The thoracic diaphragm is formed of two muscles, whose innervations derive from the cervical spine areas 3 4 5 ('C3 4 5, keep the diaphragm alive'); the port (left) side lung shares some of its space with the heart and is therefore smaller than the starboard (right) side lung. The ALS regression need not be symmetrical and, as many patients know, one side may be affected before the other. Such is possible for the thoracic diaphragm, as was shown in one case during Dr. Onders's presentation in Greece last year. Since the starboard side lung is larger, one might be better off were any affects to occur at all, they would occur on the port lung side initially.

You've most likely dropped a bottle or can of soda at some point of time and discovered opening same soon after may result in foamy liquid bursting out of the container. I wonder if patting an ALS patient on the back might have a similar effect. If you have picked up a baby because it was crying and placed the baby over your shoulder, the baby soon stops crying possibly because of the carbon dioxide build-up. . . .

The usual practice in evaluating cases for inclusion in statistical calculations is to exclude cases where the patient did not provide all the data needed and with such practice in mind, the number of cases exceeding five years reached 45 percent. I thought I should add, there are 145 cases found so far where the patient had limb onset ALS; of these 61 exceeded five years, with more on the way: hence, the five year survival point for limb onset ALS patients using the pacer currently exceeds 40%, whereas 20% is indicated as the norm. Plausibly, well timed pacer utilization may double patient life expectancy. Possibly more important issue is the dEMG data from the pacer, . . . , Lechtzin observed a chart providing about five data points per patient regarding their respiratory health - the Onders's paper shows one method were thousands of data points could be obtained in one minute, possibly showing in real time the impact of the ALS disease processes on the diaphragm muscle . . . such may be better than a biomarker, so, so long as a patient has good health in their diaphragm they ought to be valuable subjects in clinical studies if they undergo the implant and avail the dEMG data to the researchers. Yet it remains the case clinical studies do not wish to accommodate the pacer . . . more thoughts on same later.

Although the fact remains I have no print copy of the DiPALS report, I continue to be developing or computing the analytical range of outcomes evidencing efficacy. Not an easy calculation but I think I almost have useful results and hope to post them this week.

French Study Of NeuRx® Diaphragm Pacing System (DPS) In Off-Label ALS Patients Confirms: NeuRx DPS® Should Be Used With NIV In Later Stage Of Disease

http://www.prnewswire.com/news-relea...#continue-jump

In reflecting upon media reports on medical research, I keep wondering whether those offering their opinions ought to include their academic background and areas of expertise: especially when they are not known for commenting on medical research. I suggest readers keep in mind each particular author's relevant qualifications; where an author does not disclose them and is unknown to the subject area, their opinion may have validity issues. We live in a country known for freedoms of speech and press . . . differences in the opinion of ordinary persons and experts exist in many areas, such as where issues are complex or remote and therefore poorly understood. Journalists want to make headlines . . . .

Diaphragmatic pacing in amyotrophic lateral sclerosis
by Richard A. Lewis of Cedars Sinai, Los Angeles, California

http://www.thelancet.com/pdfs/journa...16)30259-9.pdf

Diaphragm pacing in patients with amyotrophic lateral sclerosis
by Robert G. Miller and Richard A. Lewis of Cedars Sinai, Los Angeles, California

http://www.thelancet.com/journals/la...012-6/fulltext

(comment on the DiPALS study report)

Early diaphragm pacing in patients with amyotrophic lateral sclerosis (RespiStimALS): a randomised controlled triple-blind trial

http://www.thelancet.com/pdfs/journa...16)30233-2.pdf

(RespiTrimALS report from France)

A quick note; I briefly accessed copy of the aforesaid reports but have not thoroughly read them. Apparently, ages for the french study matched ages for the DiPALS study; a web based randomization program is mentioned but not identified . . . median survival of treatment group was 51 months, comparing to 28 months in the DiPALS study? Since the treatment groups appear to be older and extensive literature regards age as worse adverse factor in prognosis.

In reflecting on the '. . . statistically significant . . .' expression used in both the DiPALS and the RespiStimALS study, I have doubts as to whether sufficient patients were involved in these studies for the determination to be valid due to the high variance of regression rates in patients. The report of the DiPALS study group implies the patients were of middle to fast regression rates - one third suffered from bulbar onset. The report of the RespiStimALS group implies the patients were of middle to slow regression rates, with less than the expected quantity of bulbar onset cases. The RespiStimALS also reports theirs was a multicenter study but is unclear on how many surgical teams were involved . . . only one, or one for each cite . . ? The RespiStimALS group also use a web based service to decide what group to enter each patient into.