| Autor: |
Shakeeb H. Moosavi, C G Golding, E Debrah, Alexander L. Green |
| Rok vydání: |
2018 |
| Předmět: |
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| Zdroj: |
An update in lung physiology. |
| DOI: |
10.1136/thorax-2018-212555.392 |
| Popis: |
Introduction and objectives Deep brain stimulation (DBS) of motor thalamic nuclei is a therapy used to alleviate essential tremor or freezing of gait. Electrodes are surgically inserted to provide high frequency electrical stimulation to a specific nucleus which is thought to create a reversible virtual lesion. We aimed to determine what effect this might have on experimentally induced or pre-existing breathlessness. On the basis of anecdotal comments by one patient we hypothesized that motor thalamic DBS would increase breathlessness sensitivity. Methods Eleven patients with bilateral electrodes in the Ventral Intermediate Nucleus (VIM) for relief of essential tremor were studied (mean age ±sd =65±10.7, Male=9). Air Hunger (AH) a particularly unpleasant facet of breathlessness was induced experimentally by raising inspired CO2 while ventilation was restricted to baseline levels. Two steady state 5 min AH tests were performed in random order; once with DBS turned ON and once with it turned OFF. Test level of hypercapnia was the same for ON and OFF states (mean ±sd end-tidal PCO242±3 mmHg). Patients rated AH on a 100 mm visual analogue scale (VAS) every 15 s. AH ratings in the last minute of each test were averaged and mean levels compared for ON and OFF states. Results Ten of eleven patients rated less AH with DBS ON (median reduction −12 mmVAS; range −9 to −52 mmVAS). Overall mean ±sd steady state AH was significantly different (p=0.018; paired t-test) with 49±28 mmVAS for the ON state and 65±26 mmVAS for the OFF state. This difference exceeded minimal clinically important difference of 10 mmVAS. Conclusions Contrary to expectations, DBS of motor thalamic nuclei (VIM) substantially reduced experimentally induced hypercapnic AH. We suggest that ‘virtual lesion’ created by the DBS blocks the ascending dyspnoea signal. The extent of the relief suggests that DBS may prove to be a viable therapy for intractable dyspnoea in the worst affected patients whose breathlessness is refractory to current treatment options. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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