{"id":340049,"date":"2017-04-05T02:00:00","date_gmt":"2017-04-05T00:00:00","guid":{"rendered":"https:\/\/medizinonline.com\/la-stimulation-precoce-du-diaphragme-dans-la-sla-est-nocive\/"},"modified":"2017-04-05T02:00:00","modified_gmt":"2017-04-05T00:00:00","slug":"la-stimulation-precoce-du-diaphragme-dans-la-sla-est-nocive","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/fr\/la-stimulation-precoce-du-diaphragme-dans-la-sla-est-nocive\/","title":{"rendered":"La stimulation pr\u00e9coce du diaphragme dans la SLA est nocive"},"content":{"rendered":"<p><strong><em>Probl\u00e9matique :<\/em> La stimulation pr\u00e9coce du diaphragme dans la SLA peut-elle retarder la n\u00e9cessit\u00e9 d&#8217;une ventilation non invasive ?<\/strong><\/p>\n<p> <!--more--> <\/p>\n<p><strong>Contexte : <\/strong>la SLA est une maladie neurod\u00e9g\u00e9n\u00e9rative associ\u00e9e \u00e0 une faiblesse du diaphragme et \u00e0 une insuffisance respiratoire. La ventilation non invasive permet de soulager les difficult\u00e9s respiratoires et de prolonger la survie. On esp\u00e9rait que la stimulation pr\u00e9coce du diaphragme entra\u00eenerait un affaiblissement retard\u00e9 du diaphragme avant m\u00eame l&#8217;insuffisance respiratoire.<\/p>\n<p><strong>Patients et m\u00e9thodologie : <\/strong>RespiStimALS est une \u00e9tude contr\u00f4l\u00e9e, randomis\u00e9e, en triple aveugle, men\u00e9e chez des patients atteints de SLA certaine ou probable en France. Les crit\u00e8res d&#8217;inclusion comprenaient des difficult\u00e9s respiratoires mod\u00e9r\u00e9es (capacit\u00e9 vitale forc\u00e9e attendue de 60 \u00e0 80 %) et une r\u00e9ponse bilat\u00e9rale du diaphragme \u00e0 la stimulation diagnostique du nerf phr\u00e9nique. Tous les patients ont re\u00e7u un stimulateur phr\u00e9nique par laparoscopie, avec attribution al\u00e9atoire d&#8217;un stimulateur actif ou d&#8217;un stimulateur fictif inactif (1:1). Le crit\u00e8re d&#8217;\u00e9valuation principal \u00e9tait la survie jusqu&#8217;\u00e0 la n\u00e9cessit\u00e9 d&#8217;une ventilation non invasive.<\/p>\n<p><strong>R\u00e9sultats :<\/strong> 74 participants ont \u00e9t\u00e9 inclus entre 2012 et 2015. Apr\u00e8s qu&#8217;une \u00e9tude (DiPALS) men\u00e9e en Angleterre a montr\u00e9 une augmentation de la mortalit\u00e9 chez les patients atteints de SLA souffrant d&#8217;insuffisance respiratoire et recevant une stimulation diaphragmatique, une analyse non planifi\u00e9e a \u00e9t\u00e9 men\u00e9e en 2015, avec \u00e9galement une augmentation de la mortalit\u00e9 dans le groupe &#8220;actif&#8221;. De plus, la survie m\u00e9diane jusqu&#8217;\u00e0 la n\u00e9cessit\u00e9 d&#8217;une ventilation non invasive \u00e9tait de 6,0 mois dans le groupe &#8220;actif&#8221;,&nbsp; de 8,8 mois dans le groupe t\u00e9moin (p=0,02).<\/p>\n<p><strong>Conclusions des auteurs : <\/strong>La stimulation pr\u00e9coce du diaphragme chez les patients atteints de SLA n&#8217;entra\u00eene pas de retard dans la n\u00e9cessit\u00e9 d&#8217;une ventilation non invasive, n&#8217;a pas de b\u00e9n\u00e9fice sur la qualit\u00e9 de vie et diminue m\u00eame la survie. La raison de cet effet n\u00e9faste n&#8217;a pas encore \u00e9t\u00e9 \u00e9lucid\u00e9e.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><em>InFo NEUROLOGIE &amp; PSYCHIATRIE 2017 ; 15(2) : 27<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Probl\u00e9matique : La stimulation pr\u00e9coce du diaphragme dans la SLA peut-elle retarder la n\u00e9cessit\u00e9 d&#8217;une ventilation non invasive ?<\/p>\n","protected":false},"author":7,"featured_media":65157,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"pmpro_default_level":"","cat_1_feature_home_top":false,"cat_2_editor_pick":false,"csco_eyebrow_text":"Traitement invasif et symptomatique de la scl\u00e9rose lat\u00e9rale amyotrophique","footnotes":""},"category":[11527,11383,11549],"tags":[24476,39081],"powerkit_post_featured":[],"class_list":["post-340049","post","type-post","status-publish","format-standard","has-post-thumbnail","category-etudes","category-neurologie-fr","category-rx-fr","tag-als-fr","tag-stimulation-du-diaphragme","pmpro-has-access"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-06-30 00:48:54","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"wpml_current_locale":"fr_FR","wpml_translations":{"it_IT":{"locale":"it_IT","id":340056,"slug":"la-stimolazione-diaframmatica-precoce-nella-sla-danneggia","post_title":"La stimolazione diaframmatica precoce nella SLA danneggia","href":"https:\/\/medizinonline.com\/it\/la-stimolazione-diaframmatica-precoce-nella-sla-danneggia\/"},"pt_PT":{"locale":"pt_PT","id":340064,"slug":"a-estimulacao-diafragmatica-precoce-na-als-prejudica","post_title":"A estimula\u00e7\u00e3o diafragm\u00e1tica precoce na ALS prejudica","href":"https:\/\/medizinonline.com\/pt-pt\/a-estimulacao-diafragmatica-precoce-na-als-prejudica\/"},"es_ES":{"locale":"es_ES","id":340069,"slug":"la-estimulacion-diafragmatica-precoz-en-la-ela-perjudica","post_title":"La estimulaci\u00f3n diafragm\u00e1tica precoz en la ELA perjudica","href":"https:\/\/medizinonline.com\/es\/la-estimulacion-diafragmatica-precoz-en-la-ela-perjudica\/"}},"_links":{"self":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/posts\/340049","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/comments?post=340049"}],"version-history":[{"count":0,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/posts\/340049\/revisions"}],"wp:attachment":[{"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/media?parent=340049"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/category?post=340049"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/tags?post=340049"},{"taxonomy":"powerkit_post_featured","embeddable":true,"href":"https:\/\/medizinonline.com\/fr\/wp-json\/wp\/v2\/powerkit_post_featured?post=340049"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}