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J Appl Physiol 95: 26-34, 2003. First published March 14, 2003; doi:10.1152/japplphysiol.00918.2002
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Effect of voluntary facilitation on the diaphragmatic response to transcranial magnetic stimulation

Tarek Sharshar,1 Ewen Ross,1 Nicholas S. Hopkinson,1 Mark Dayer,1 Annabel Nickol,1 Frédéric Lofaso,2 John Moxham,1 Thomas Similowski,3 and Michael I. Polkey1

1Respiratory Muscle Laboratory, Royal Brompton and Harefield National Health Service Trust and King's College Hospital, London SW3 6NP, United Kingdom; 3Service de Pneumologie et de Réanimation, Groupe Hospitalier Pitié-Salpétriëre, 75651 Paris Cedex 13; and 2Service d'Exploration Fonctionnelles, Hôpital Raymond Poincaré, 92380 Garches, France

Submitted 7 October 2002 ; accepted in final form 24 February 2003

We assessed recruitment curves of the surface diaphragm motor-evoked potential (MEP) after transcranial magnetic stimulation during relaxation and at three different levels of facilitation (20, 40, and 60% of maximal inspiratory esophageal pressure) in 10 healthy subjects (six young and four elderly). MEP amplitude recruitment curves varied between individuals during relaxation and at each level of facilitation. Amplitude recruitment curves during relaxation were reproducible in individual subjects. Inspiratory maneuvers caused a decrease in motor threshold and latency and an increase in MEP amplitude, positively correlated to the intensity of facilitation. These changes were similar in young and elderly subjects. The best fit for MEP amplitude recruitment curves for each condition was obtained with a Boltzmann model. The performance of repeated submaximal inspiratory maneuvers did not affect the amplitude recruitment curves of the relaxed diaphragm. We conclude that the recruitment curve of the diaphragm with transcranial magnetic stimulation is repeatable and changes consistently with facilitation and will, therefore, be a robust experimental tool for the investigation of supraspinal pathways to the diaphragm.

relaxation; diaphragm; motor cortex; motor-evoked potential


Address for reprint requests and other correspondence: M. Polkey, Respiratory Muscle Laboratory, Royal Brompton Hospital, Sydney St., London SW3 6NP, UK (E-mail: m.polkey{at}rbh.nthames.nhs.uk).




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