Early use of an implantable diaphragm pacing stimulator for a child with severe acute flaccid myelitis-a case report

Spinal Cord Series and Cases
Travis L EdmistonCristina L Sadowsky

Abstract

Acute Flaccid Myelitis (AFM) is a recently recognized, polio-like illness of children that can be functionally devastating. Severe cases can lead to ventilatory failure. Incomplete phrenic nerve injuries in other populations has been shown to respond to diaphragmatic stimulation. We therefore proposed an early assessment for incomplete denervation by laparoscopic direct stimulation of the diaphragm and placement of a diaphragmatic pacing system to enhance diaphragm function. A 3 year-old girl presented with AFM with clinically and electrodiagnostically severe involvement of all four limbs and muscles of respiration. Direct stimulation of the diaphragm demonstrated contraction and a diaphragmatic stimulator was placed at 3 weeks post presentation. The patient was immediately able to tolerate short bouts of reduced ventilation settings. Electromyography via the pacing wires demonstrated intact motor units consistent with partial denervation/reinnervation in the left hemidiaphragm, and no motor units in the right hemidiaphragm. At three months, she tolerated 6 h of pacing on pressure support setting. At 5 months she demonstrated larger tidal volumes with active pacing than without. In our experience, AFM patients who require chron...Continue Reading

References

Aug 1, 1988·Journal of Pediatric Surgery·J C LangerJ F Edmonds
Sep 19, 2007·The Journal of Spinal Cord Medicine·Raymond P OndersAnthony R Ignagni
Jan 9, 2008·The Journal of Thoracic and Cardiovascular Surgery·Craig J BakerWinfield J Wells
Jul 10, 2018·The Journal of Trauma and Acute Care Surgery·Andrew J KerwinMarie L Crandall
Mar 19, 2019·The Journal of Spinal Cord Medicine·Jacob LatreilleHarsh Grewal

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Citations

Dec 29, 2020·Lancet·Olwen C MurphyUNKNOWN AFM working group
Jun 28, 2021·Physical Medicine and Rehabilitation Clinics of North America·William IdeMelissa K Trovato

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Methods Mentioned

BETA
AFM

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