Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1998 Dec;65(6):848–856. doi: 10.1136/jnnp.65.6.848

Clinical and electrophysiological evaluation of dysphagia in myasthenia gravis

C Ertekin 1, N Yuceyar 1, I Aydogdu 1
PMCID: PMC2170405  PMID: 9854960

Abstract

OBJECTIVE—To evaluate dysphagia at the oropharyngeal stage of swallowing and to determine the pathophysiological mechanisms of dysphagia in patients with myasthenia gravis.
METHODS—Fifteen patients with myasthenia gravis with dysphagia and 10 patients without dysphagia were investigated by a combined electrophysiological and mechanical method described previously. Laryngeal movements were detected by a piezoelectric transducer and the related submental EMG (SM-EMG) and sometimes the EMG of cricopharyngeal muscle of the upper esophageal sphincter (CP-EMG) were recorded during dry or wet swallowing. The results of these electrophysiological variables were compared with those of normal age matched control subjects.
RESULTS—In patients with myasthenia gravis with dysphagia, it was found that the time necessary for the larynx to remain in its superior position during swallowing and swallowing variability in successive swallows increased significantly compared with normal subjects and with patients with myasthenia gravis without dysphagia. The total duration of SM-EMG activity was also prolonged in both groups but more severely in the dysphagic patients. Electromyographic activity of the CP sphincter was found to be normal in the dysphagic patients investigated. All the patients with myasthenia gravis with dysphagia had pathological dysphagia limits (<20 ml water) whereas other patients except two, were within normal limits.
CONCLUSIONS—Because the electrophysiological variables related to oropharyngeal swallowing were prolonged even in patients with myasthenia gravis without dysphagia, it is concluded that the submental and laryngeal elevators are involved subclinically in myasthenia gravis and, because of compensating mechanisms, the patient may not be dysphagic. As the CP-EMG behaviour was found to be normal, a coordination disorder between normal CP sphincter muscle and the affected striated muscles of the laryngeal elevators may be one of the reasons for dysphagia in myasthenia gravis. This method also made it possible to investigate the myasthenic involvement in the laryngeal elevators that cannot be evaluated by other electrophysiological methods in myasthenia gravis.



Full Text

The Full Text of this article is available as a PDF (211.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bonington A., Mahon M., Whitmore I. A histological and histochemical study of the cricopharyngeus muscle in man. J Anat. 1988 Feb;156:27–37. [PMC free article] [PubMed] [Google Scholar]
  2. Carpenter R. J., 3rd, McDonald T. J., Howard F. M., Jr The otolaryngologic presentation of myasthenia gravis. Laryngoscope. 1979 Jun;89(6 Pt 1):922–928. doi: 10.1288/00005537-197906000-00008. [DOI] [PubMed] [Google Scholar]
  3. Cook I. J. Normal and disordered swallowing: new insights. Baillieres Clin Gastroenterol. 1991 Jun;5(2):245–267. doi: 10.1016/0950-3528(91)90029-z. [DOI] [PubMed] [Google Scholar]
  4. Dodds W. J., Stewart E. T., Logemann J. A. Physiology and radiology of the normal oral and pharyngeal phases of swallowing. AJR Am J Roentgenol. 1990 May;154(5):953–963. doi: 10.2214/ajr.154.5.2108569. [DOI] [PubMed] [Google Scholar]
  5. Donner M. W., Silbiger M. L. Cinefluorographic analysis of pharyngeal swallowing in neuromuscular disorders. Am J Med Sci. 1966 May;251(5):600–616. doi: 10.1097/00000441-196605000-00013. [DOI] [PubMed] [Google Scholar]
  6. Elidan J., Shochina M., Gonen B., Gay I. Manometry and electromyography of the pharyngeal muscles in patients with dysphagia. Arch Otolaryngol Head Neck Surg. 1990 Aug;116(8):910–913. doi: 10.1001/archotol.1990.01870080032009. [DOI] [PubMed] [Google Scholar]
  7. Ertekin C., Aydoğdu I., Yüceyar N., Pehlivan M., Ertaş M., Uludağ B., Celebi G. Effects of bolus volume on oropharyngeal swallowing: an electrophysiologic study in man. Am J Gastroenterol. 1997 Nov;92(11):2049–2053. [PubMed] [Google Scholar]
  8. Ertekin C., Aydoğdu I., Yüceyar N. Piecemeal deglutition and dysphagia limit in normal subjects and in patients with swallowing disorders. J Neurol Neurosurg Psychiatry. 1996 Nov;61(5):491–496. doi: 10.1136/jnnp.61.5.491. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Ertekin C., Pehlivan M., Aydoğdu I., Ertaş M., Uludağ B., Celebi G., Colakoğlu Z., Sağduyu A., Yüceyar N. An electrophysiological investigation of deglutition in man. Muscle Nerve. 1995 Oct;18(10):1177–1186. doi: 10.1002/mus.880181014. [DOI] [PubMed] [Google Scholar]
  10. Grob D., Arsura E. L., Brunner N. G., Namba T. The course of myasthenia gravis and therapies affecting outcome. Ann N Y Acad Sci. 1987;505:472–499. doi: 10.1111/j.1749-6632.1987.tb51317.x. [DOI] [PubMed] [Google Scholar]
  11. Huang M. H., King K. L., Chien K. Y. Esophageal manometric studies in patients with myasthenia gravis. J Thorac Cardiovasc Surg. 1988 Feb;95(2):281–285. [PubMed] [Google Scholar]
  12. Jones B., Ravich W. J., Donner M. W., Kramer S. S., Hendrix T. R. Pharyngoesophageal interrelationships: observations and working concepts. Gastrointest Radiol. 1985;10(3):225–233. doi: 10.1007/BF01893105. [DOI] [PubMed] [Google Scholar]
  13. Khan O. A., Campbell W. W. Myasthenia gravis presenting as dysphagia: clinical considerations. Am J Gastroenterol. 1994 Jul;89(7):1083–1085. [PubMed] [Google Scholar]
  14. Kilman W. J., Goyal R. K. Disorders of pharyngeal and upper esophageal sphincter motor function. Arch Intern Med. 1976 May;136(5):592–601. [PubMed] [Google Scholar]
  15. Kluin K. J., Bromberg M. B., Feldman E. L., Simmons Z. Dysphagia in elderly men with myasthenia gravis. J Neurol Sci. 1996 Jun;138(1-2):49–52. doi: 10.1016/0022-510x(95)00329-z. [DOI] [PubMed] [Google Scholar]
  16. McConnel F. M., Cerenko D., Jackson R. T., Guffin T. N., Jr Timing of major events of pharyngeal swallowing. Arch Otolaryngol Head Neck Surg. 1988 Dec;114(12):1413–1418. doi: 10.1001/archotol.1988.01860240063025. [DOI] [PubMed] [Google Scholar]
  17. Miller A. J. Deglutition. Physiol Rev. 1982 Jan;62(1):129–184. doi: 10.1152/physrev.1982.62.1.129. [DOI] [PubMed] [Google Scholar]
  18. Pehlivan M., Yüceyar N., Ertekin C., Celebi G., Ertaş M., Kalayci T., Aydoĝdu I. An electronic device measuring the frequency of spontaneous swallowing: digital phagometer. Dysphagia. 1996 Fall;11(4):259–264. doi: 10.1007/BF00265212. [DOI] [PubMed] [Google Scholar]
  19. Sanders D. B., Howard J. F., Jr AAEE minimonograph #25: Single-fiber electromyography in myasthenia gravis. Muscle Nerve. 1986 Nov-Dec;9(9):809–819. doi: 10.1002/mus.880090904. [DOI] [PubMed] [Google Scholar]
  20. Sanders D. B., Howard J. F., Jr, Johns T. R. Single-fiber electromyography in myasthenia gravis. Neurology. 1979 Jan;29(1):68–76. doi: 10.1212/wnl.29.1.68. [DOI] [PubMed] [Google Scholar]
  21. Seamen W. B. Pharyngeal and upper esophageal dysphagia. JAMA. 1976 Jun 14;235(24):2643–2646. doi: 10.1001/jama.235.24.2643. [DOI] [PubMed] [Google Scholar]
  22. Shipp T., Deatsch W. W., Robertson K. Pharyngoesophageal muscle activity during swallowing in man. Laryngoscope. 1970 Jan;80(1):1–16. doi: 10.1288/00005537-197001000-00001. [DOI] [PubMed] [Google Scholar]
  23. Silbiger M. L., Pikielney R., Donner M. W. Neuromuscular disorders affecting the pharynx. Cineradiographic analysis. Invest Radiol. 1967 Nov-Dec;2(6):442–448. doi: 10.1097/00004424-196711000-00024. [DOI] [PubMed] [Google Scholar]
  24. van Overbeek J. J., Wit H. P., Paping R. H., Segenhout H. M. Simultaneous manometry and electromyography in the pharyngoesophageal segment. Laryngoscope. 1985 May;95(5):582–584. doi: 10.1288/00005537-198505000-00011. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES