Ryo Morishima1,2, Toshio Shimizu3, Yukie Ishizaka4, Hideki Kimura3, Kota Bokuda3, Kazushi Takahashi3, Masanari Itokawa5,6. 1. Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, 183-0042, Japan. riyou_morishima@tmhp.jp. 2. Course of Molecular and Cellular Medicine, Niigata University Graduate School of Medicine, 757, Tori-Ichibancho, Asahimachi, Chuo-ku, Niigata, 951-8510, Japan. riyou_morishima@tmhp.jp. 3. Department of Neurology, Tokyo Metropolitan Neurological Hospital, 2-6-1, Musashidai, Fuchu, Tokyo, 183-0042, Japan. 4. Department of Clinical Laboratory Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22, Honkomagome, Bunkyo, Tokyo, 113-8677, Japan. 5. Course of Molecular and Cellular Medicine, Niigata University Graduate School of Medicine, 757, Tori-Ichibancho, Asahimachi, Chuo-ku, Niigata, 951-8510, Japan. 6. Deputy Director General, Tokyo Metropolitan Institute of Medical Science, 2-1-6, Kamikitazawa, Setagaya, Tokyo, 156-8506, Japan.
Abstract
INTRODUCTION: We aimed to clarify the differences in static and dynamic diaphragm parameters between the expiratory and inspiratory phases in amyotrophic lateral sclerosis (ALS). METHODS: Twenty patients with early-stage ALS and 16 healthy controls were enrolled in the study. We measured the amplitudes of compound muscle action potential (phCMAP) by electrical stimulation of the phrenic nerve and the zone of apposition wall thickness of the diaphragm (DT) using ultrasonography. We analyzed the differences in phCMAP (∆phCMAP) and DT (∆DT) between the end-inspiratory and end-expiratory phases and their correlation with forced vital capacity (FVC). RESULTS: The ΔphCMAP (mean 129.7 ± SD 204.7 µV) and ∆DT (0.80 ± 0.88 cm) in patients were significantly smaller than those in controls (348.6 ± 247.7 µV, p = 0.0003 and 1.89 ± 1.10 cm, p = 0.0002, respectively). Although ∆DT was significantly correlated with FVC, we found no correlation between ∆phCMAP and FVC. The phCMAP was paradoxically smaller during inspiration than during expiration in 35% of patients but in none of the controls. CONCLUSION: Dynamic parameters of the diaphragm were abnormal in early-stage ALS. The paradoxical reduction in phCMAP during inspiration may reflect early respiratory dysfunction. Assessment of dynamic abnormalities of the diaphragm may provide helpful information for respiratory management in patients with ALS.
INTRODUCTION: We aimed to clarify the differences in static and dynamic diaphragm parameters between the expiratory and inspiratory phases in amyotrophic lateral sclerosis (ALS). METHODS: Twenty patients with early-stage ALS and 16 healthy controls were enrolled in the study. We measured the amplitudes of compound muscle action potential (phCMAP) by electrical stimulation of the phrenic nerve and the zone of apposition wall thickness of the diaphragm (DT) using ultrasonography. We analyzed the differences in phCMAP (∆phCMAP) and DT (∆DT) between the end-inspiratory and end-expiratory phases and their correlation with forced vital capacity (FVC). RESULTS: The ΔphCMAP (mean 129.7 ± SD 204.7 µV) and ∆DT (0.80 ± 0.88 cm) in patients were significantly smaller than those in controls (348.6 ± 247.7 µV, p = 0.0003 and 1.89 ± 1.10 cm, p = 0.0002, respectively). Although ∆DT was significantly correlated with FVC, we found no correlation between ∆phCMAP and FVC. The phCMAP was paradoxically smaller during inspiration than during expiration in 35% of patients but in none of the controls. CONCLUSION: Dynamic parameters of the diaphragm were abnormal in early-stage ALS. The paradoxical reduction in phCMAP during inspiration may reflect early respiratory dysfunction. Assessment of dynamic abnormalities of the diaphragm may provide helpful information for respiratory management in patients with ALS.
Authors: P M Andersen; G D Borasio; R Dengler; O Hardiman; K Kollewe; P N Leigh; P-F Pradat; V Silani; B Tomik Journal: Eur J Neurol Date: 2005-12 Impact factor: 6.089
Authors: Noah Lechtzin; Merit E Cudkowicz; Mamede de Carvalho; Angela Genge; Orla Hardiman; Hiroshi Mitsumoto; Jesus S Mora; Jeremy Shefner; Leonard H Van den Berg; Jinsy A Andrews Journal: Amyotroph Lateral Scler Frontotemporal Degener Date: 2018-03-23 Impact factor: 4.092