Electrical activity of the masseter and supra hyoid muscles during swallowing of patients with multiple sclerosis

Santos, Valéria Alves dos; Vieira, Ana Cláudia de Carvalho; Silva, Hilton Justino da

doi:10.1590/2317-1782/20192018207

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Original Article • CoDAS 31 (6) • 2019 • https://doi.org/10.1590/2317-1782/20192018207 linkcopy

Electrical activity of the masseter and supra hyoid muscles during swallowing of patients with multiple sclerosis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose characterize the swallowing muscles electromyographic activity in EM.

Methods we evaluated 60 individuals being 30 with definitive diagnosis in EMG and 30 without neurologic changes. Volunteers provided personal data through interview, and we also obtained data from clinical records on the time of diagnosis, disease clinic form and the EDSS scale score. We then administered the DYMUS questionnaire. All evaluations occurred according to the Swallowing Electromyographic Evaluation Protocol.

Results Saliva swallowing, liquid swallowing with comfortable volume and continuous swallowing showed differences in the groups at the masseter, with higher averages in the comparison group. We verified differences between masseter and supra hyoid in each group, at rest, in saliva swallowing, liquid swallowing with comfortable volume and continued swallowing. In all situations the averages were higher in the supra hyoid, being that the smaller difference occurred at rest and the higher at continuous swallow. We recorded correlations between EDSS and the activity of supra hyoid at saliva swallow, liquid swallow with comfortable volume and swallow continuous. With the DYMUS, we observed correlations with the masseter activity and with the swallowing time. The high punctuation at the DYMUS presented correlations with the increase electrical activity of the masseter.

Conclusion patients with more severe conditions show lower supra hyoid electric activity, and the electric activity of the masseter is related to difficulty in swallowing.

Keywords:
Multiple Sclerosis; Electromyography; Masseter Muscle; Suprahyoid Muscle; Electrical Activity; Swallowing

Variable	Group		P value
Variable	G1	G2	P value
TOTAL	30 (100.0)	30 (100.0)
Age (years old): Average ± DP (Median)	37.57 ± 11.37 (34.50)	37.90 ± 11.41 (35.00)	p⁽1⁾ = 0.882
Age group: n (%)
- 21 to 29	7 (23.3)	7 (23.3)	p⁽2⁾ = 1.000
- 30 to 39	13 (43.3)	13 (43.3)
- 40 or more	10 (33.3)	10 (33.3)
Sex: n (%)
- Male	6 (20.0)	6 (20.0)	p⁽²⁾ = 1.000
- Female	24 (80.0)	24 (80.0)
Swallowing difficulty: n (%)
- Yes	14 (46.7)
- No	16 (53.3)
Diagnosis time (years): Average ± DP (Median)	7.20 ± 4.53 (6.50)
Diagnosis time: n (%)
- Up to 4 year	10 (33.3)
- From 5 to 9 years	12 (40.0)
- 10 or more	8 (26.7)
EDSS: Average ± DP (Median)	3.60 ± 1.61 (3.25)
DYMUS: Average ± DP (Median)	1.30 ± 2.15 (0.00)

Variable	Side	Group		P value
		G1	G2
		Average ± DP (Median)	Average ± DP (Median)
Rest
- Masseter	Right	10.86 ± 8.92 (6.36)	5.32 ± 5.62 (3.33)	p⁽1⁾ = 0.001*
	Left	20.74 ± 22.80 (10.18)	5.80 ± 6.01 (3.58)	p⁽¹⁾ < 0.001*
	Absolute diff. average	9.88	0.47	p⁽¹⁾ = 0.012*
	P value	p⁽2⁾ = 0.007*	p⁽²⁾ = 0.289
- Suprahyoid	Right	27.26 ± 20.76 (24.58)	17.35 ± 9.96 (13.95)	p⁽¹⁾ = 0.041*
	Left	31.30 ± 21.32 (23.93)	20.02 ± 13.36 (15.21)	p⁽¹⁾ = 0.032*
	Absolute diff. average	4.04	2.68	p⁽¹⁾ = 0.615
	P value	p⁽²⁾ = 0.478	p⁽²⁾ = 0.019*
	P value	p⁽3⁾ < 0.001*	p⁽³⁾ < 0.001*
	P value	p⁽4⁾ = 0.012*	p⁽⁴⁾ < 0.001*
Saliva swallowing
- Masseter	Right	24.80 ± 22.73 (18.35)	12.26 ± 12.61 (6.61)	p⁽¹⁾ = 0.003*
	Left	50.20 ± 81.82 (21.99)	11.19 ± 10.51 (6.99)	p⁽¹⁾ < 0.001*
	Absolute diff. average	25.40	-1.07	p⁽¹⁾ < 0.001*
	P value	p⁽²⁾ = 0.001*	p⁽²⁾ = 0.781
- Suprahyoid	Right	102.46 ± 98.38 (75.03)	102.29 ± 62.07 (89.36)	p⁽¹⁾ = 0.506
	Left	101.89 ± 68.87 (89.26)	105.05 ± 67.86 (90.31)	p⁽¹⁾ = 0.802
	Absolute diff. average	-0.57	2.76	p⁽¹⁾ = 0.802
	P value	p⁽²⁾ = 0.959	p⁽²⁾ = 0.845
	P value	p⁽³⁾ < 0.001*	p⁽³⁾ < 0.001*
	P value	p⁽⁴⁾ = 0.003*	p⁽⁴⁾ < 0.001*
Liquid swallowing (5mL)
- Masseter	Right	25.41 ± 24.97 (13.05)	9.93 ± 10.56 (5.35)	p⁽¹⁾ < 0.001*
	Left	50.06 ± 82.18 (24.90)	10.45 ± 12.09 (6.81)	p⁽¹⁾ < 0.001*
	Absolute diff. average	24.65	0.52	p⁽¹⁾ = 0.014*
	P value	p⁽²⁾ = 0.007*	p⁽²⁾ = 0.762
- Suprahyoid	Right	94.40 ± 117.38 (60.69)	95.21 ± 58.33 (85.66)	p⁽¹⁾ = 0.231
	Left	86.38 ± 57.34 (78.94)	99.27 ± 72.61 (79.43)	p⁽¹⁾ = 0.554
	Absolute diff. average	-8.03	4.06	p⁽¹⁾ = 1.000
	P value	p⁽²⁾ = 0.813	p⁽²⁾ = 0.845
	P value	p⁽³⁾ < 0.001*	p⁽³⁾ < 0.001*
	P value	p⁽⁴⁾ = 0.005*	p⁽⁴⁾ < 0.001*
Continuous swallowing (100mL)
- Masseter	Right	24.45 ± 27.41 (14.20)	10.22 ± 12.20 (5.57)	p⁽¹⁾ = 0.001*
	Left	49.10 ± 81.10 (17.88)	10.14 ± 10.16 (6.17)	p⁽¹⁾ < 0.001*
	Absolute diff. average	24.64	-0.08	p⁽¹⁾ = 0.033*
	Valor de p	p⁽²⁾ = 0.009*	p⁽²⁾ = 0.230
- Suprahyoid	Right	96.50 ± 86.42 (75.73)	103.38 ± 60.29 (84.94)	p⁽¹⁾ = 0.301
	Left	95.74 ± 57.30 (88.31)	111.97 ± 76.72 (95.11)	p⁽¹⁾ = 0.595
	Absolute diff. average	-0.76	8.59	p⁽¹⁾ = 0.668
	P value	p⁽²⁾ = 0.861	p⁽²⁾ = 0.371
	P value	p⁽³⁾ < 0.001*	p⁽³⁾ < 0.001*
	P value	p⁽⁴⁾ = 0.002*	p⁽⁴⁾ < 0.001*

Muscle	Side	Diagnosis time	EDSS	DYMUS
Muscle	Side	s (p)	s (p)	s (p)
Rest
- Masseter	Right	-0.069 (0.718)	0.154 (0.416)	0.470 (0.009)*
	Left	-0.105 (0.581)	0.168 (0.374)	0.633 (< 0.000)*
- Suprahyoid	Right	-0.031 (0.869)	-0.005 (0.980)	0.160 (0.398)
	Left	-0.116 (0.542)	0.100 (0.600)	-0.012 (0.952)
Saliva swallowing
- Masseter	Right	-0.139 (0.465)	0.140 (0.461)	0.404 (0.027)*
	Left	-0.163 (0.390)	0.241 (0.199)	0.568 (0.001)*
- Suprahyoid	Right	0.019 (0.923)	-0.407 (0.026)*	-0.349 (0.059)
	Left	-0.197 (0.296)	-0.340 (0.066)	-0.306 (0.100)
Liquid swallowing (5mL)
- Masseter	Right	-0.137 (0.471)	0.246 (0.191)	0.401 (0.028)*
	Left	-0.061 (0.750)	0.317 (0.088)	0.502 (0.005)*
- Suprahyoid	Right	-0.085 (0.655)	-0.441 (0.015)*	-0.329 (0.076)
	Left	-0.133 (0.484)	-0.379 (0.039)*	-0.302 (0.105)
Continuous swallowing (100mL)
- Masseter	Right	-0.274 (0.143)	0.161 (0.395)	0.447 (0.013)*
	Left	-0.155 (0.415)	0.146 (0.442)	0.531 (0.003)*
- Suprahyoid	Right	-0.138 (0.466)	-0.396 (0.030)*	-0.299 (0.109)
	Left	-0.230 (0.221)	-0.290 (0.119)	-0.323 (0.082)
Swallowing time		-0.174 (0.357)	0.020 (0.919)	0.370 (0.044)*
Number of swallows		-0.081 (0.672)	0.041 (0.831)	0.149 (0.432)

Muscle	Side	Dymus ≥ 1	Dymus = 0	s (p)
Muscle	Side	s (p)	s (p)	s (p)
Rest
- Masseter	Right	0.36 ± 0.28	0.16 ± 0.11	0.071
	Left	-0.105 (0.581)	0.168 (0.374)	0.633 (< 0.000)
- Suprahyoid	Right	-0.031 (0.869)	-0.005 (0.980)	0.160 (0.398)
	Left	-0.116 (0.542)	0.100 (0.600)	-0.012 (0.952)
Saliva swallowing
- Masseter	Right	0.36 ± 0.28	0.16 ± 0.11	0.071
	Left	0.87 ± 1.10	0.18 ±0.13	0.002
- Suprahyoid	Right	1.04 ±1.39	1.01± 0.44	0.980
	Left	0.86 ± 0.74	1.16 ± 0.63	0.110
5ml swallowing
- Masseter	Right	0.35 ± 0.29	0.17 ± 0.18	0.109
	Left	0.82 ± 1.10	0.22± 0.27	0.007
- Suprahyoid	Right	1.04 ± 1.70	0.86 ± 0.39	0.064
	Left	0.78 ± 0.76	0.93 ± 0.39	0.140
100ml swallowing
- Masseter	Right	0.34± 0.33	0.16 ± 0.18	0.039
	Left	0.82 ± 1.08	0.20 ± 0.27	0.002
- Suprahyoid	Right	0.92 ± 1.14	1.00 ± 0.56	0.096
	Left	0.85 ± 0.69	1.05 ± 0.45	0.146

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[1] ⁽¹⁾: Using Mann-Whitney test;

[2] ⁽²⁾: Using Pearson's chi-squared test