title: Treatment of Idiopathic Diaphragm Flutter: A Case Study.
abstract: Diaphragm flutter is a rare disorder defined by dyspnea and often thoracoabdominal pain associated with rapid rhythmic involuntary contractions of the diaphragm with no effective treatment. A 35-year-old woman's flutter was triggered by increasing the depth of breathing and by (electrical) stimulation of the diaphragm. Medical therapy, phrenic nerve crush, and diaphragm pacer stimulation were ineffective. Since increasing diaphragm activity was a trigger, resting the diaphragm was tried. A manual resuscitator and, subsequently, mouthpiece and nasal noninvasive ventilatory support (NVS) instantaneously halted the flutter for 3 months and almost instantaneously for another 6 months. For 16 months, it has continued to halt flutter with rare episodes when getting out of bed that resolve with up to 40 minutes of NVS. To our knowledge, this is the first case of idiopathic diaphragmatic flutter for which diaphragm rest was used as successful treatment with no adverse effects. This should be tried for future cases.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Michael
authors.initials: M
authors.lastname: Chiou
authors.affiliation: Petrona Villegas de Cordero Hospital, San Fernando, Buenos Aires, Argentina.
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Herrero
authors.affiliation: Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ. Electronic address: bachjr@njms.rutgers.edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Bach
authors.affiliation: Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Cole
authors.affiliation: Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ.
authors.forename: Enrique Luis
authors.initials: EL
authors.lastname: Gonzales
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D003964:Diaphragm / Q000294:innervation / Q000503:physiopathology*; D004576:Electromyography; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D009207:Myoclonus / Q000175:diagnosis* / Q000628:therapy*; D010791:Phrenic Nerve / Q000503:physiopathology / Q000601:surgery; D012132:Respiratory Muscles / Q000503:physiopathology*
keywords: diaphragm pacing; diaphragmatic flutter; noninvasive ventilatory support; treatment