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NEUROLOGY 2007;68:583-589
© 2007 American Academy of Neurology

Electrophysiologic patterns of oral-pharyngeal swallowing in parkinsonian syndromes

E. Alfonsi, MD, M. Versino, MD, I. M. Merlo, MD, C. Pacchetti, MD, E. Martignoni, MD, G. Bertino, MD, A. Moglia, MD, C. Tassorelli, MD and G. Nappi, MD

From the Spinal and Cranial Reflexes Laboratory (E.A., I.M.M.), Neuro-ophthalmology and Neuro-otology Laboratory (M.V.), and Movement Disorders and Parkinson Disease Unit (C.P., A.M., C.T.), Department of Neurological Sciences, Università di Pavia, and Istituto Neurologico C. Mondino I.R.C.C.S., Pavia; Unit of Neurorehabilitation and Movement Disorders, Istituto Scientifico di Veruno (NO), Fondazione S. Maugeri I.R.C.C.S., and Department of Medical Science (E.M.), Università "A. Avogadro," Novara; Department of Otolaryngology (G.B.), Policlinico S. Matteo, Pavia; and Department of Neurology and Otolaryngology, Università La Sapienza, Rome, and Istituto Neurologico C. Mondino I.R.C.C.S. (G.N.), Pavia, Italy.

Address correspondence and reprint requests to Dr. Enrico Alfonsi, Fondazione "Istituto Neurologico C. Mondino" I.R.C.C.S, Via Mondino, 2–27100 Pavia, Italy; e-mail: enrico.alfonsi{at}mondino.it

Objectives: To assess the presence, severity, and differences in dysphagia in Parkinson disease (PD), Parkinson variant of multiple system atrophy (MSA-P), and progressive supranuclear palsy (PSP), and to study the pathophysiology of swallowing abnormalities in these disorders.

Methods: We applied an electrophysiologic method to evaluate oral-pharyngeal swallowing. We analyzed the following measures: duration of EMG activity of suprahyoid/submental muscles (SHEMG-D); duration of laryngeal–pharyngeal mechanogram (LPM-D); duration of the inhibition of the cricopharyngeal muscle activity (CPEMG-ID); interval between onset of EMG activity of suprahyoid/submental muscles and onset of laryngeal-pharyngeal mechanogram (I-SHEMG-LPM); and swallowing reaction time (SRT).

Results: The prolongation of I-SHEMG-LPM was more typical in PD, whereas the most distinctive finding both in patients with PSP and MSA-P was the reduction or the absence of CPEMG-ID early in the course of the disease.

Conclusions: Involvement of the peduncolo-pontine tegmental nucleus, with subsequent dysfunction of basal ganglia and of the medullary central pattern generator of swallowing, may account for the abnormalities detected in these parkinsonian syndromes. The method described was able to identify swallowing abnormalities also in patients without symptoms of dysphagia and to evaluate dysphagia severity in all patients.

Supported by a grant of the Italian Ministry of Health to IRCCS Mondino (ex art. 56 2003, conv. PS/03/13).

Disclosure: The authors report no conflicts of interest.

Received May 31, 2006. Accepted in final form November 6, 2006.


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