RESEARCH QUESTION We previously reported that Deep Brain Stimulation (DBS) of motor thalamus (MT), in a patient with post-stroke tremor, relieved breathlessness associated with chronic obstructive pulmonary disease. This raised the question of whether MT DBS mitigates the ascending dyspnoea signal. We therefore sought to conduct a fully powered cohort study of experimentally induced air hunger (AH), an uncomfortable urge to breathe in patients with MT DBS ON and OFF. METHODS 16 patients (3 females) with DBS of the ventral intermediate nucleus (VIM) as treatment for tremor, underwent hypercapnic AH tests, with DBS "ON" and "OFF". Patients rated AH on a visual analogue scale (VAS) every 15 s. Hypercapnia and ventilation were matched for ON and OFF states (mean±sd 43±4 and 43±4 mmHg for end-tidal PCO2, 13.7 and 13.4 L·min-1 for ventilation). Participants ventilation was constrained to baseline levels by breathing from a 3-litre inspiratory reservoir with fixed flow of fresh gas while targeting their resting breathing frequency to a metronome. RESULTS Overall steady state AH was 52±28%VAS for "ON" and 67±20%VAS for "OFF" (p=0.002; two-tailed paired t-test). The mean reduction in AH during VIM DBS was -14.4%VAS. MT DBS relieved AH in thirteen patients, heightened AH in two and caused no change in one. CONCLUSION MT DBS for tremor relief also mitigates the AH component of dyspnoea. We posit that DBS of the MT 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.

中文翻译：

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运动丘脑的深部脑刺激可缓解实验诱导的空气饥饿。


研究问题 我们之前报道过，运动丘脑 （MT） 的深部脑刺激 （DBS） 在中风后震颤患者中缓解了与慢性阻塞性肺病相关的呼吸困难。这就提出了 MT DBS 是否减轻上行呼吸困难信号的问题。因此，我们试图对实验诱导的空气饥饿 （AH） 进行一项完全有力的队列研究，这是一种 MT DBS ON 和 OFF 患者不舒服的呼吸冲动。方法 16 名患者（3 名女性）以腹侧中间核 （VIM） 的 DBS 治疗震颤，接受了高碳酸血症 AH 测试，DBS 为“ON”和“OFF”。患者每 15 秒在视觉模拟量表 （VAS） 上对 AH 进行评分。高碳酸血症和通气量在 ON 和 OFF 状态下匹配 （呼气末 PCO2 的平均 ±sd 为 43±4 和 43±4 mmHg，通气的平均 43.4 和 13.4 L·min-1）。参与者通过从 3 升吸气罐呼吸（具有固定的新鲜气体流量）呼吸，同时将他们的静息呼吸频率设置为节拍器，将通气限制在基线水平。结果 总体稳态 AH 为 52±28%VAS 为 “ON”，67±20%VAS（p=0.002;双尾配对 t 检验）。VIM DBS 期间 AH 的平均降低为 -14.4%VAS。MT DBS 缓解了 13 例患者的 AH，2 例患者增加了 AH，1 例没有引起变化。结论 用于震颤缓解的 MT DBS 也减轻了呼吸困难的 AH 成分。我们假设 MT 的 DBS 增强了丘脑的门控控制，从而调节了上升的空气饥饿信号。缓解程度表明丘脑 DBS 可能被证明是顽固性呼吸困难的可行疗法。