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Open Access Case report

Stuttered swallowing: Electric stimulation of the right insula interferes with water swallowing. A case report

Peter Sörös12*, Faisal Al-Otaibi2, Savio WH Wong34, J Kevin Shoemaker3, Seyed M Mirsattari2, Vladimir Hachinski2 and Ruth E Martin15

Author Affiliations

1 School of Communication Sciences and Disorders, University of Western Ontario, London, Ontario, Canada

2 Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada

3 School of Kinesiology, University of Western Ontario, London, Ontario, Canada

4 Brain and Creativity Institute, University of Southern California, Los Angeles, California, USA

5 Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada

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BMC Neurology 2011, 11:20  doi:10.1186/1471-2377-11-20

Published: 5 February 2011

Abstract

Background

Various functional resonance imaging, magnetoencephalographic and lesion studies suggest the involvement of the insular cortex in the control of swallowing. However, the exact location of insular activation during swallowing and its functional significance remain unclear.

Case presentation

Invasive electroencephalographic monitoring was performed in a 24-year-old man with medically intractable stereotyped nocturnal hypermotor seizures due to a ganglioglioma. During stimulation of the right inferior posterior insular cortex with depth electrodes the patient spontaneously reported a perception of a "stutter in swallowing". Stimulation of the inferior posterior insular cortex at highest intensity (4 mA) was also associated with irregular and delayed swallows. Swallowing was not impaired during stimulation of the superior posterior insular cortex, regardless of stimulation intensity.

Conclusions

These results indicate that the right inferior posterior insular cortex is involved in the neural circuitry underlying the control of swallowing.