Reversal of phrenic nerve palsy with topiramate

Rice, Amanda L.; Ullal, Jagdeesh; Vinik, Aaron I.

doi:10.1016/j.jdiacomp.2006.04.002

Cited by 14 publications

(12 citation statements)

References 16 publications

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“…Recently, it has been shown that topiramate may reverse phrenic nerve paralysis in patients with diabetes, but there are no data about its use in patients with zoster-induced diaphragmatic paralysis. 13 …”

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confidence: 99%

Unilateral diaphragmatic paralysis and segmental motor paresis following herpes zoster

2008

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We report the case of a 73-year-old woman who complained of acute onset of pain and weakness of her left shoulder and proximal arm muscles 3 weeks after a diagnosis of herpes zoster. Electromyography revealed involvement of the C5-6 myotomes and the upper trunk of the brachial plexus. Chest X-ray and electromyographic studies documented paralysis of the left diaphragm. One year after onset, muscle strength returned to normal, but radiographic and electrophysiologic findings of diaphragm paralysis were unchanged.

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confidence: 99%

Unilateral diaphragmatic paralysis and segmental motor paresis following herpes zoster

2008

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“…Topiramate has been successfully used in patients with phrenic nerve paralysis secondary to diabetes mellitus. [21] Other treatment options for severe cases include positive pressure ventilation, negative pressure cuirass, rocking beds and positive pressure pneumobelts. In life threatening cases, tracheostomy with positive pressure ventilation is necessary.…”

Section: Discussionmentioning

confidence: 99%

Failing phrenics

Rafiq

Ijaz²,

Tariq³

et al. 2016

Medicine

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Introduction:Idiopathic phrenic nerve palsy is a rare cause of exertional dyspnea. We present a case of a patient presenting with worsening dyspnea of an unknown etiology found to be related to bilateral phrenic nerve palsy.Discussion:Forty-two-year-old man presented to our emergency department with exertional dyspnea, orthopnea, and a left lower lobe consolidation treated initially as bronchitis by his primary physician as an outpatient, then subsequently as pneumonia at another institution, with no improvement in symptomatology. After admission to our hospital, CT chest demonstrated only supradiaphragmatic atelectatic changes. Echocardiography was normal. Bronchoscopy was contemplated however the patient could not lie flat. A fluoroscopic sniff test demonstrated diaphragmatic dysfunction and pulmonary function tests revealed restrictive pulmonary disease with evidence of neuromuscular etiology. Nerve conduction studies confirmed bilateral phrenic neuropathy. He was referred to a specialized neuromuscular disease center where subsequent workup did not demonstrate any specific etiology. A sleep study confirmed sleep disordered breathing suggestive of diaphragmatic paralysis and he was discharged on bi-level positive pressure ventilation.Conclusion:This is a unique case of exertional dyspnea and orthopnea from diaphragmatic paresis caused by bilateral phrenic nerve palsy where the initial workup for pulmonary and cardiovascular etiologies was essentially unremarkable. Shortness of breath and orthopnea caused by phrenic neuropathy is a rare condition, yet has a variety of etiologies. Our case suggests a template to the diagnostic approach, management, and follow up of bilateral phrenic nerve palsy.

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“…Although rare, diabetes can affect phrenic nerves causing unilateral or bilateral diaphragmatic paralysis with subsequent respiratory compromise [11][12][13] . In one study, prolonged phrenic nerve latencies were found in 23% of diabetic patients with exertional dyspnea 14 .…”

Section: Discussionmentioning

confidence: 99%

“…The long-term prognosis of unilateral diaphragmatic paralysis is excellent except in patients with an underlying lung disease. As for the medical treatment, one case report described successful use of topiramate as treatment of diabetic phrenic nerve palsy 13 . CPAP may be used to prevent ventilatory failure in patients with bilateral paralysis, in pediatric patients and as a bridge for patients waiting for surgical correction 24,25 .…”

Section: Treatment and Prognosismentioning

confidence: 99%

Unilateral Diaphragmatic Paralysis in a Diabetic Patient: A Case of Trepopnea

et al. 2010

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Dyspnea is a common presenting complaint. Trepopnea, an under-recognized form of dyspnea, is difficult breathing in only one lateral decubitus position. One cause of trepopnea is unilateral diaphragmatic paralysis, which in itself is an uncommon diagnosis. We report a unique case of a 55-year-old diabetic man who presented with trepopnea and was found to have unilateral diaphragmatic paralysis secondary to isolated diabetic phrenic neuropathy. This case highlights the importance of recognizing trepopnea as an early clinical symptom of diaphragmatic paralysis and discusses diabetic phrenic neuropathy which can occur in the absence of peripheral neuropathy.

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Reversal of phrenic nerve palsy with topiramate

Cited by 14 publications

References 16 publications

Unilateral diaphragmatic paralysis and segmental motor paresis following herpes zoster

Unilateral diaphragmatic paralysis and segmental motor paresis following herpes zoster

Failing phrenics

Unilateral Diaphragmatic Paralysis in a Diabetic Patient: A Case of Trepopnea

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