Diaphragm Paralysis

Overview

What is Diaphragm Paralysis?

Diaphragm Paralysis is the loss of control of one or both hemidiaphragms caused by a traumatic injury or disease process which decreases or terminates the impulse of respiratory stimuli originating in the brain. Causes of diaphragm paralysis include, but are not limited to:

  • • Central neurological disorders such as a brain or brainstem stroke,

  • • Spinal cord disorders such as syringomyelia or poliomyelitis,

  • • Direct trauma to the phrenic nerve from surgery, radiation, or tumor,

  • • Autoimmune diseases such as multiple sclerosis,

  • • Demyelinating disease processes such as Guillan-Barré syndrome and ALS (Lou Gehrig’s Disease),

  • • Phrenic nerve neuropathy, viral or bacterial infections, and idiopathic (ie, unknown) etiologies.

xRay

Chest X-Ray Showing elevated right hemidiaphragm

PHRENIC NERVE ANATOMY
(Click for larger image)

PACEMAKERS FOR DIAPHRAGM PARALYSIS

Breathing pacemakers are indicated for patients with diaphragm paralysis who would otherwise be completely or partially dependent on mechanical ventilation so long as the phrenic nerve(s) and diaphragm(s) are intact. Patients with diseases in which the phrenic nerves have completely demyelinated, such as advanced ALS, or the diaphragm muscle is irreversibly atrophied,such as muscular dystrophy, are not candidates for diaphragm pacing.

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Patient Profiles

Diaphragm Paralysis Patient

Michael

MICHAEL

United States

In 2005, Michael began to exhibit difficulty breathing. After an extensive workup and an unsuccessful trial with C-Pap, he was provided with a chest cuirass. About one week later, he suffered a stroke to the brain stem which paralyzed his diaphragms. Michael was left no other option than a tracheotomy and a mechanical ventilator.

Michael was evaluated for a breathing pacemaker at the Methodist Hospital in Indianapolis. After some preoperative testing to ensure his phrenic nerves were intact, he was implanted and began pacing in June 2006.

He has undergone extensive physical therapy, and “can now walk, talk, eat, and drink all on my own with very little help.” He still uses his ventilator at night and occasionally when under the weather, “but it sure beats being hooked to that thing 24/7.”

He states “Thanks to the breathing pacemaker system, I have been given an extension on my life. I am embracing that extension with happiness and joy and alot of love!”

Anders

Anders

Sweden

In 1974, Anders was a young electrical engineer working in Africa helping to install a power grid. Soon after his return to his home in Sweden, he became afflicted by a mysterious neuromuscular ailment which rendered him completely paralyzed and ventilator-dependent.

His physicians were unable to establish a definitive diagnosis, although a viral infection was suspected. Although the paralysis eventually passed, Anders was unable to wean from mechanical ventilation.

In 1987, Anders was implanted with a breathing pacemaker. Although he was never able to obtain adequate ventilation from his left side, he was weaned from the ventilator using unilateral pacing. Anders has continued to pace for over twenty years.