Diaphragm paralysis is when a traumatic injury or disease process interrupts the brain’s communication with the diaphragm. This interruption leads to decreased or stopped impulses from the respiratory stimuli in the brain. Breathing pacemakers are a helpful and effective treatment option for patients with diaphragm paralysis, as long as the phrenic nerve(s) and diaphragm(s) are intact.
Phrenic Nerve Palsy
Phrenic nerve palsy, or phrenic nerve paralysis, is caused by a number of different conditions or traumatic events. The phrenic nerve originates in the neck, passing downward between the lungs and heart to connect to the diaphragm. The nerve branches to the left and right, connecting to different parts of the diaphragm. The phrenic nerve is the only source of motor supply for the diaphragm, meaning that when it stops working, the diaphragm cannot function normally. When a patient has phrenic nerve damage, it is usually caused by one of the following:
Patients with quadriplegia do not have sensation or control of moment in all four extremities. This is usually caused by spinal cord injury in the cervical (neck) area. In addition to spinal cord injuries, the condition can be caused by a brain stem lesion or spinal meningitis. Vertebrae are numbered according to their place in the spine. Quadriplegics are concerned with cervical vertebrae that range from C1 to C5. Breathing pacemakers can be helpful for patients who have injuries between C1 and C3 and need consistent diaphragmatic stimulation.
Central Sleep Apnea (CSA)
Patients with CSA have pauses in their breathing during sleep. The condition is acquired, usually later in life, and can have a negative impact on a patient’s sleep, as well as wakeful hours. The condition usually results from a brain stem stroke, tumor, or other spinal cord trauma, which disrupts the brain’s ability to regulate respiration. A breathing pacemaker makes respiration more consistent and prevents the disruptions in breathing.
Congenital Central Hypoventilation Syndrome (CCHS)
When patients are born with Central Sleep Apnea, it is known as CCHS. It is caused by a genetic mutation. Children with this condition hypoventilate, or take very shallow breaths. This is especially prevalent during sleep, which results in a high concentration of carbon dioxide in the blood. The patient’s brain does not stimulate the diaphragm to expand to compensate for this, or to wake up, which is why ventilation is needed. Breathing pacemakers can be life changing for patients with this condition, some of whom need breathing support 24 hours a day.
Amyotrophic Lateral Sclerosis, or ALS, is a neurodegenerative disease that impacts the motor neurons that are responsible for voluntary movement. When these neurons stop working effectively, patients with ALS no longer have control of their muscle movements. When the nerve breakdown starts impacting the phrenic nerve, patients start to have difficulty breathing. If the ALS is still in an early stage and the patient meets a certain set of eligibility requirements, a breathing pacemaker can be suggested for regulating breathing.