Ann Rehabil Med.  2013 Dec;37(6):907-912. 10.5535/arm.2013.37.6.907.

Diagnosis With Manometry and Treatment With Repetitive Transcranial Magnetic Stimulation in Dysphagia

• Rhee WI
• Won SJ
• Ko SB

• KMID: 2266573
• DOI: http://doi.org/10.5535/arm.2013.37.6.907

Abstract

Videofluoroscopic swallowing study (VFSS) used for the diagnosis of dysphagia has limitations in objectively assessing the contractility of the pharyngeal muscle or the degree of the upper esophageal sphincter relaxation. With a manometer, however, it is possible to objectively assess the pressure changes in the pharynx caused by pharyngeal muscle contraction during swallowing or upper esophageal sphincter relaxation, hence remedying the limitations of VFSS. The following case report describes a patient diagnosed with lateral medullar infarction presenting a 52-year-old male who had dysphagia. We suggested that the manometer could be used to assess the specific site of dysfunction in patients with dysphagia complementing the limitations of VFSS. We also found that repetitive transcranial magnetic stimulation was effective in treating patients refractory to traditional dysphagia rehabilitation.

Keyword

Manometry; Dysphagia; Transcranial magnetic stimulation

MeSH Terms

Complement System Proteins
Deglutition
Deglutition Disorders*
Diagnosis*
Esophageal Sphincter, Upper
Humans
Infarction
Male
Manometry*
Middle Aged
Pharyngeal Muscles
Pharynx
Rehabilitation
Relaxation
Transcranial Magnetic Stimulation*
Complement System Proteins

Figure

• 

  Fig. 1 Videofluoroscopic swallowing study finding (A) and manometry finding (B) before repetitive transcranial magnetic stimulation. The pressure changes in the pharynx and oesophagus were recorded using a 5-lumen perfused catheter system. The plots are: 10 cm upper of the UES (blue line), 5 cm upper of the UES (green line), UES (brown line), 5 cm lower of the UES (yellow line), 10 cm lower of the UES (purple line). The pressure increase was reduced at the site 5 cm upper of the UES (green line). The decreased pressure due to UES relaxation was clear (brown line), but the retained foods not passing by the UES due to the reduced duration was observed. In addition, no pressure change caused by peristalsis was observed due to the retained foods did not pass by the esophageal body. UES, upper esophageal sphincter.

• 

  Fig. 2 Videofluoroscopic swallowing study finding (A) and manometry finding (B) after the 2-week repetitive transcranial magnetic stimulation treatment. Compared to the status observed 2 weeks prior, no significant increase in the pressure change at the site 5 cm upper of the UES was observed. However, foods passed by the UES due to the extended duration of UES relaxation, and peristalsis were also observed in the esophageal body. UES, upper esophageal sphincter.

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