Predicting the recovery of ventilatory activity in central respiratory paralysis.
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.


CONCLUSIONS
Electrophysiologic studies of the diaphragm in response to transcranial magnetic stimulation may help predict the recovery of central respiratory paralysis within 1 year.
Duguet
A
A
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.
Demoule
A
A
Gonzalez
J
J
Remy-Neris
O
O
Derenne
J P
JP
Similowski
T
T
D000293:Adolescent; D000328:Adult; D015984:Causality; D002493:Central Nervous System Diseases / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D012123:Pulmonary Ventilation; D020127:Recovery of Function; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012133:Respiratory Paralysis / Q000453:epidemiology* / Q000628:therapy*; D012680:Sensitivity and Specificity; D050781:Transcranial Magnetic Stimulation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000706:statistics & numerical data