Diaphragm Pacing with a Spinal Cord Stimulator

Abstract

Chronic hypoventilation because of dysfunction of the brainstem or the high cervical spinal cord poses a serious medicosocial problem. Patients with such hypoventilation are usually managed with the use of artificial ventilators. However, chronic use of positive pressure ventilation is not physiological, easily causes infections, and restricts the patient’s activities. It has been known for a long time that diaphragm pacing with an implanted electric device to stimulate the phrenic nerve is a reasonable solution for such patients [1–5]. Almost all the patients with diaphragm pacing so far have been using a device specifically made for this purpose by Avery Laboratories Inc. (Commack, NY). Because this device is not readily available in our country, we applied a stimulator for spinal cord stimulation or deep brain stimulation for pain control to electrical stimulation of the phrenic nerves to pace the diaphragm. The aim of this study is to prove the feasibility of diaphragm pacing with electrical stimulators originally made for pain relief. Patients and Methods From March 2000 to September 2004, we performed diaphragm pacing using a stimulator for spinal cord stimulation in 6 patients with chronic hypoventilation because of brainstem dysfunction who were on a ventilator. After detailed discussion with the patient’s family and the patient, if possible, we obtained written informed consent. There were one man and three women ranging in age from 34 to 63 years (mean age, 51.6 years). These patients were reviewed, retrospectively. Table 1 summarizes the profile of these patients with regard to age, gender, and the cause, and duration of hypoventilation.Key wordscentral hypoventilationdiaphragm pacingspinal cord stimulator