Chapman Tom P, Divanbeighi Zand Amir P, Debrah Emmanuel, Petric Beth, Farrell Sarah M, FitzGerald James J, Moosavi Shakeeb H, Green Alexander L
Department of Biological and Medical Sciences, Oxford Brookes University, Headington, UK.
Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
Eur Respir J. 2024 Dec 5;64(6). doi: 10.1183/13993003.01156-2024. Print 2024 Dec.
We previously reported that deep brain stimulation (DBS) of the motor thalamus, in a patient with post-stroke tremor, relieved breathlessness associated with COPD. This raised the question of whether motor thalamus DBS mitigates the ascending dyspnoea signal. We therefore sought to conduct a fully powered cohort study of experimentally induced air hunger, an uncomfortable urge to breathe in patients with motor thalamus DBS "ON" and "OFF".
16 patients (three females) with DBS of the ventral intermediate nucleus (VIM) as treatment for tremor underwent hypercapnic air hunger tests, with DBS ON and OFF. Patients rated air hunger on a visual analogue scale (VAS) every 15 s. Hypercapnia and ventilation were matched for ON and OFF states (end-tidal carbon dioxide tension mean±sd 43±4 and 43±4 mmHg, respectively; ventilation 13.7 and 13.4 L·min, respectively). Participants' ventilation was constrained to baseline levels by breathing from a 3-L inspiratory reservoir with fixed flow of fresh gas while targeting their resting breathing frequency to a metronome.
Overall steady-state air hunger was 52±28%VAS for ON and 67±20%VAS for OFF (p=0.002; two-tailed paired t-test). The mean reduction in air hunger during VIM DBS was -14.4%VAS. DBS of the motor thalamus relieved air hunger in 13 patients, heightened air hunger in two and caused no change in one.
DBS of the motor thalamus for tremor relief also mitigates the air hunger component of dyspnoea. We posit that DBS of the motor thalamus heightens the gating control of the thalamus modulating the ascending air hunger signal. Extent of relief suggests that thalamic DBS may prove to be a viable therapy for intractable dyspnoea.
我们之前报道过，对一名中风后震颤患者的运动丘脑进行深部脑刺激（DBS）可缓解与慢性阻塞性肺疾病（COPD）相关的呼吸困难。这就提出了一个问题，即运动丘脑DBS是否能减轻上升性呼吸困难信号。因此，我们试图对运动丘脑DBS“开启”和“关闭”状态下的实验性诱发的空气饥饿（一种不舒服的呼吸冲动）进行一项充分有力的队列研究。
16例（3名女性）接受腹中间核（VIM）DBS治疗震颤的患者，在DBS开启和关闭状态下进行高碳酸血症性空气饥饿测试。患者每15秒通过视觉模拟量表（VAS）对空气饥饿进行评分。高碳酸血症和通气在开启和关闭状态下相匹配（呼气末二氧化碳分压平均值±标准差分别为43±4和43±4 mmHg；通气量分别为13.7和13.4 L·min）。参与者通过从一个3升的吸气储气罐以固定的新鲜气体流量呼吸，同时将其静息呼吸频率对准节拍器，将通气量限制在基线水平。
总体稳态空气饥饿评分在开启状态下为52±28%VAS，关闭状态下为67±20%VAS（p = 0.002；双侧配对t检验）。VIM DBS期间空气饥饿的平均降低幅度为-14.4%VAS。运动丘脑DBS使13例患者的空气饥饿得到缓解，2例患者空气饥饿加重，1例患者无变化。
用于缓解震颤的运动丘脑DBS也可减轻呼吸困难的空气饥饿成分。我们认为运动丘脑DBS增强了丘脑对上升性空气饥饿信号的门控控制。缓解程度表明丘脑DBS可能被证明是治疗顽固性呼吸困难的一种可行疗法。
