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• W2032908064 abstract "<b>Background:</b> Expiratory muscle weakness due to cerebral infarction may contribute to reduced airway clearance in stroke patients. <b>Methods:</b> Transcranial magnetic stimulation (TMS) at the vertex and over each hemisphere and magnetic stimulation over the T_10-11 spinal roots (Tw T₁₀) and the phrenic nerves bilaterally (BAMPS) were performed in 15 acute ischemic stroke patients (age 68.9 ± 9.8 years) and 16 matched controls. Surface electrodes recorded motor evoked potentials (MEPs) in the rectus abdominis (RA) and external oblique (EO) muscles bilaterally. Respiratory muscle function was assessed by measuring maximum static expiratory pressure (PE_max) and changes in intragastric (P_gas) and transdiaphragmatic (P_di) pressure after voluntary cough, TMS, TwT₁₀, and BAMPS. Regression models were used to assess determinants of peak voluntary cough flow rates (PCFR). <b>Results:</b> PCFR, cough P_gas, and vertex TMS P_gas were decreased in stroke patients compared with controls (203.6 ± 151.1 vs 350.8 ± 111.7 L/min, <i>p</i> = 0.004; 72.7 ± 64.5 vs 163.4 ± 55.8 cm H₂O, <i>p</i> = 0.0003 and 8.7 ± 3.3 vs 16.7 ± 11.5 cm H₂O, <i>p</i> = 0.023, respectively). There were no differences in TwT₁₀ P_gas (25.2 ± 7.8 vs 29.4 ± 12.4 cm H₂O, <i>p</i> = 0.153) or BAMPS P_di (21.6 ± 7.2 vs 19.2 ± 3.4 cm H₂O, <i>p</i> = 0.163). TMS P_gas was lower (4.1 ± 2.8 vs 6.1 ± 1.9 cm H₂O, <i>p</i> = 0.023) following TMS of the injured compared with the uninjured hemisphere in stroke patients. Age and gender adjusted PCFR correlated with P_gas (r = 0.51, <i>p</i> = 0.009) and PE_max (r = 0.46, <i>p</i> = 0.024). Stroke was an independent determinant of PCFR after adjusting for P_gas and PE_max (<i>p</i> = 0.031). <b>Conclusion:</b> Ischemic cortical injury is associated with expiratory muscle weakness and may contribute to cough impairment in stroke patients. <b>BAMPS</b> = bilateral anterolateral magnetic phrenic stimulation; <b>EO</b> = external oblique; <b>MEP</b> = motor evoked potential; <b>NIHSS</b> = NIH Stroke Scale; <b>P_di</b> = transdiaphragmatic pressure; <b>P_es</b> = esophageal pressure; <b>P_gas</b> = intragastric pressure; <b>PCFR</b> = peak voluntary cough flow rates; <b>PE_max</b> = maximum static expiratory pressure; <b>POE</b> = point of optimal excitability; <b>RA</b> = rectus abdominis; <b>TMS</b> = transcranial magnetic stimulation." @default.
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• W2032908064 date "2008-12-08" @default.
• W2032908064 modified "2023-10-14" @default.
• W2032908064 title "Transcranial magnetic stimulation study of expiratory muscle weakness in acute ischemic stroke" @default.
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• W2032908064 doi "https://doi.org/10.1212/01.wnl.0000336927.30977.56" @default.
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