Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Duguet, A.
Right arrow Articles by Similowski, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Duguet, A.
Right arrow Articles by Similowski, T.
Related Collections
Right arrow All Medical/Systemic disease
Right arrow TMS
NEUROLOGY 2006;67:288-292
© 2006 American Academy of Neurology

Predicting the recovery of ventilatory activity in central respiratory paralysis

A. Duguet, MD, PhD, A. Demoule, MD, J. Gonzalez, MD, O. Remy-Neris, MD, PhD, J. P. Derenne, MD and T. Similowski, MD, PhD

From the Laboratoire de Physiopathologie Respiratoire (A.D., A.D., J.G., J.P.D., T.S.), Unité de Réanimation et Centre de Stimulation Phrénique Implantée, Service de Pneumologie, Groupe Hospitalier Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, and UPRES EA 2397 (A.D., A.D., J.G., J.P.D., T.S.), Université Paris VI Pierre and Marie Curie, Paris; Service de Rééducation et de Médecine Physique (O.R.-N.), Fondation Hopale, Berck-sur-Mer, France; and Université Bretagne Occidentale (O.R.-N.), Inserm U650 and Service de Médecine Physique et de Réadaptation Hopital Foch, Brest, France.

Address correspondence and reprint requests to Dr. T. Similowski, Service de Pneumologie et de Réanimation, Groupe Hospitalier Pitié–Salpêtrière, 47-83 Bd de l’Hôpital, 75651 Paris Cedex 13, France; e-mail: thomas.similowski{at}psl.ap-hop-paris.fr

Objective: To assess the value of the diaphragmatic response to transcranial magnetic stimulation (TMS) in predicting the recovery of ventilatory activity after CNS lesions responsible for central respiratory paralysis.

Methods: The authors studied 11 long-term ventilator-dependent patients with central respiratory paralysis (description group: spinal trauma 10, medullary ischemia 1) and 16 patients with central respiratory paralysis for less than 10 weeks (prognostic group, evaluated after a 1-year follow-up: spinal trauma 8, medullary ischemia 4, radiation myelitis 1, subdural hematoma 1, complication of neurosurgery 2).

Results: In the description group, all the patients had a bilaterally abolished diaphragm response. In the prognostic group, six patients were fully ventilator dependent because of a complete absence of ventilatory activity at follow-up time. They lacked any diaphragm response. The 10 other patients had recovered ventilatory activity and full (n = 9) or partial (n = 1) ventilatory autonomy. In nine cases, diaphragm response was present at least on one side, with a normal latency (right: 15.6 ± 1.5 milliseconds; left: 16.2 ± 2.2 milliseconds). The test had 100% specificity (95% CI 52 to 100) and 90% sensitivity (95% CI 54 to 99) to predict the recovery of ventilatory activity.

Conclusion: Electrophysiologic studies of the diaphragm in response to transcranial magnetic stimulation may help predict the recovery of central respiratory paralysis within 1 year.

Supported by the Association pour le Développement et l’Organisation de la Recherche en Pneumologie (ADOREP), Paris, France.

Disclosure: The authors report no conflicts of interest.

Received September 12, 2005. Accepted in final form March 27, 2006.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2006 by AAN Enterprises, Inc.