Experimental study of a late response recorded from the thoracic wall after phrenic nerve stimulation.
OBJECTIVE
The phrenic nerve cervical stimulation induces an early motor diaphragmatic M response that may be recorded from the 7th ipsilateral intercostal space (ICS). Some responses with prolonged latency and of unclear origin can be recorded from the same recording site. The aim of the study was to determine the electrophysiological characteristics and the neuroanatomical pathways underlying the long-latency responses (LLRs) recorded from the 7th ICS.


METHODS
We studied seven healthy volunteers, five patients with spinal cord injury and five patients with diaphragmatic palsy. All underwent phrenic nerve conduction study. An LLR was sought for at different stimulation sites using various stimulus intensities.


RESULTS
A polyphasic LLR was recorded from the 7th ICS in all healthy subjects. It was mainly elicited by nociceptive stimulations, not only of the phrenic, but also of the median nerves. Its latency was longer than 70ms, with a wide inter- and intra-individual variability. Amplitude was highly variable and some habituation phenomenon occurred. The LLR was retained in most tetraplegic patients after phrenic nerve stimulation, but absent otherwise. It was present in all patients with diaphragmatic palsy after phrenic nerve stimulation.


CONCLUSIONS
The LLR is likely to be produced by both intercostal and diaphragm muscles. It is a polysynaptic and multisegmental spinal response, probably conveyed by small-diameter nociceptive A-delta and/or C fibres and modulated by a supraspinal control.


CONCLUSIONS
The LLR recorded from the chest wall may constitute, by analogy with the nociceptive component of the lower limb flexion reflex in humans, a protective and withdrawal spinal reflex response.
Rouaud
Tiphaine
T
CHU Nantes, Laboratoire d'Explorations Fonctionnelles, Nantes, France.
Magot
Armelle
A
Guihéneuc
Pierre
P
Perrouin Verbe
Brigitte
B
Truffert
André
A
Péréon
Yann
Y
D000200:Action Potentials / Q000502:physiology; D000293:Adolescent; D000328:Adult; D003964:Diaphragm / Q000503:physiopathology*; D004558:Electric Stimulation / Q000379:methods*; D004576:Electromyography / Q000379:methods; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000473:pathology; D010791:Phrenic Nerve / Q000503:physiopathology*; D011930:Reaction Time / Q000502:physiology*; D013119:Spinal Cord Injuries / Q000473:pathology / Q000503:physiopathology; D035441:Thoracic Wall / Q000294:innervation*; D055815:Young Adult