Phrenic nerve conduction study in demyelinating neuropathies and open-heart surgery

Objectives: The aim of this study was to determine normal values of phrenic nerve conduction (PNC) in healthy individuals; to evaluate the subclinical extent of phrenic nerve involvement in Guillain-Barre syndrome (G-B) and h ereditary motor and sensory neuropathy-I (HMSN-I), and to evaluate phrenic nerve damage after cardiac surgery. Materials and methods: PNC was performed by transcutaneous stimulation in t he neck and recording the diaphragmatic potential from surface electrodes p laced at the seventh and eight intercostal spaces. PNC was performed bilate rally in 25 healthy volunteers and 25 patients before and after open-heart surgery. Right PNC was also performed in 5 cases with G-B and 5 patients wi th HMNS-I. Results: Latency and amplitude of the diaphragmatic potential were the same in controls and in patients with cardiac disease before surgery. After sur gery, 28% of patients had left phrenic nerve inexcitability, and 8% had red uced amplitude of the response. These 9 patients demonstrated elevation of the left hemidiaphragm on chest radiography. Left PNC performed 1 year afte r the operation showed improvement in latency and amplitude of the response s in all except one patient. PNC was prolonged in 4 out of 5 cases with G-B and in all patients with HMNS-I. Conclusions: PNC is an easy and reliable method in evaluating phrenic nerve damage due to hypothermia or primary stretch injury in patients after card iac surgery, PNC may be helpful in detecting diaphragmatic involvement befo re clinical ventilatory insufficiency in demyelinating neuropathies such as G-B and HMNS-I. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved .