Apneustic breathing in children with brainstem damage due to hypoxic-ischemic encephalopathy.
To confirm the presence of apneusis in patients with hypoxic-ischemic encephalopathy and to clarify which factors influence their respiratory patterns, polygraphic studies were performed on two patients. Apneusis was clinically suspected in both patients who had severe brainstem damage. In one subject, inputs of vagal afferents from the gastrointestinal tract and the urinary bladder often resulted in extreme tachypnea instead of apneusis. Lung inflation facilitated expiration during inspiratory arrest. Expiration preceded a periodic inhibition of rigospastic discharge in the right biceps muscle. In the other subject, prolonged inspiratory pauses with cyanosis occurred with or without preceding epileptic seizure. Both phenytoin dose reduction and treatment with tandospirone, a serotonin-1A agonist, were effective in improving the respiratory distress in this subject.
Saito
Y
Y
Department of Child Neurology, National Center Hospital for Mental, Nervous and Muscular Disorders, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
Hashimoto
T
T
Iwata
H
H
Takahashi
K
K
Fukumizu
M
M
Sasaki
M
M
Hanaoka
S
S
Sugai
K
K
D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D001927:Brain Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D002545:Brain Ischemia / Q000150:complications*; D001933:Brain Stem / Q000000981:diagnostic imaging*; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications*; D054833:Isoindoles; D008279:Magnetic Resonance Imaging; D008297:Male; D009125:Muscle Relaxants, Central / Q000627:therapeutic use; D009128:Muscle Spasticity / Q000188:drug therapy; D010672:Phenytoin / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use; D012120:Respiration Disorders / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D054833:Isoindoles; D009125:Muscle Relaxants, Central; D010879:Piperazines; D011743:Pyrimidines; D017366:Serotonin Receptor Agonists; C055267:tandospirone; D010672:Phenytoin