Phrenic Neuropathy Etiologies and Recovery Trajectories in Outpatient Rehabilitation and Neuromuscular Medicine Clinics: A Retrospective Analysis

Nicholas Demetriou, Alexandra S. Jensen, Ellen Farr, Shreya Khanna, John M. Coleman, Senda Ajroud-Driss, Adenike A. Adewuyi, Lisa F. Wolfe, Colin K. Franz
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Abstract

Introduction/Aims: Phrenic Neuropathy (PhN) impairs diaphragm muscle function, causing a spectrum of breathing disability. PhN etiologies and their natural history are ill defined. This knowledge gap hinders informed prognosis and management decisions. This study aims to help fill this knowledge gap on PhN etiologies, outcomes, and recovery patterns, especially in the context of non-surgical clinical practice. Methods: This is a retrospective study from two interdisciplinary clinics, physiatry and neurology based. Patients were included if PhN was identified, and other causes of hemi-diaphragm muscle dysfunction excluded. Patients were followed serially per the discretion of the neuromuscular trained neurologist or physiatrist. Recovery was assessed using pulmonary function tests (PFTs), diaphragm muscle US thickening ratio, and patient-reported outcomes in patients presenting within two years of PhN onset. Results: We identified 151 patients with PhN. The most common etiologies included idiopathic (27%), associated with cardiothoracic procedure (24%), and intensive care unit (17%). Of these patients, 117 (77%) were evaluated within two years of PhN onset. Of patients included in outcome analyses, 69% saw improvement on serial US, 50% on serial PFTs and 79% reported symptomatic improvement at an average of 13, 16, and 17 months respectively. Conclusion: This study maps PhN etiologies and recovery. A clear majority of PhN patients show improvement in diaphragm muscle function, but on average improvements took 13-17 months depending on the assessment type. These insights are vital for developing tailored treatments and can guide physicians in prognosis and decision-making, especially if more invasive interventions are being considered.
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康复和神经肌肉医学门诊中的膈神经病病因和康复轨迹:回顾性分析
导言/目的:膈神经病变(PhN)会损害膈肌功能,导致一系列呼吸障碍。膈神经病的病因及其自然史尚不明确。这一知识空白阻碍了知情预后和管理决策。本研究旨在帮助填补有关 PhN 病因、结果和恢复模式的知识空白,尤其是在非手术临床实践中。方法:这是一项回顾性研究,来自两个跨学科诊所,分别是物理治疗诊所和神经病学诊所。如果确定患者患有 PhN,则将其纳入研究范围,并排除导致半膈肌功能障碍的其他原因。患者由受过神经肌肉训练的神经科医生或物理治疗师进行连续随访。通过肺功能测试(PFT)、膈肌US增厚比值和患者报告结果来评估PhN发病两年内患者的恢复情况。结果:我们发现了 151 名 PhN 患者。最常见的病因包括特发性(27%)、心胸手术相关(24%)和重症监护室(17%)。在这些患者中,有 117 人(77%)在 PhN 发病两年内接受了评估。在纳入疗效分析的患者中,69%的患者在连续的 US 检查中有所改善,50%的患者在连续的 PFT 检查中有所改善,79%的患者在平均 13、16 和 17 个月后报告症状有所改善。结论这项研究描绘了 PhN 的病因和恢复情况。大多数 PhN 患者的膈肌功能明显改善,但根据评估类型的不同,平均需要 13-17 个月才能有所改善。这些见解对于开发有针对性的治疗方法至关重要,并能指导医生进行预后判断和决策,尤其是在考虑采取更具侵入性的干预措施时。
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