[Diaphragm pacing with a spinal cord stimulator].
BACKGROUND
Diaphragm pacing with electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. The device, however, is not readily available in Japan. For pain control, we applied the spinal cord stimulator to bring about phrenic nerve stimulation. The purpose of this study is to evaluate the efficacy and feasibility of phrenic pacing using the compromise method.


METHODS
We implanted a spinal cord stimulator in five patients with chronic central hypoventilation. The stimulation electrode was placed along the phrenic nerve in the neck, and the device was implanted in the anterior chest. We used the cyclic mode, and set the parameters at 1 second ramp up, 2 second on, 3 second off. The pulse width and the frequency were set at 150 mu sec and 21 Hz respectively. The amplitude was adjusted to obtain sufficient tidal volume and to maintain PaCO2 at around 40 mmHg.


RESULTS
During the follow-up period from 3 to 34 months (mean 23), stable and sufficient ventilation was observed in all patients without complications.


CONCLUSIONS
Though longer follow-up is necessary, diaphragm pacing with the spinal cord stimulator is feasible as a treatment for central hypoventilation syndrome.
Mitsuyama
Tetsuryu
T
Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Taira
Takaomi
T
Oikawa
Akihiro
A
Takeda
Naoto
N
Matsumoto
Yukiko
Y
Harashima
Shiho
S
Hori
Tomokatsu
T
D000328:Adult; D003964:Diaphragm / Q000294:innervation*; D004599:Electric Stimulation Therapy / Q000295:instrumentation; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D007040:Hypoventilation / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000503:physiopathology*