Diaphragm pacing with a spinal cord stimulator: current state and future directions

Phrenic nerve stimulation for diaphragm pacing in a quadriplegic patient

Chronic hypoventilation due to injury to the brain stem respiratory center or high cervical cord (above the C3 level) can result in dependence to prolonged mechanical ventilation with tracheostomy, frequent nosocomial pneumonia, and prolonged hospitalization. Diaphragm pacing through electrical stimulation of the phrenic nerve is an established treatment for central hypoventilation syndrome. We performed chronic phrenic nerve stimulation for diaphragm pacing with the spinal cord stimulator for pain control in a quadriplegic patient with central apnea due to complete spinal cord injury at the level of C2 from cervical epidural hematoma. After diaphragmatic pacing, the patient who was completely dependent on the mechanical ventilator could ambulate up to three hours every day without aid of mechanical ventilation during the 12 months of follow-up. Diaphragm pacing through unilateral phrenic nerve stimulation with spinal cord stimulator was feasible in an apneic patient with complete quadriplegia who was completely dependent on mechanical ventilation. Diaphragm pacing with the spinal cord stimulator is feasible and effective for the treatment of the central hypoventilation syndrome.

Validation and perspectives of neuromodulation in Japan

Neuromodulation in functional neurosurgery is closely related to the development and availability of devices such as implantable electric stimulators and pumps. All such devices used in Japan are developed and made in foreign countries, and no made-in-Japan device exists. Introduction and approval by the government took many years for most devices, during which time many patients had to continue to live in our medically conservative country. The history of neuromodulation is summarized in Japan and the problems surrounding neuromodulation pointed out. Everyone has to aware of such circumstances and make every effort to improve the internationally unusual situation of neuromodulation in Japan. Otherwise, Japan will become a medically isolated country in the near future.