Functional Imaging of the cereberal representation of swallowing; MR-kinematic and functional MR-tomographic investigations during swallowing movements in young and elderly healthy individuals and in patients after restitution of swallowing.

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Neural control of swallowing consists of complex networks which coordinate voluntary movement, sensory stimuli and reflective movement patterns. The complexity of swallowing control often results in an impairment of swallowing after cerebral damage. From a clinical aspect it is crucial to identify and treat dysphagia, since undetected aspiration can lead to mortality due to recurrent pneumonia. Accurate knowledge of swallowing representation and their differentially tangible subprocesses could help to enhance the diagnosis. Currently this diagnosis is reduced to clinical symptoms. Although the cerebral representation of swallowing can be detected using functional imaging, there is still a lack of important details to understand it. This is especially true for the brainstem, where no functional magnetic resonance imaging (fMRI) data on central pattern generators has been produced. During the first funding period we identified the main control centers in the brainstem. Secondly, concerning the specificity of swallowing compared to jaw movements, we demonstrated an overlapping and differential representation. Thirdly, it is unclear how the temporal interaction of swallowing representation correlates with the distinction of the oral and pharyngeal phase, an important aspect for therapy and diagnosis purposes. This is especially true for other representation areas than the primary sensorimotor cortex for which magnetoencephalography data are available. We investigated the swallowing processes anatomically with a cinematographic sequence. These processes were then put in context with the fMRI activation maps using a pressure transducer on the larynx. It was thus possible to differentiate the control processes of the oral and esopharyngeal phase. In the remaining funding period the current approach is now being optimized and compared to a group of old and young healthy subjects. During the new funding period we will use the methods and findings optimized on the healthy subjects to characterize the swallowing control of patients after restitution of swallowing following dysphagia. This will be characterized both spatially and temporally. The cooperation of the acute neurology and ENT clinic was expanded to aid us in finding a larger amount of patients.