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Long-term recovery of diaphragm
strength in neuralgic amyotrophy. P.D. Hughes, M.I. Polkey,
J. Moxham, M. Green. ©ERS Journals Ltd 1999.
ABSTRACT: Diaphragm paralysis is a recognized
complication of neuralgic amyotrophy that causes severe
dyspnoea. Although recovery of strength in the arm muscles,
when affected, is common, there are little data on recovery
of diaphragm function. This study, therefore, reassessed
diaphragm strength in cases of bilateral diaphragm paralysis
due to neuralgic amyotrophy that had previously been
diagnosed at the authors institutions.
Fourteen patients were recalled between 2 and 11 yrs after
the original diagnosis. Respiratory muscle and diaphragm
strength were measured by volitional manoeuvres as maximal
inspiratory pressure and sniff transdiaphragmatic pressure.
Cervical magnetic phrenic nerve stimulation was used to give
a nonvolitional measure of diaphragm strength: twitch
transdiaphragmatic pressure.
Only two patients remained severely breathless. Ten of the
14 patients had evidence of some recovery of diaphragm
strength, in seven cases to within 50% of the lower limit of
normal. The rate of recovery was variable: one patient had
some recovery after 2 yrs, and the rest took 3 yrs or
more.
In conclusion, in most patients with diaphragm paralysis due
to neuralgic amyotrophy, some recovery of the diaphragm
strength occurs, but the rate of recovery may be
slow.
Eur Respir J 1999; 13: 379-384.
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Respiratory Muscle Laboratories, *Royal
Brompton and **King's College Hospitals, London,
UK.
Correspondence: P.D. Hughes
Respiratory Muscle Laboratory
National Heart & Lung Institute
Royal Brompton Hospital
Fulham Rd
London SW3 6NP
UK
Fax: 44 1713518939
Keywords: Diaphragm
neuralgic amyotrophy
Received: July 14 1998
Accepted after revision October 12 1998
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