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1 Respiratory Muscle Laboratory, Royal Brompton and King's College Hospital, London, United Kingdom
2 Service de Pneumologie et de Reanimation, Hopital Pitie-Salpetriere, Paris, France
3 Service d'explorations fonctionnelles, Hopital Raymond Poincare, Garches, France
* To whom correspondence should be addressed. E-mail: m.polkey{at}rbh.nthames.nhs.uk.
We assessed recruitment curves of the surface diaphragmatic motor evoked potential following 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 manoeuvres 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 manoeuvres did not affect the amplitude recruitment curves of the relaxed diaphragm. We conclude that the recruitment curve of the diaphragm with TMS is repeatable and changes consistently with facilitation, and will therefore be a robust experimental tool for the investigation of supraspinal pathways to the diaphragm.
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