Phrenic nerve conduction and diaphragmatic motor evoked potentials: evaluation of respiratory dysfunction

To investigate preliminarily the value of phrenic nerve conduction (PNC) and diaphragmatic motor evoked potentials (MEPs) in the evaluation of various respiratory dysfunction (RDF).

Thirty-four patients with various RDF, (19 patients with neurogenical diseases and 15 patients with respiratory disorders) were investigated. Fifty healthy volunteers served as controls. The phrenic nerve was cutaneously stimulated by electrical pulse current at the midpoint of the posterior border of the sternomastoid muscle, and the diaphragmatic muscle compound action potentials (DCAP) were recorded between the 7th and 8th intercostal space and xiphoid process. When the magnetic transcranial stimulation (MTS) of the cortex was given, the recordings were made under the condition of maximal deep inspiration.

All patients with myopathies had normal PNC. The patients with Guillain Barre syndrome (GBS), hereditary motor and sensory neuropathy (HMSN) and myasthenic crisis had abnormal PNC. The findings in PNC studies remarkably correlated with RDF, while serial examinations were performed in the patients with GBS and myasthenia gravis (MG). In 7 patients with sleep apnea syndrome (SAS), 4 had abnormal PNC, and 2 of 3 patients with chronic obstructive pulmonary diseases (COPD), and 1 of 5 patients with chest tightness or breathlessness on the supine position showed decreased amplitude. When MEPs were recorded, 3 of 5 patients showed abnormal SAS (1 had no response, 2 lower amplitude). Three patients with COPD had normal MEP.

PNC studies could not only evaluate neuromuscular RDF and predict the outcome of diseases, but also supply additional information about diaphragmatic dysfunction for the RDF caused by respiratory disorders. The results of PNC and diaphragmatic MEP may differentiate the types of SAS.