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OBJECTIVE:To assess the value of the diaphragmatic response to transcranial magnetic stimulation(TMS)in predicting the recovery of ventilatory activity after CNS lesions responsible for central respiratory paralysis.METHODS:The authors studied 11 long-term ventilator-dependent patients with central respiratory paralysis(description group:spinal trauma 10,medullary ischemia1)and 16 patients with central respiratory paralysis for less than 10 weeks(prognostic group,evaluated after a 1-year follow-up:spinal trauma 8,medullary ischemia 4,radiation myelitis 1,subdural hematoma 1,complication of neurosurgery 2).RESULTS:In the description group,all the patients had a bilaterally abolished diaphragm response.In the prognostic group,six patients were fully ventilator dependent because of a complete absence of ventilatory activity at follow-up time.They lacked any diaphragm response.The 10 other patients had recovered ventilatory activity and full(n = 9)or partial(n = 1)ventilatory autonomy.In nine cases,diaphragm response was present at least on one side,with a normal latency(right:15.6 ±1.5 milliseconds;left:16.2 ±2.2 milliseconds).The test had 100%specificity(95%CI 52 to 100)and 90%sensitivity(95%CI 54 to 99)to predict the recovery of ventilatory activity.CONCLUSION:Electrophysiologic studies of the diaphragm in response to transcranial magnetic stimulation may help predict the recovery of central respiratory paralysis within 1 year.
OBJECTIVE: To assess the value of the diaphragmatic response to transcranial magnetic stimulation (TMS) in predicting the recovery of ventilatory activity after CNS lesions responsible for central respiratory paralysis. METHODS: The authors studied 11 long-term ventilator-dependent patients with central respiratory paralysis (description group: spinal trauma 10, medullary ischemia1) and 16 patients with central respiratory paralysis for less than 10 weeks (prognostic group, evaluated after a 1-year follow-up: spinal trauma 8, medullary ischemia 4, radiation myelitis 1, subdural hematoma 1, complication of neurosurgery 2) .RESULTS: In the description group, all the patients had a bilaterally abolished diaphragm response. In the prognostic group, six patients were fully ventilator dependent because of a complete absence of ventilatory activity at follow-up time They lacked any diaphragm response. 10 other patients had recovered ventilatory activity and full (n = 9) or partial (n = 1) ventilatory autonomy. In n The test responses were 100% specificity (95% CI 52 to 100) and 90% specificity sensitivity (95% CI 54 to 99) to predict the recovery of ventilatory activity. CONCLUSION: Electrophysiologic studies of the diaphragm in response to transcranial magnetic stimulation may help predict the recovery of central respiratory paralysis within 1 year.