphagic patients. In the process of degeneration, brain reorganization may also be induced in other areas than the sensorimotor cortices. Furthermore, ALS patients with dysphagia often show a longer duration of swallowing. However, there have been no reports on brain activity in other cortical areas and the time course of brain activity during prolonged swallowing in these patients. In this case report, we investigated the distribution and the time course of ERD and corticomuscular coherence (CMC) in the beta (15–25 Hz) frequency band during volitional swallow using electroencephalography (EEG) in two patients with ALS. Case 1 (a 71-year-old man) was diagnosed 2 years before the evaluation. His first symptom was muscle weakness in the right hand; 5 months later, dysphagia developed and exacerbated. Since his dietary intake decreased, he was given an implantable venous access port. Case 2 (a 64-year-old woman) was diagnosed 1 year before the evaluation. Her first symptom was open-nasal voice and dysarthria; 3 months later, dysphagia developed and exacerbated. She was given a percutaneous endoscopic gastrostomy. EEG recordings were performed during volitional swallowing, and the ERD was calculated. The average swallow durations were 7.6 ± 3.0 s in Case 1 and 8.3 ± 2.9 s in Case 2. The significant ERD was localized in the prefrontal and premotor areas and lasted from a few seconds after the initiation of swallowing to the end in Case 1. The ERD was localized in the lateral sensorimotor areas only at the initiation of swallowing in Case 2. CMC was not observed in either case. These results suggest that compensatory processes for cortical motor outputs might depend on individual patients and that a new therapeutic approach using ERD should be developed according to the individuality of ALS patients with dysphagia.
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