Thickening fraction as a measure of ultrasonographic diaphragm dysfunction in amyotrophic lateral sclerosis
Objective: Respiratory failure is the most common cause of death in ALS patients secondary to diaphragmatic dysfunction. Herein, we report three ALS patients, and we sought to determine the diaphragm dysfunction by the measurement of ultrasonographic diaphragmatic thickness fraction (DTf). Methods:...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-01-01
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| Series: | Clinical Neurophysiology Practice |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2467981X20300020 |
| _version_ | 1818838913888813056 |
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| author | Lakshmi P. Digala Raghav Govindarajan |
| author_facet | Lakshmi P. Digala Raghav Govindarajan |
| author_sort | Lakshmi P. Digala |
| collection | DOAJ |
| description | Objective: Respiratory failure is the most common cause of death in ALS patients secondary to diaphragmatic dysfunction. Herein, we report three ALS patients, and we sought to determine the diaphragm dysfunction by the measurement of ultrasonographic diaphragmatic thickness fraction (DTf). Methods: High-resolution linear US probe of 10 MHz (Philips Healthcare EPIQ 7 Ultrasound System Inc.) was used to measure the diaphragm thickness (DT) using B mode at the Zone of Apposition. Phrenic nerve compound muscle action potential measured stimulating the nerve, posterior to the sternocleidomastoid muscle, approximately 3 cm above the clavicle and recording the diaphragm with electrode G1 placed fingerbreadth above the xiphoid process and electrode G2 placed over the anterior costal margin 16 cm from G1. Results: The diaphragmatic thickening fraction (DTf) measured in these three patients recorded was less than 15%. Diaphragm dysfunction was also suggested by low amplitude of the diaphragmatic compound muscle action potential in each patient. Conclusion: Diaphragm dysfunction, secondary to lower motor neuron loss, was mirrored by the low amplitude of the diaphragm CMAP in the 3 patient case reports. These cases suggest that a thickening fraction ≤15% is associated with severe diaphragm weakness and risk of respiratory failure. Significance: Before appropriate data obtained in a population of ALS patients are available, we propose DTf (%) <20% as a possible indicator of diaphragm dysfunction in ALS patients. |
| first_indexed | 2024-12-19T03:45:57Z |
| format | Article |
| id | doaj.art-5cbe18e569df4a14b2fe3c04a13d5ebf |
| institution | Directory Open Access Journal |
| issn | 2467-981X |
| language | English |
| last_indexed | 2024-12-19T03:45:57Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Neurophysiology Practice |
| spelling | doaj.art-5cbe18e569df4a14b2fe3c04a13d5ebf2022-12-21T20:37:07ZengElsevierClinical Neurophysiology Practice2467-981X2020-01-0153537Thickening fraction as a measure of ultrasonographic diaphragm dysfunction in amyotrophic lateral sclerosisLakshmi P. Digala0Raghav Govindarajan1Corresponding author at: Department of Neurology, One hospital Dr University of Missouri Health Care, Columbia, MO 65201, USA.; University of Missouri Health Care, Columbia, MO, USAUniversity of Missouri Health Care, Columbia, MO, USAObjective: Respiratory failure is the most common cause of death in ALS patients secondary to diaphragmatic dysfunction. Herein, we report three ALS patients, and we sought to determine the diaphragm dysfunction by the measurement of ultrasonographic diaphragmatic thickness fraction (DTf). Methods: High-resolution linear US probe of 10 MHz (Philips Healthcare EPIQ 7 Ultrasound System Inc.) was used to measure the diaphragm thickness (DT) using B mode at the Zone of Apposition. Phrenic nerve compound muscle action potential measured stimulating the nerve, posterior to the sternocleidomastoid muscle, approximately 3 cm above the clavicle and recording the diaphragm with electrode G1 placed fingerbreadth above the xiphoid process and electrode G2 placed over the anterior costal margin 16 cm from G1. Results: The diaphragmatic thickening fraction (DTf) measured in these three patients recorded was less than 15%. Diaphragm dysfunction was also suggested by low amplitude of the diaphragmatic compound muscle action potential in each patient. Conclusion: Diaphragm dysfunction, secondary to lower motor neuron loss, was mirrored by the low amplitude of the diaphragm CMAP in the 3 patient case reports. These cases suggest that a thickening fraction ≤15% is associated with severe diaphragm weakness and risk of respiratory failure. Significance: Before appropriate data obtained in a population of ALS patients are available, we propose DTf (%) <20% as a possible indicator of diaphragm dysfunction in ALS patients.http://www.sciencedirect.com/science/article/pii/S2467981X20300020Motor-neuron diseaseNeuromuscular diseaseThickening fraction of diaphragmDiaphragm dysfunctionDiaphragm thicknessUltrasonography |
| spellingShingle | Lakshmi P. Digala Raghav Govindarajan Thickening fraction as a measure of ultrasonographic diaphragm dysfunction in amyotrophic lateral sclerosis Clinical Neurophysiology Practice Motor-neuron disease Neuromuscular disease Thickening fraction of diaphragm Diaphragm dysfunction Diaphragm thickness Ultrasonography |
| title | Thickening fraction as a measure of ultrasonographic diaphragm dysfunction in amyotrophic lateral sclerosis |
| title_full | Thickening fraction as a measure of ultrasonographic diaphragm dysfunction in amyotrophic lateral sclerosis |
| title_fullStr | Thickening fraction as a measure of ultrasonographic diaphragm dysfunction in amyotrophic lateral sclerosis |
| title_full_unstemmed | Thickening fraction as a measure of ultrasonographic diaphragm dysfunction in amyotrophic lateral sclerosis |
| title_short | Thickening fraction as a measure of ultrasonographic diaphragm dysfunction in amyotrophic lateral sclerosis |
| title_sort | thickening fraction as a measure of ultrasonographic diaphragm dysfunction in amyotrophic lateral sclerosis |
| topic | Motor-neuron disease Neuromuscular disease Thickening fraction of diaphragm Diaphragm dysfunction Diaphragm thickness Ultrasonography |
| url | http://www.sciencedirect.com/science/article/pii/S2467981X20300020 |
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