Nevin Gürgör - Academia.edu (original) (raw)

Papers by Nevin Gürgör

Research paper thumbnail of Koma ve Elektroensefalografi

Research paper thumbnail of Simvastatin vetrakonazolün Birlikte Kullanilmasina Bali Bir Rabdomiyoliz Olgusu

Research paper thumbnail of Fokal Nöropatilerde Sinir İletimi

Turkiye Klinikleri Journal of Neurology Special Topics, 2014

Research paper thumbnail of P07.12 Electrophysiological investigation of botulinum toxin effect mechanism on hemifacial spasm

Clinical Neurophysiology, 2006

Research paper thumbnail of Activity of facial and swallowing muscles during water and sour bolus deglutition in healthy adult humans

Journal of Neurological Sciences (Turkish), 2017

There are very close relationships among deglutition, taste sensations, and facial expressions in... more There are very close relationships among deglutition, taste sensations, and facial expressions in humans. However, the associations among mimicking, swallowing, and the suprahyoid/submental muscle group (SM) during deglutition events have yet to be investigated using electrophysiological techniques to elucidate taste sensation and facial expression further. Thus, this study used surface EMG to evaluate synchronous electromyography activity in the facial and swallowing muscles during the swallowing of water and sour boluses in 20 normal healthy adults. All participants were instructed to swallow four bolus volumes (5, 10, 15, and 20 ml) each of a water bolus and a sour bolus (lemon juice) in a neutral head position. EMG recordings were obtained from the orbicularis oculi (OC; a mimic muscle), orbicularis oris (OR; a mimic and swallowing muscle), and SM (deglutition muscles) to determine whether these muscles were synchronously activated during voluntary oropharyngeal swallowing. The mimic (OC and OR) and swallowing muscles (SM) were synchronously activated in more than 90% of participants during water swallowing. Swallowing lemon juice increased the number of spontaneous swallows after the first deglutition and significantly shortened the duration of a single swallowing apnea. The present findings indicate that both taste and the intraoral trigeminal afferents of water and sour boluses excite facial neurons via the nucleus tractus solitarius and/or a central pattern generator. Additionally, sour boluses produced stronger and safer oropharyngeal swallowing in conjunction with increases in facial expressions due to the activation of facial mimic muscles.

Research paper thumbnail of Guillain–Barré Syndrome and Swallowing Dysfunction

Journal of Clinical Neurophysiology, 2017

Purpose: Patients with Guillain-Barré syndrome (GBS), especially severe cases that require treatm... more Purpose: Patients with Guillain-Barré syndrome (GBS), especially severe cases that require treatment in intensive care units, often experience swallowing difficulties. However, the oropharyngeal function of patients with GBS not treated in intensive care units is not typically evaluated using neurophysiological techniques. Methods: Electrophysiological techniques were used to determine dysphagia limit and sequential water swallowing values in an electromyography laboratory. Results: This study assessed 18 patients with GBS who were not treated in the intensive care unit between 4 and 45 days after their hospital admission; 18 healthy volunteers were used as a control group. Of the 18 patients with GBS, 7 exhibited the clinical involvement of either a single cranial nerve or a combination of cranial nerves while 11 did not show any lower cranial nerve involvement. Clinical dysphagia was observed in seven patients and six of these cases involved a lower cranial nerve while five patients without cranial nerve involvement had silent dysphagia according to the dysphagia limit test. In addition, the duration of sequential swallowing was significantly prolonged in all patients with GBS compared with the control subjects. Conclusions: The present findings demonstrated that neurophysiological techniques are useful and easily applicable for patients with GBS and that there were no complications. Furthermore, cranial nerve involvement in patients with GBS likely increased the incidence of oropharyngeal dysphagia, and subclinical dysphagia may be present in this population as well. Therefore, neurophysiological techniques can be initially used and then repeated during follow-up visits for all types of patients with GBS.

Research paper thumbnail of Activity of facial and swallowing muscles during water and sour bolus deglutition in healthy adult humans

Journal of Neurological Sciences (Turkish), 2017

There are very close relationships among deglutition, taste sensations, and facial expressions in... more There are very close relationships among deglutition, taste sensations, and facial expressions in humans. However, the associations among mimicking, swallowing, and the suprahyoid/submental muscle group (SM) during deglutition events have yet to be investigated using electrophysiological techniques to elucidate taste sensation and facial expression further. Thus, this study used surface EMG to evaluate synchronous electromyography activity in the facial and swallowing muscles during the swallowing of water and sour boluses in 20 normal healthy adults. All participants were instructed to swallow four bolus volumes (5, 10, 15, and 20 ml) each of a water bolus and a sour bolus (lemon juice) in a neutral head position. EMG recordings were obtained from the orbicularis oculi (OC; a mimic muscle), orbicularis oris (OR; a mimic and swallowing muscle), and SM (deglutition muscles) to determine whether these muscles were synchronously activated during voluntary oropharyngeal swallowing. The mimic (OC and OR) and swallowing muscles (SM) were synchronously activated in more than 90% of participants during water swallowing. Swallowing lemon juice increased the number of spontaneous swallows after the first deglutition and significantly shortened the duration of a single swallowing apnea. The present findings indicate that both taste and the intraoral trigeminal afferents of water and sour boluses excite facial neurons via the nucleus tractus solitarius and/or a central pattern generator. Additionally, sour boluses produced stronger and safer oropharyngeal swallowing in conjunction with increases in facial expressions due to the activation of facial mimic muscles.

Research paper thumbnail of Dysphagia in Alzheimer's disease

Neurophysiologie clinique = Clinical neurophysiology, Jan 25, 2016

To investigate electrophysiological parameters of swallowing in all stages of Alzheimer's dis... more To investigate electrophysiological parameters of swallowing in all stages of Alzheimer's disease. Forty Alzheimer's disease patients, 20 age-matched normal controls and 20 young normal controls were included. Dysphagia limit (DL) and sequential water swallowing (SWS) tests were performed. Cardiac rhythm, respiration and sympathetic skin responses were concomitantly recorded. Dysphagia was found in 30/40 (75%) of Alzheimer's disease patients. Mean volume at the DL test was significantly reduced (16.5±1.0mL) in the Alzheimer's disease group. Swallowing and apnea times in the SWS test were significantly prolonged in elderly controls, but even longer in Alzheimer's disease patients. Alzheimer's disease patients had electrophysiological features of dysphagia, even in the early period of disease. The cortical involvement and severity of cognitive disorder can increase swallowing problems, but subclinical signs of dysphagia may be observed even in patients with mil...

Research paper thumbnail of Suppression of the jaw opening reflex prior to liquid swallowing

Research paper thumbnail of Guillain–Barré Syndrome and Swallowing Dysfunction

Journal of Clinical Neurophysiology, 2017

Purpose: Patients with Guillain-Barré syndrome (GBS), especially severe cases that require treatm... more Purpose: Patients with Guillain-Barré syndrome (GBS), especially severe cases that require treatment in intensive care units, often experience swallowing difficulties. However, the oropharyngeal function of patients with GBS not treated in intensive care units is not typically evaluated using neurophysiological techniques. Methods: Electrophysiological techniques were used to determine dysphagia limit and sequential water swallowing values in an electromyography laboratory. Results: This study assessed 18 patients with GBS who were not treated in the intensive care unit between 4 and 45 days after their hospital admission; 18 healthy volunteers were used as a control group. Of the 18 patients with GBS, 7 exhibited the clinical involvement of either a single cranial nerve or a combination of cranial nerves while 11 did not show any lower cranial nerve involvement. Clinical dysphagia was observed in seven patients and six of these cases involved a lower cranial nerve while five patients without cranial nerve involvement had silent dysphagia according to the dysphagia limit test. In addition, the duration of sequential swallowing was significantly prolonged in all patients with GBS compared with the control subjects. Conclusions: The present findings demonstrated that neurophysiological techniques are useful and easily applicable for patients with GBS and that there were no complications. Furthermore, cranial nerve involvement in patients with GBS likely increased the incidence of oropharyngeal dysphagia, and subclinical dysphagia may be present in this population as well. Therefore, neurophysiological techniques can be initially used and then repeated during follow-up visits for all types of patients with GBS.

Research paper thumbnail of P317: The effect of lemon juice and water on oropharyngeal swallowing and the gustato-facial reflexes in healthy adult subjects

Clinical Neurophysiology, 2014

s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S133 latenc... more s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S133 latencies, we think that prolongation of LLR II and cortical relay time in PD without apraxia reflects a deficit in PD probably other than dopaminergic deficit because we examined our cases under optimum dopaminergic treatment when they do not have PD symptoms. However, in PD apraxia functional magnetic resonance imaging studies also showed overactivity of default mode which may be the underlying factor of shortening of cortical relay time. P314 Excitability changes in spinal reciprocal inhibitory circuit induced by periodical sensory inputs S. Kubota1, M. Hirano1, T. Morishita1,2, K. Uehara1,2, K. Funase1 1Hiroshima University, Higashihiroshima, Japan; 2Research Fellow of the Japan Society for the Promotion of Science, Tokyo, Japan Question: Our question is how sensory inputs from antagonist muscle influence the excitability changes in reciprocal Ia inhibitory circuit. Methods: The degree of reciprocal Ia inhibition and the conditioning effects of transcranial magnetic stimulation (TMS) on the Soleus (Sol) H-reflex were examined in ten healthy subjects. The degree of reciprocal Ia inhibition was determined via short-latency (condition-test interval: 1, 2, 3ms) suppression of the Sol H-reflex by conditioning stimulation of common peroneal nerve (CPN). The TMS-conditioning effects on the Sol H-reflex was measured at short-latency condition-test intervals (-3, -2, -1, 0ms). Negative condition-test intervals indicate that the conditioning stimulus was applied after the test stimulation. The stimulus position for TMS was defined as the site where TMS consistently resulted in the largest Sol motor evoked potential. The periodical electrical stimulation was applied on CPN every 1sec (100Hz-5train) at motor threshold intensity of tibialis anterior muscle. The degree of reciprocal Ia inhibition and the TMS conditioned H-reflex amplitude were assessed before, immediately after, and 15 minutes after of the electrical stimulation. Results: The degree of reciprocal Ia inhibition and the amplitude of the TMS-conditioned H-reflex around -1ms were increased by periodical sensory inputs from antagonist muscle, which were not concomitant with the change in Sol motoneuron excitability. Conclusions: Our results indicated that Ia inhibitory interneurons are sensitive to periodical sensory inputs, because the change in the amplitude of the TMS-conditioned H-reflex was only observed in the specific condition-test interval which is assumed to be mediated by Ia inhibitory interneurons. P315 Influence of limb temperature on cutaneous silent periods M. Kofler1, J. Valls-Solé2, P. Vasko3, V. Boček3, I. Štetkárová3 1Hochzirl Hospital, Neurology, Zirl, Austria, Austria; 2Hospital Clinic I Provincial de Barcelona, Barcelona, Spain, Spain; 3Charles University, Third Faculty of Medicine, Department of Neurology, Prague, Czech Republic, Czech

Research paper thumbnail of Dysphagia in Alzheimer's disease

Neurophysiologie clinique = Clinical neurophysiology, Jan 25, 2016

To investigate electrophysiological parameters of swallowing in all stages of Alzheimer's dis... more To investigate electrophysiological parameters of swallowing in all stages of Alzheimer's disease. Forty Alzheimer's disease patients, 20 age-matched normal controls and 20 young normal controls were included. Dysphagia limit (DL) and sequential water swallowing (SWS) tests were performed. Cardiac rhythm, respiration and sympathetic skin responses were concomitantly recorded. Dysphagia was found in 30/40 (75%) of Alzheimer's disease patients. Mean volume at the DL test was significantly reduced (16.5±1.0mL) in the Alzheimer's disease group. Swallowing and apnea times in the SWS test were significantly prolonged in elderly controls, but even longer in Alzheimer's disease patients. Alzheimer's disease patients had electrophysiological features of dysphagia, even in the early period of disease. The cortical involvement and severity of cognitive disorder can increase swallowing problems, but subclinical signs of dysphagia may be observed even in patients with mil...

Research paper thumbnail of Suppression of the jaw opening reflex prior to liquid swallowing

Research paper thumbnail of Electrophysiological association of spontaneous yawning and swallowing

Experimental Brain Research, 2015

with swallows could be classified into the following three categories. The characteristics or the... more with swallows could be classified into the following three categories. The characteristics or the duration of swallows and yawns were similar between controls and disease subjects, with the exception of increased duration of yawning in subjects with BSS. Our findings support the presence of common neuroanatomico-physiological pathways for spontaneous swallows and yawning.

Research paper thumbnail of P317: The effect of lemon juice and water on oropharyngeal swallowing and the gustato-facial reflexes in healthy adult subjects

Clinical Neurophysiology, 2014

s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S133 latenc... more s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S133 latencies, we think that prolongation of LLR II and cortical relay time in PD without apraxia reflects a deficit in PD probably other than dopaminergic deficit because we examined our cases under optimum dopaminergic treatment when they do not have PD symptoms. However, in PD apraxia functional magnetic resonance imaging studies also showed overactivity of default mode which may be the underlying factor of shortening of cortical relay time. P314 Excitability changes in spinal reciprocal inhibitory circuit induced by periodical sensory inputs S. Kubota1, M. Hirano1, T. Morishita1,2, K. Uehara1,2, K. Funase1 1Hiroshima University, Higashihiroshima, Japan; 2Research Fellow of the Japan Society for the Promotion of Science, Tokyo, Japan Question: Our question is how sensory inputs from antagonist muscle influence the excitability changes in reciprocal Ia inhibitory circuit. Methods: The degree of reciprocal Ia inhibition and the conditioning effects of transcranial magnetic stimulation (TMS) on the Soleus (Sol) H-reflex were examined in ten healthy subjects. The degree of reciprocal Ia inhibition was determined via short-latency (condition-test interval: 1, 2, 3ms) suppression of the Sol H-reflex by conditioning stimulation of common peroneal nerve (CPN). The TMS-conditioning effects on the Sol H-reflex was measured at short-latency condition-test intervals (-3, -2, -1, 0ms). Negative condition-test intervals indicate that the conditioning stimulus was applied after the test stimulation. The stimulus position for TMS was defined as the site where TMS consistently resulted in the largest Sol motor evoked potential. The periodical electrical stimulation was applied on CPN every 1sec (100Hz-5train) at motor threshold intensity of tibialis anterior muscle. The degree of reciprocal Ia inhibition and the TMS conditioned H-reflex amplitude were assessed before, immediately after, and 15 minutes after of the electrical stimulation. Results: The degree of reciprocal Ia inhibition and the amplitude of the TMS-conditioned H-reflex around -1ms were increased by periodical sensory inputs from antagonist muscle, which were not concomitant with the change in Sol motoneuron excitability. Conclusions: Our results indicated that Ia inhibitory interneurons are sensitive to periodical sensory inputs, because the change in the amplitude of the TMS-conditioned H-reflex was only observed in the specific condition-test interval which is assumed to be mediated by Ia inhibitory interneurons. P315 Influence of limb temperature on cutaneous silent periods M. Kofler1, J. Valls-Solé2, P. Vasko3, V. Boček3, I. Štetkárová3 1Hochzirl Hospital, Neurology, Zirl, Austria, Austria; 2Hospital Clinic I Provincial de Barcelona, Barcelona, Spain, Spain; 3Charles University, Third Faculty of Medicine, Department of Neurology, Prague, Czech Republic, Czech

Research paper thumbnail of P431: Sympathetic skin response latency difference between multiple sclerosis patients and normal controls during sequential water swallowing

Clinical Neurophysiology, 2014

Question: Clustering index (CI) method is a noninvasive and quantitative analysis method of singl... more Question: Clustering index (CI) method is a noninvasive and quantitative analysis method of single channel surface EMG (SEMG) for diagnosing neurogenic and myopathic changes. This index aims to evaluate how the total area of the SEMG signals is clustered into large single motor unit potentials (MUPs). For this purpose, unitary windows with an appropriate width need to be set out. In the first study applying this method to the tibialis anterior (TA) muscle, the window width was determined as 15 ms, so that the window would cover large single MUPs observed in this muscle. In the second study done in the abductor digiti minimi (ADM) muscle, the window width was determined as 7.5 ms so that it would achieve the best discrimination between normal and neurogenic signals. The latter approach has not been attempted for the TA muscle and there may be a more appropriate window width. In this study, we aimed to find out the most appropriate window width for the CI method at the TA muscle. Methods: Signals collected in the previous study and some newly-collectd materials were reanalyzed. Re-evaluated subjects were 65 normal volunteers, 13 patients with neurogenic disorders, and 20 patients with myopathic disorders. The CI values were calculated using different window widths from 5 to 27.5 ms at the interval of 2.5 ms. The Z-score of the mean residual values after linear regression for the normative data was calculated for each subject. Because we expected that this method is sensitive for both neurogenic and myopathic subjects, the sum of mean absolute values of Z-scores for neurogenic and myopathic subjects were used as a primary indicator. Results: The sum of mean absolute Z-score values was highest when the window width was set at 17.5 ms (7.65; 4.31±1.34 for neurogenic subjects and-3.33±1.84 for myopathic subjects). Using this window width, the sensitivities for neurogenic and myopathic patients were 100% and 65%, respectively. The specificity for control subjects was 97%. Conclusion: The most appropriate widow width in the CI method for the TA muscle seems to be 17.5 ms.

Research paper thumbnail of Electrophysiological association of spontaneous yawning and swallowing

Experimental Brain Research, 2015

with swallows could be classified into the following three categories. The characteristics or the... more with swallows could be classified into the following three categories. The characteristics or the duration of swallows and yawns were similar between controls and disease subjects, with the exception of increased duration of yawning in subjects with BSS. Our findings support the presence of common neuroanatomico-physiological pathways for spontaneous swallows and yawning.

Research paper thumbnail of The Effects of Botulinum Toxin a on Ephaptic Transmission in Idiopathic Hemifacial Spasm

International Journal of Neuroscience, 2009

Objective: Lateral spreading and synkinetic responses of blink reflex are a sign of ephaptic tran... more Objective: Lateral spreading and synkinetic responses of blink reflex are a sign of ephaptic transmission in idiopathic hemifacial spasm (HFS). The aim of this study was to evaluate the effect of botulinum toxin A (Btx A) on ephaptic transmission in idiopathic HFS. Methods: Thirty-three patients with idiopathic HFS were investigated. Btx A was injected only into the affected orbicularis oculi (OC) muscle. Electrophysiological studies were performed before and three weeks after the Btx A injection. Results: After Btx A, the latencies of motor response and blink reflexes elicited from the OC muscle were significantly increased. The lateral

Research paper thumbnail of P431: Sympathetic skin response latency difference between multiple sclerosis patients and normal controls during sequential water swallowing

Clinical Neurophysiology, 2014

Question: Clustering index (CI) method is a noninvasive and quantitative analysis method of singl... more Question: Clustering index (CI) method is a noninvasive and quantitative analysis method of single channel surface EMG (SEMG) for diagnosing neurogenic and myopathic changes. This index aims to evaluate how the total area of the SEMG signals is clustered into large single motor unit potentials (MUPs). For this purpose, unitary windows with an appropriate width need to be set out. In the first study applying this method to the tibialis anterior (TA) muscle, the window width was determined as 15 ms, so that the window would cover large single MUPs observed in this muscle. In the second study done in the abductor digiti minimi (ADM) muscle, the window width was determined as 7.5 ms so that it would achieve the best discrimination between normal and neurogenic signals. The latter approach has not been attempted for the TA muscle and there may be a more appropriate window width. In this study, we aimed to find out the most appropriate window width for the CI method at the TA muscle. Methods: Signals collected in the previous study and some newly-collectd materials were reanalyzed. Re-evaluated subjects were 65 normal volunteers, 13 patients with neurogenic disorders, and 20 patients with myopathic disorders. The CI values were calculated using different window widths from 5 to 27.5 ms at the interval of 2.5 ms. The Z-score of the mean residual values after linear regression for the normative data was calculated for each subject. Because we expected that this method is sensitive for both neurogenic and myopathic subjects, the sum of mean absolute values of Z-scores for neurogenic and myopathic subjects were used as a primary indicator. Results: The sum of mean absolute Z-score values was highest when the window width was set at 17.5 ms (7.65; 4.31±1.34 for neurogenic subjects and-3.33±1.84 for myopathic subjects). Using this window width, the sensitivities for neurogenic and myopathic patients were 100% and 65%, respectively. The specificity for control subjects was 97%. Conclusion: The most appropriate widow width in the CI method for the TA muscle seems to be 17.5 ms.

Research paper thumbnail of Painful legs and moving toes syndrome: responsive to dopaminergic treatment

Acta Neurologica Belgica, 2014

Research paper thumbnail of Koma ve Elektroensefalografi

Research paper thumbnail of Simvastatin vetrakonazolün Birlikte Kullanilmasina Bali Bir Rabdomiyoliz Olgusu

Research paper thumbnail of Fokal Nöropatilerde Sinir İletimi

Turkiye Klinikleri Journal of Neurology Special Topics, 2014

Research paper thumbnail of P07.12 Electrophysiological investigation of botulinum toxin effect mechanism on hemifacial spasm

Clinical Neurophysiology, 2006

Research paper thumbnail of Activity of facial and swallowing muscles during water and sour bolus deglutition in healthy adult humans

Journal of Neurological Sciences (Turkish), 2017

There are very close relationships among deglutition, taste sensations, and facial expressions in... more There are very close relationships among deglutition, taste sensations, and facial expressions in humans. However, the associations among mimicking, swallowing, and the suprahyoid/submental muscle group (SM) during deglutition events have yet to be investigated using electrophysiological techniques to elucidate taste sensation and facial expression further. Thus, this study used surface EMG to evaluate synchronous electromyography activity in the facial and swallowing muscles during the swallowing of water and sour boluses in 20 normal healthy adults. All participants were instructed to swallow four bolus volumes (5, 10, 15, and 20 ml) each of a water bolus and a sour bolus (lemon juice) in a neutral head position. EMG recordings were obtained from the orbicularis oculi (OC; a mimic muscle), orbicularis oris (OR; a mimic and swallowing muscle), and SM (deglutition muscles) to determine whether these muscles were synchronously activated during voluntary oropharyngeal swallowing. The mimic (OC and OR) and swallowing muscles (SM) were synchronously activated in more than 90% of participants during water swallowing. Swallowing lemon juice increased the number of spontaneous swallows after the first deglutition and significantly shortened the duration of a single swallowing apnea. The present findings indicate that both taste and the intraoral trigeminal afferents of water and sour boluses excite facial neurons via the nucleus tractus solitarius and/or a central pattern generator. Additionally, sour boluses produced stronger and safer oropharyngeal swallowing in conjunction with increases in facial expressions due to the activation of facial mimic muscles.

Research paper thumbnail of Guillain–Barré Syndrome and Swallowing Dysfunction

Journal of Clinical Neurophysiology, 2017

Purpose: Patients with Guillain-Barré syndrome (GBS), especially severe cases that require treatm... more Purpose: Patients with Guillain-Barré syndrome (GBS), especially severe cases that require treatment in intensive care units, often experience swallowing difficulties. However, the oropharyngeal function of patients with GBS not treated in intensive care units is not typically evaluated using neurophysiological techniques. Methods: Electrophysiological techniques were used to determine dysphagia limit and sequential water swallowing values in an electromyography laboratory. Results: This study assessed 18 patients with GBS who were not treated in the intensive care unit between 4 and 45 days after their hospital admission; 18 healthy volunteers were used as a control group. Of the 18 patients with GBS, 7 exhibited the clinical involvement of either a single cranial nerve or a combination of cranial nerves while 11 did not show any lower cranial nerve involvement. Clinical dysphagia was observed in seven patients and six of these cases involved a lower cranial nerve while five patients without cranial nerve involvement had silent dysphagia according to the dysphagia limit test. In addition, the duration of sequential swallowing was significantly prolonged in all patients with GBS compared with the control subjects. Conclusions: The present findings demonstrated that neurophysiological techniques are useful and easily applicable for patients with GBS and that there were no complications. Furthermore, cranial nerve involvement in patients with GBS likely increased the incidence of oropharyngeal dysphagia, and subclinical dysphagia may be present in this population as well. Therefore, neurophysiological techniques can be initially used and then repeated during follow-up visits for all types of patients with GBS.

Research paper thumbnail of Activity of facial and swallowing muscles during water and sour bolus deglutition in healthy adult humans

Journal of Neurological Sciences (Turkish), 2017

There are very close relationships among deglutition, taste sensations, and facial expressions in... more There are very close relationships among deglutition, taste sensations, and facial expressions in humans. However, the associations among mimicking, swallowing, and the suprahyoid/submental muscle group (SM) during deglutition events have yet to be investigated using electrophysiological techniques to elucidate taste sensation and facial expression further. Thus, this study used surface EMG to evaluate synchronous electromyography activity in the facial and swallowing muscles during the swallowing of water and sour boluses in 20 normal healthy adults. All participants were instructed to swallow four bolus volumes (5, 10, 15, and 20 ml) each of a water bolus and a sour bolus (lemon juice) in a neutral head position. EMG recordings were obtained from the orbicularis oculi (OC; a mimic muscle), orbicularis oris (OR; a mimic and swallowing muscle), and SM (deglutition muscles) to determine whether these muscles were synchronously activated during voluntary oropharyngeal swallowing. The mimic (OC and OR) and swallowing muscles (SM) were synchronously activated in more than 90% of participants during water swallowing. Swallowing lemon juice increased the number of spontaneous swallows after the first deglutition and significantly shortened the duration of a single swallowing apnea. The present findings indicate that both taste and the intraoral trigeminal afferents of water and sour boluses excite facial neurons via the nucleus tractus solitarius and/or a central pattern generator. Additionally, sour boluses produced stronger and safer oropharyngeal swallowing in conjunction with increases in facial expressions due to the activation of facial mimic muscles.

Research paper thumbnail of Dysphagia in Alzheimer's disease

Neurophysiologie clinique = Clinical neurophysiology, Jan 25, 2016

To investigate electrophysiological parameters of swallowing in all stages of Alzheimer's dis... more To investigate electrophysiological parameters of swallowing in all stages of Alzheimer's disease. Forty Alzheimer's disease patients, 20 age-matched normal controls and 20 young normal controls were included. Dysphagia limit (DL) and sequential water swallowing (SWS) tests were performed. Cardiac rhythm, respiration and sympathetic skin responses were concomitantly recorded. Dysphagia was found in 30/40 (75%) of Alzheimer's disease patients. Mean volume at the DL test was significantly reduced (16.5±1.0mL) in the Alzheimer's disease group. Swallowing and apnea times in the SWS test were significantly prolonged in elderly controls, but even longer in Alzheimer's disease patients. Alzheimer's disease patients had electrophysiological features of dysphagia, even in the early period of disease. The cortical involvement and severity of cognitive disorder can increase swallowing problems, but subclinical signs of dysphagia may be observed even in patients with mil...

Research paper thumbnail of Suppression of the jaw opening reflex prior to liquid swallowing

Research paper thumbnail of Guillain–Barré Syndrome and Swallowing Dysfunction

Journal of Clinical Neurophysiology, 2017

Purpose: Patients with Guillain-Barré syndrome (GBS), especially severe cases that require treatm... more Purpose: Patients with Guillain-Barré syndrome (GBS), especially severe cases that require treatment in intensive care units, often experience swallowing difficulties. However, the oropharyngeal function of patients with GBS not treated in intensive care units is not typically evaluated using neurophysiological techniques. Methods: Electrophysiological techniques were used to determine dysphagia limit and sequential water swallowing values in an electromyography laboratory. Results: This study assessed 18 patients with GBS who were not treated in the intensive care unit between 4 and 45 days after their hospital admission; 18 healthy volunteers were used as a control group. Of the 18 patients with GBS, 7 exhibited the clinical involvement of either a single cranial nerve or a combination of cranial nerves while 11 did not show any lower cranial nerve involvement. Clinical dysphagia was observed in seven patients and six of these cases involved a lower cranial nerve while five patients without cranial nerve involvement had silent dysphagia according to the dysphagia limit test. In addition, the duration of sequential swallowing was significantly prolonged in all patients with GBS compared with the control subjects. Conclusions: The present findings demonstrated that neurophysiological techniques are useful and easily applicable for patients with GBS and that there were no complications. Furthermore, cranial nerve involvement in patients with GBS likely increased the incidence of oropharyngeal dysphagia, and subclinical dysphagia may be present in this population as well. Therefore, neurophysiological techniques can be initially used and then repeated during follow-up visits for all types of patients with GBS.

Research paper thumbnail of P317: The effect of lemon juice and water on oropharyngeal swallowing and the gustato-facial reflexes in healthy adult subjects

Clinical Neurophysiology, 2014

s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S133 latenc... more s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S133 latencies, we think that prolongation of LLR II and cortical relay time in PD without apraxia reflects a deficit in PD probably other than dopaminergic deficit because we examined our cases under optimum dopaminergic treatment when they do not have PD symptoms. However, in PD apraxia functional magnetic resonance imaging studies also showed overactivity of default mode which may be the underlying factor of shortening of cortical relay time. P314 Excitability changes in spinal reciprocal inhibitory circuit induced by periodical sensory inputs S. Kubota1, M. Hirano1, T. Morishita1,2, K. Uehara1,2, K. Funase1 1Hiroshima University, Higashihiroshima, Japan; 2Research Fellow of the Japan Society for the Promotion of Science, Tokyo, Japan Question: Our question is how sensory inputs from antagonist muscle influence the excitability changes in reciprocal Ia inhibitory circuit. Methods: The degree of reciprocal Ia inhibition and the conditioning effects of transcranial magnetic stimulation (TMS) on the Soleus (Sol) H-reflex were examined in ten healthy subjects. The degree of reciprocal Ia inhibition was determined via short-latency (condition-test interval: 1, 2, 3ms) suppression of the Sol H-reflex by conditioning stimulation of common peroneal nerve (CPN). The TMS-conditioning effects on the Sol H-reflex was measured at short-latency condition-test intervals (-3, -2, -1, 0ms). Negative condition-test intervals indicate that the conditioning stimulus was applied after the test stimulation. The stimulus position for TMS was defined as the site where TMS consistently resulted in the largest Sol motor evoked potential. The periodical electrical stimulation was applied on CPN every 1sec (100Hz-5train) at motor threshold intensity of tibialis anterior muscle. The degree of reciprocal Ia inhibition and the TMS conditioned H-reflex amplitude were assessed before, immediately after, and 15 minutes after of the electrical stimulation. Results: The degree of reciprocal Ia inhibition and the amplitude of the TMS-conditioned H-reflex around -1ms were increased by periodical sensory inputs from antagonist muscle, which were not concomitant with the change in Sol motoneuron excitability. Conclusions: Our results indicated that Ia inhibitory interneurons are sensitive to periodical sensory inputs, because the change in the amplitude of the TMS-conditioned H-reflex was only observed in the specific condition-test interval which is assumed to be mediated by Ia inhibitory interneurons. P315 Influence of limb temperature on cutaneous silent periods M. Kofler1, J. Valls-Solé2, P. Vasko3, V. Boček3, I. Štetkárová3 1Hochzirl Hospital, Neurology, Zirl, Austria, Austria; 2Hospital Clinic I Provincial de Barcelona, Barcelona, Spain, Spain; 3Charles University, Third Faculty of Medicine, Department of Neurology, Prague, Czech Republic, Czech

Research paper thumbnail of Dysphagia in Alzheimer's disease

Neurophysiologie clinique = Clinical neurophysiology, Jan 25, 2016

To investigate electrophysiological parameters of swallowing in all stages of Alzheimer's dis... more To investigate electrophysiological parameters of swallowing in all stages of Alzheimer's disease. Forty Alzheimer's disease patients, 20 age-matched normal controls and 20 young normal controls were included. Dysphagia limit (DL) and sequential water swallowing (SWS) tests were performed. Cardiac rhythm, respiration and sympathetic skin responses were concomitantly recorded. Dysphagia was found in 30/40 (75%) of Alzheimer's disease patients. Mean volume at the DL test was significantly reduced (16.5±1.0mL) in the Alzheimer's disease group. Swallowing and apnea times in the SWS test were significantly prolonged in elderly controls, but even longer in Alzheimer's disease patients. Alzheimer's disease patients had electrophysiological features of dysphagia, even in the early period of disease. The cortical involvement and severity of cognitive disorder can increase swallowing problems, but subclinical signs of dysphagia may be observed even in patients with mil...

Research paper thumbnail of Suppression of the jaw opening reflex prior to liquid swallowing

Research paper thumbnail of Electrophysiological association of spontaneous yawning and swallowing

Experimental Brain Research, 2015

with swallows could be classified into the following three categories. The characteristics or the... more with swallows could be classified into the following three categories. The characteristics or the duration of swallows and yawns were similar between controls and disease subjects, with the exception of increased duration of yawning in subjects with BSS. Our findings support the presence of common neuroanatomico-physiological pathways for spontaneous swallows and yawning.

Research paper thumbnail of P317: The effect of lemon juice and water on oropharyngeal swallowing and the gustato-facial reflexes in healthy adult subjects

Clinical Neurophysiology, 2014

s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S133 latenc... more s of Poster Presentations / Clinical Neurophysiology 125, Supplement 1 (2014) S1–S339 S133 latencies, we think that prolongation of LLR II and cortical relay time in PD without apraxia reflects a deficit in PD probably other than dopaminergic deficit because we examined our cases under optimum dopaminergic treatment when they do not have PD symptoms. However, in PD apraxia functional magnetic resonance imaging studies also showed overactivity of default mode which may be the underlying factor of shortening of cortical relay time. P314 Excitability changes in spinal reciprocal inhibitory circuit induced by periodical sensory inputs S. Kubota1, M. Hirano1, T. Morishita1,2, K. Uehara1,2, K. Funase1 1Hiroshima University, Higashihiroshima, Japan; 2Research Fellow of the Japan Society for the Promotion of Science, Tokyo, Japan Question: Our question is how sensory inputs from antagonist muscle influence the excitability changes in reciprocal Ia inhibitory circuit. Methods: The degree of reciprocal Ia inhibition and the conditioning effects of transcranial magnetic stimulation (TMS) on the Soleus (Sol) H-reflex were examined in ten healthy subjects. The degree of reciprocal Ia inhibition was determined via short-latency (condition-test interval: 1, 2, 3ms) suppression of the Sol H-reflex by conditioning stimulation of common peroneal nerve (CPN). The TMS-conditioning effects on the Sol H-reflex was measured at short-latency condition-test intervals (-3, -2, -1, 0ms). Negative condition-test intervals indicate that the conditioning stimulus was applied after the test stimulation. The stimulus position for TMS was defined as the site where TMS consistently resulted in the largest Sol motor evoked potential. The periodical electrical stimulation was applied on CPN every 1sec (100Hz-5train) at motor threshold intensity of tibialis anterior muscle. The degree of reciprocal Ia inhibition and the TMS conditioned H-reflex amplitude were assessed before, immediately after, and 15 minutes after of the electrical stimulation. Results: The degree of reciprocal Ia inhibition and the amplitude of the TMS-conditioned H-reflex around -1ms were increased by periodical sensory inputs from antagonist muscle, which were not concomitant with the change in Sol motoneuron excitability. Conclusions: Our results indicated that Ia inhibitory interneurons are sensitive to periodical sensory inputs, because the change in the amplitude of the TMS-conditioned H-reflex was only observed in the specific condition-test interval which is assumed to be mediated by Ia inhibitory interneurons. P315 Influence of limb temperature on cutaneous silent periods M. Kofler1, J. Valls-Solé2, P. Vasko3, V. Boček3, I. Štetkárová3 1Hochzirl Hospital, Neurology, Zirl, Austria, Austria; 2Hospital Clinic I Provincial de Barcelona, Barcelona, Spain, Spain; 3Charles University, Third Faculty of Medicine, Department of Neurology, Prague, Czech Republic, Czech

Research paper thumbnail of P431: Sympathetic skin response latency difference between multiple sclerosis patients and normal controls during sequential water swallowing

Clinical Neurophysiology, 2014

Question: Clustering index (CI) method is a noninvasive and quantitative analysis method of singl... more Question: Clustering index (CI) method is a noninvasive and quantitative analysis method of single channel surface EMG (SEMG) for diagnosing neurogenic and myopathic changes. This index aims to evaluate how the total area of the SEMG signals is clustered into large single motor unit potentials (MUPs). For this purpose, unitary windows with an appropriate width need to be set out. In the first study applying this method to the tibialis anterior (TA) muscle, the window width was determined as 15 ms, so that the window would cover large single MUPs observed in this muscle. In the second study done in the abductor digiti minimi (ADM) muscle, the window width was determined as 7.5 ms so that it would achieve the best discrimination between normal and neurogenic signals. The latter approach has not been attempted for the TA muscle and there may be a more appropriate window width. In this study, we aimed to find out the most appropriate window width for the CI method at the TA muscle. Methods: Signals collected in the previous study and some newly-collectd materials were reanalyzed. Re-evaluated subjects were 65 normal volunteers, 13 patients with neurogenic disorders, and 20 patients with myopathic disorders. The CI values were calculated using different window widths from 5 to 27.5 ms at the interval of 2.5 ms. The Z-score of the mean residual values after linear regression for the normative data was calculated for each subject. Because we expected that this method is sensitive for both neurogenic and myopathic subjects, the sum of mean absolute values of Z-scores for neurogenic and myopathic subjects were used as a primary indicator. Results: The sum of mean absolute Z-score values was highest when the window width was set at 17.5 ms (7.65; 4.31±1.34 for neurogenic subjects and-3.33±1.84 for myopathic subjects). Using this window width, the sensitivities for neurogenic and myopathic patients were 100% and 65%, respectively. The specificity for control subjects was 97%. Conclusion: The most appropriate widow width in the CI method for the TA muscle seems to be 17.5 ms.

Research paper thumbnail of Electrophysiological association of spontaneous yawning and swallowing

Experimental Brain Research, 2015

with swallows could be classified into the following three categories. The characteristics or the... more with swallows could be classified into the following three categories. The characteristics or the duration of swallows and yawns were similar between controls and disease subjects, with the exception of increased duration of yawning in subjects with BSS. Our findings support the presence of common neuroanatomico-physiological pathways for spontaneous swallows and yawning.

Research paper thumbnail of The Effects of Botulinum Toxin a on Ephaptic Transmission in Idiopathic Hemifacial Spasm

International Journal of Neuroscience, 2009

Objective: Lateral spreading and synkinetic responses of blink reflex are a sign of ephaptic tran... more Objective: Lateral spreading and synkinetic responses of blink reflex are a sign of ephaptic transmission in idiopathic hemifacial spasm (HFS). The aim of this study was to evaluate the effect of botulinum toxin A (Btx A) on ephaptic transmission in idiopathic HFS. Methods: Thirty-three patients with idiopathic HFS were investigated. Btx A was injected only into the affected orbicularis oculi (OC) muscle. Electrophysiological studies were performed before and three weeks after the Btx A injection. Results: After Btx A, the latencies of motor response and blink reflexes elicited from the OC muscle were significantly increased. The lateral

Research paper thumbnail of P431: Sympathetic skin response latency difference between multiple sclerosis patients and normal controls during sequential water swallowing

Clinical Neurophysiology, 2014

Question: Clustering index (CI) method is a noninvasive and quantitative analysis method of singl... more Question: Clustering index (CI) method is a noninvasive and quantitative analysis method of single channel surface EMG (SEMG) for diagnosing neurogenic and myopathic changes. This index aims to evaluate how the total area of the SEMG signals is clustered into large single motor unit potentials (MUPs). For this purpose, unitary windows with an appropriate width need to be set out. In the first study applying this method to the tibialis anterior (TA) muscle, the window width was determined as 15 ms, so that the window would cover large single MUPs observed in this muscle. In the second study done in the abductor digiti minimi (ADM) muscle, the window width was determined as 7.5 ms so that it would achieve the best discrimination between normal and neurogenic signals. The latter approach has not been attempted for the TA muscle and there may be a more appropriate window width. In this study, we aimed to find out the most appropriate window width for the CI method at the TA muscle. Methods: Signals collected in the previous study and some newly-collectd materials were reanalyzed. Re-evaluated subjects were 65 normal volunteers, 13 patients with neurogenic disorders, and 20 patients with myopathic disorders. The CI values were calculated using different window widths from 5 to 27.5 ms at the interval of 2.5 ms. The Z-score of the mean residual values after linear regression for the normative data was calculated for each subject. Because we expected that this method is sensitive for both neurogenic and myopathic subjects, the sum of mean absolute values of Z-scores for neurogenic and myopathic subjects were used as a primary indicator. Results: The sum of mean absolute Z-score values was highest when the window width was set at 17.5 ms (7.65; 4.31±1.34 for neurogenic subjects and-3.33±1.84 for myopathic subjects). Using this window width, the sensitivities for neurogenic and myopathic patients were 100% and 65%, respectively. The specificity for control subjects was 97%. Conclusion: The most appropriate widow width in the CI method for the TA muscle seems to be 17.5 ms.

Research paper thumbnail of Painful legs and moving toes syndrome: responsive to dopaminergic treatment

Acta Neurologica Belgica, 2014