Phrenic neuropathy and diaphragm dysfunction in neuralgic amyotrophy

Nens Van Alfen, Jonne Doorduin, Marieke H.J. Van Rosmalen, Jeroen J.J. Van Eijk, Yvonne Heijdra, Andrea Boon, Michael A. Gaytant, Ries J.M. Van Den Biggelaar, Roy T.M. Sprooten, Peter J. Wijkstra, Jan T. Groothuis

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4 Scopus citations

Abstract

Objective To describe the clinical phenotype and recovery of diaphragm dysfunction caused by neuralgic amyotrophy in a large cohort of patients, to improve accurate awareness of this entity, and to encourage adoption of a standardized approach for diagnosis and treatment. Methods This observational cohort study recruited adult patients with neuralgic amyotrophy and symptoms of idiopathic phrenic neuropathy from the database of the Dutch expert center for neuralgic amyotrophy and the Dutch centers for home mechanical ventilation. Demographic and clinical information on diagnosis, symptoms, and recovery was obtained from chart review. We attempted to contact all patients for a follow-up interview. Results Phrenic neuropathy occurs in 7.6% of patients with neuralgic amyotrophy. Unilateral diaphragmatic dysfunction and bilateral diaphragmatic dysfunction are frequently symptomatic, causing exertional dyspnea, orthopnea, disturbed sleep, and excessive fatigue. Diagnostic practices varied widely and were often not optimally targeted. The majority of patients experienced at least moderate recovery within 2 years. Conclusion We recommend screening every patient with neuralgic amyotrophy for diaphragm dysfunction by asking about orthopnea and by performing upright and supine vital capacity screening and diaphragm ultrasound in cases of suspected phrenic neuropathy to optimize diagnosis and care.

Original languageEnglish (US)
Pages (from-to)e843-e849
JournalNeurology
Volume91
Issue number9
DOIs
StatePublished - Aug 28 2018

ASJC Scopus subject areas

  • Clinical Neurology

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    Van Alfen, N., Doorduin, J., Van Rosmalen, M. H. J., Van Eijk, J. J. J., Heijdra, Y., Boon, A., Gaytant, M. A., Van Den Biggelaar, R. J. M., Sprooten, R. T. M., Wijkstra, P. J., & Groothuis, J. T. (2018). Phrenic neuropathy and diaphragm dysfunction in neuralgic amyotrophy. Neurology, 91(9), e843-e849. https://doi.org/10.1212/WNL.0000000000006076