Welche Rolle spielt der insuläre Kortex beim Schlucken?

Zusammenfassung

Die Insel wird in einen hinteren granulären (Brodmann- Area [BA 13]) und einen vorderen agranulären (BA 14–16) Abschnitt unterteilt. Während die granuläre hintere Insel unter anderem somatosensible, vestibuläre und akustische Informationen verarbeitet, erfüllt die agranuläre vordere Insel neben sprechmotorischen auch ,,limbische“ Aufgaben: Verarbeitung gustatorischer, olfaktorischer und viszeroafferenter Informationen bzw. Kontrolle viszeromotorischer Abläufe. Funktionell-bildgebende Studien zeigten, dass die anteriore Insel bei willkürlichem, nicht aber bei reflektorischem Schluckvorgang aktiv ist. Sie ist funktionell eingebettet in ein weitverzweigtes sensomotorisches Netzwerk für das Schlucken, wobei sie bidirektionale Verbindungen zu motorischen und supplementär-motorischen Kortexgebieten, zum Thalamus und zu limbischen Hirnstammarealen, insbesondere zum Nucleus tractus solitarii aufweist. Dadurch wird die vordere Insel in die Lage versetzt, einerseits den Schluckvorgang zu initiieren und ihn andererseits in Abhängigkeit von gustatorischen und somatosensiblen Reizen aus dem oropharyngolaryngealen Bereich zu modulieren. Isolierte einseitige Läsionen der schluckdominanten Insel können wahrscheinlich zu einer Dysphagie führen.

Summary

The human insula has historically been divided into a posterior granular part (corresponding to Brodmann‘s area [BA] 13) and an anterior agranular region (BA 14-16). The granular part displays characteristics of somatosensory, auditory and vestibular cortex, whereas the agranular insula is involved with gustatory, olfactory, visceral and other “limbic” functions. Functional brain imaging studies have recently shown that the anterior insula plays a role in volitional swallowing. It is part of a widely distributed swallowing network and has bidirectional connections with the primary and supplementary motor cortex, with the thalamus and with limbic brainstem regions, especially with the solitary tract nucleus. Thus, the anterior insula is likely to play a crucial role in swallowing, firstly by initiating deglutition and secondly in modifying the swallow pattern in association with gustatory and somatosensory inputs from the oropharyngolaryngeal region. Isolated unilateral lesions of the swallowing-dominant insula may directly induce dysphagia.

Schlüsselwörter

Schlucken - Dysphagie - Insel - Insula

Keywords

Swallowing - deglutition - dysphagia - insula - insular cortex

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