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Case Study
Clinical Case Study
Clinical Effect
of Theophylline on Inspiratory Muscle Drive in Tetraplegia G.T. Ferguson,
MD; N.N. Khanchandani; C.D. Lattin; E. Nieshoff; H.G. Goshgarian
Background
Previous work in rats has shown that theophylline restores function
to a hemidiaphragm paralyzed by an ipsilateral C2 spinal cord hemisection.
Although theophylline has been used clinically in several pulmonary
diseases for decades, it has never been proven to augment respiratory
muscle function in cervical spinal cord injured tetraplegics. The
present objective was to demonstrate the action of theophylline
in improving respiratory muscle function after cervical spinal
cord injury in man.
Methods
An asymmetric C5-7 tetraplegic patient (left C5-6, right C6-7) injured
in 1979 was assessed before and after receiving IV aminophylline
and oral theophylline. Central drive/neural activation to inspiratory
muscles was assessed by P0.1 and EMGs (right and left 4th intercostal
and diaphragm) during quiet breathing and maximal inspiratory efforts.
Inspiratory muscle forces were assessed by vital capacity and maximal
inspired pressures.
Results
| |
IV(12.4ug/ml)
|
Oral (17.2ug/ml)
|
| Pre |
Post |
%Change |
Pre |
Post |
%Change |
| Muscle Force |
| PIMax (cm H2O) |
115 |
129 |
12 |
80 |
100 |
25 |
| FVC (liters) |
1.96 |
2.15 |
10 |
2.05 |
2.17 |
6 |
| Central Drive |
| P0.1 (quiet-cm H2O |
0.5 |
0.8 |
60 |
0.5 |
0.6 |
20 |
| P0.1 (max-cm H2O |
10.5 |
28.5 |
171 |
13.6 |
19.4 |
43 |
| EMGsm (mV.s) |
| L. Diaphragm (quiet) |
3.8 |
2.7 |
-29 |
5.4 |
3.5 |
-35 |
|
(max) |
11 |
16 |
45 |
11 |
17 |
55 |
| L. Diaphragm (quiet) |
3.2 |
2.0 |
-37 |
5.3 |
4.4 |
-15 |
|
(max) |
21 |
23 |
9 |
18 |
23 |
27 |
| L. Intercostal (quite) |
0.6 |
0.7 |
16 |
0.5 |
1.0 |
100 |
|
(max) |
38 |
80 |
110 |
11 |
30 |
172 |
| R. Intercostal (quite) |
0.3 |
0.5 |
66 |
0.4 |
0.9 |
125 |
|
(max) |
47 |
75 |
60 |
18 |
25 |
39 |
Conclusions
Both acute IV treatment and longer term oral treatment with theophylline
increased inspiratory muscle force and central drive/neural activation
to the inspiratory muscles. Intercostal (T4) EMG activity was recruited
bilaterally in spite of being below the level of cervical injury.
Diaphragmatic EMG activity impacted by theophylline is evidenced
by improved left hemidiaphragm activation during maximal breathing
efforts.
Source of funding: NIH Grant HD 31550 and Michigan Paralyzed Veterans
of America
Published in: The Journal of Spinal Cord Medicine, 21(4):362
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