Percutaneous magnetic coil stimulation of the phrenic nerve roots and trunk

Chokroverty, Sudhansu; Shah, Shruti; Chokroverty, M.; Deutsch, A.; Belsh, Jerry M.

doi:10.1016/0924-980x(95)00159-i

Cited by 21 publications

(25 citation statements)

References 10 publications

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“…We had reasons to believe that, in our setting, surface electrodes could provide an uncontaminated diaphragm signal with CMS as well as with ES. Among the strongest of these reasons was the fact that surface electrodes could be silent in response to CMS in patients with phrenic paralysis (1,6,35). In our view, the most likely explanation for the difference between our findings and those of others is our use of a variant placement of the electrodes over the chest wall.…”

contrasting

confidence: 52%

“…We recently reported a case of demyelinating phrenic neuropathy (12) in which CMS and ES latencies varied together over 2 yr, which seems to us an argument against contamination. Another argument is the observation of an abolished response to CMS in patients with phrenic nerve palsy (6). We used this argument in a previous study [complete absence of response from surface electrodes in six patients with amyotrophic lateral sclerosis and complete diaphragm paralysis diagnosed on mechanical grounds (1, 35)].…”

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confidence: 99%

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Validation of improved recording site to measure phrenic conduction from surface electrodes in humans

Vérin

Straus

Demoule

et al. 2002

Journal of Applied Physiology

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Phrenic nerve stimulation, electrical (ES) or from cervical magnetic stimulation (CMS), allows one to assess the diaphragm contractile properties and the conduction time of the phrenic nerve (PNCT) through recording of an electromyographic response, traditionally by using surface electrodes. Because of the coactivation of extradiaphragmatic muscles, signal contamination can jeopardize the determination of surface PNCTs. To address this, we compared PNCTs with ES and CMS from surface and needle diaphragm electrodes in five subjects (10 phrenic nerves). At a modified recording site, lower and more anterior than usual (lowest accessible intercostal space, costochondral junction) with electrodes 2 cm apart, surface and needle PNCTs were similar (CMS: 6.0 ± 0.25 ms surface vs. 6.2 ± 0.13 ms needle, not significant). Electrodes recording the activity of the most likely sources of signal contamination, i.e., the serratus anterior and pectoralis major, showed distinct responses from that of the diaphragm, their earlier occurrence strongly arguing against contamination. With ES and CMS, apparently uncontaminated signals could be consistently recorded from surface electrodes.

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confidence: 52%

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confidence: 99%

Validation of improved recording site to measure phrenic conduction from surface electrodes in humans

Vérin

Straus

Demoule

et al. 2002

Journal of Applied Physiology

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“…Using transcranial electrical stimulation, Cowan et al 17 showed the delay in the central conduction time from the motor cortex to the peripheral muscles in patients with multiple sclerosis. Several reports show that the latency is delayed for studies on the phrenic nerve by both electrical and magnetic stimulation in diseases of the peripheral nerves, such as demyelinative neuropathy, motor neurone disease, neuritis 6 and injury to the phrenic nerve after cardiothoracic surgery. 18 These studies are valuable for patients with insufficiency of the phrenic nerve.…”

Section: Discussionmentioning

confidence: 99%

Neurophysiological tests of respiratory function by compound muscle action potentials from the diaphragm

Kawaguchi

Kitagawa²,

Nakamura

et al. 2000

The Journal of Bone and Joint Surgery. British volume

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W e recorded compound muscle action potentials (CMAPs) from the diaphragm in 15 normal volunteers, nine patients with lesions of the lower cervical cord (C5 to C8), one completely quadriplegic patient (C6) and seven patients with lesions at a higher cervical level (C1 to C4). Transcranial magnetic stimulation and electrical stimulation of the phrenic nerve were carried out.When the centre of the coil was placed on the interauricular line at a point 3 cm lateral to the vertex on the scalp, the CMAPs from the diaphragm had the largest amplitude and the shortest latency. There was no difference in the mean latency of the CMAPs recorded by transcranial magnetic stimulation in the normal volunteers and in the patients with lesions of the lower cervical cord. In the quadriplegic patient, the latency of the CMAPs was not delayed, but was prolonged in the patients with lesions at a higher level. Those evoked by electrical stimulation of the phrenic nerve were not prolonged in the patients with higher lesions.Our findings suggest that the prolongation of the latency by transcranial magnetic stimulation reflects dysfunction of the higher cervical cord. The combination of transcranial magnetic stimulation and electrical stimulation of the phrenic nerve can detect the precise level of the lesion in the motor tract to the diaphragm. J Bone Joint Surg [Br] 2000;82-B:695-701.

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“…Recently this technique has been successfully proposed for the non-invasive study of the diaphragm (Dia) (Zifko et al, 1996, Similowski et al, 1996 and phrenic roots (Chokroverty et al, 1995;Similowski et al, 1997). There are only few studies which addressed the diaphragmatic impairment in MS by means of transcranial magnetic stimulation (TMS) (Garland et al, 1996;Lagueny et al, 1998).…”

Section: Introductionmentioning

confidence: 99%

Are the neurophysiological techniques useful for the diagnosis of diaphragmatic impairment in multiple sclerosis (MS)?

Miscio

Guastamacchia

Priano

et al. 2003

Clinical Neurophysiology

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Objective: To characterize cortico-diaphragmatic pathway involvement in multiple sclerosis (MS) by means of transcranial magnetic stimulation (TMS), and verify its clinical impact.Methods: TMS from diaphragm (Dia), and abductor digiti minimi (AbdV8) was performed in 26 MS patients. Phrenic nerve (PN) conduction study was also performed. Expanded disability status scale (EDSS) and fatigue descriptive scale (FDS) were measured. Forced vital capacity (FVC), forced expiratory volume at the first second (FEV1), peak expiratory flow (PEF) were tested: the predicted percentage value (% pred) was considered.Results: Cortical motor evoked potential (Cx-MEP) latency and central motor conduction time (CMCT) were prolonged, respectively, in 31 and 23% of patients from Dia, in 76 and 79% from AbdV8. PN-compound motor action potential (CMAP) was normal. EDSS correlated to Cx-MEP from AbdV8 (P , 0:01), and PN-CMAP amplitude (P , 0:05), FEV1 % pred (P , 0:01), PEF % pred (P , 0:01). PN-CMAP amplitude correlated to FVC % pred P ¼ 0:05, FEV1 % pred P , 0:01, PEF % pred P , 0:01. Fatigue was related to AbdV8 Cx-MEP and CMCT (P , 0:05 and P , 0:01).Conclusions: Cortico-diaphragmatic pathway is impaired only in a minority of MS patients. Lack of correlation between TMS findings from Dia and respiratory tests argues against its routinary use to detect subclinical respiratory alterations. Fatigue seems to be related to the motor impairment rather than to respiratory distress. q

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Percutaneous magnetic coil stimulation of the phrenic nerve roots and trunk

Cited by 21 publications

References 10 publications

Validation of improved recording site to measure phrenic conduction from surface electrodes in humans

Validation of improved recording site to measure phrenic conduction from surface electrodes in humans

Neurophysiological tests of respiratory function by compound muscle action potentials from the diaphragm

Are the neurophysiological techniques useful for the diagnosis of diaphragmatic impairment in multiple sclerosis (MS)?

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