Treatment of apneustic respiratory disturbance with a serotonin-receptor agonist☆,☆☆,★
Section snippets
METHODS
A 2-year-old girl with a previously diagnosed brain-stem tumor and hemiparesis on the right side was admitted to the department of pediatrics at the University of Göttingen.
Neurologic examination revealed a positive Babinski sign and exaggerated reflexes on the right side. Muscle tone was otherwise normal. In addition, electroencephalograms, electrocardiograms, and results of laboratory tests were normal. Magnetic resonance imaging revealed a diffuse tumor within the pontomedullary region
RESULTS
The respiratory disturbances were unaffected by administration of the sedative/anticonvulsant drugs diazepam and phenobarbital. Vigabatrin (γ-vinyl–γ-aminobutyric acid), an anticonvulsant that increases extracellular concentrations of the inhibitory neurotransmitter γ-aminobutyric acid in the brain, 16 also was ineffective. Other ineffective drugs were doxapram, a respiratory stimulant; clonidine, an α 2 -adrenoceptor agonist used to treat cyanosis 12; oxitriptan, an antidepressant 17; and
DISCUSSION
The term “apnea” is sometimes used incorrectly to describe breathing abnormalities that are, in fact, apneustic. Accordingly, apneusis may occur more frequently than is recognized. Life-threatening apneusis combined with cyanosis and episodes of reduced electroencephalographic activity have been reported in children. These have been attributed to abnormalities in central control of respiration and to hypoxemia. 12 Pharmacotherapeutic management of such breathing disorders has been generally
Acknowledgements
We thank Prof. K. Rittmeyer for the magnetic resonance imaging examinations.
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2012, Respiratory Physiology and NeurobiologyCitation Excerpt :In a wide variety of clinical disorders, antidepressant treatments have been implemented in an attempt to ameliorate respiratory dysfunction. This includes the use of the 5-HT1A receptor agonist buspirone in eliminating apneustic disturbances in human patients (Wilken et al., 1997) and the noradrenergic TCA desipramine reducing the number and severity of apneas and prolonging the lifespan in a mouse model of Rett Syndrome (Roux et al., 2007; Zanella et al., 2008). With regards to psychiatric conditions, which more traditionally utilize these therapies, the utility of 5-HT or NE reuptake inhibitors has been demonstrated by their ability to attenuate respiratory dysfunction in panic disorder patients (Nardi et al., 2003; Yeragani et al., 2004).
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Supported by SFB 406 of the Deutsche Forschungsgemeinschaft.
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Reprint requests: D. W. Richter, MD, Department of Physiology, University of Göttingen, Humboldtallee 23, D37073 Göttingen, Federal Republic of Germany.
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