Paralysis Research Today is a free monthly online journal that collates and summarizes the latest research about Paralysis, including details on treatment, diagnosis, facial paralysis, sleep paralysis.

Predicting the recovery of ventilatory activity in central respiratory paralysis.

Duguet A, Demoule A, Gonzalez J, Remy-Neris O, Derenne JP, Similowski T

Laboratoire de Physiopathologie Respiratoire, Unité de Réanimation et Centre de Stimulation Phrénique Implantée, Service de Pneumologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris.

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.

Published 25 July 2006 in Neurology, 67(2): 288-92.
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