title: Identification of unexpected respiratory abnormalities in patients with amyotrophic lateral sclerosis through electromyographic analysis using intramuscular electrodes implanted for therapeutic diaphragmatic pacing.
abstract: BACKGROUND
  Amyotrophic lateral sclerosis patients have significant respiratory abnormalities with incomplete understanding of respiratory control. This study analyzes electromyography (EMG) of the diaphragm (dEMG) using implanted diaphragm pacing (DP) electrodes.
  
  
  METHODS
  Retrospective analysis of dEMG data were obtained during Institutional Review Board and US Food and Drug Administration approved trials. The electrodes were used to analyze epochs of dEMG during multiple respiratory cycles.
  
  
  RESULTS
  Fifty-three patients were implanted. Thirty-six had bilateral dEMG assessments, 18 had continuous overnight readings with pulse oximetry, and 19 had serial analysis. Several findings revealed an alteration in the central respiratory drive including central apnea, hypoventilation, and hypercarbia. The electrodes showed unilateral dysfunction and demonstrated noninvasive ventilation suppression of diaphragm activity. DP can be used for serial monitoring, to decrease hypercarbia, improve sleep, and decrease atrophy.
  
  
  CONCLUSIONS
  Multiple abnormalities of respiratory control can be seen in amyotrophic lateral sclerosis patients using dEMG through therapeutic DP electrodes. DP is used to overcome instability of respiratory control when there are intact diaphragm motor units leading to improved survival.
authors: Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA. Electronic address: Raymond.onders@uhhospitals.org.
authors: Raymond P
authors: RP
authors: Onders
authors: Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA.
authors: MaryJo
authors: M
authors: Elmo
authors: Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA.
authors: Cindy
authors: C
authors: Kaplan
authors: Department of Neurology, Neurologic Institute, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA.
authors: Bashar
authors: B
authors: Katirji
authors: Department of Medicine, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106-5047, USA.
authors: Robert
authors: R
authors: Schilz
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000503:physiopathology; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D004576:Electromyography / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Amyotrophic lateral sclerosis; Diaphragm electromyography; Diaphragm pacing