Is there a possibility of intramuscular stimulation of the diaphragm
in patients suffering from ALS - especially if we are talking about
young patients with a still intact breathing ( muscle not yet atrophic
) - it would certainly mean a great increase in quality of life .
Thank you. Dr. U. Sucher

I'm not sure what you mean by intramuscular stimulation, but there are
electronic pacemakers which are attached to the diaphram to cause
contractions; they have been used with success in quadraplegics.

Yes , I mean the electrodes that stimulate the diaphragm and I am aware that
they have been succesfully used in quadroplegics - but i want an answe
from an expert in this field to know exactly where these electrodes are
positioned and if they would work for somebody suffering from ALS
(a-motoneuron disease ). Thank you for your comment!

Dr. Sucher,
 To the best of my knowledge, diaphragmatic pacers are not effective
in ALS due to involvement of the lower motor neurons of the phrenic
nerve.

 Typically, electrophrenic pacing is implemented only for brain,
brainstem, or high spinal injuries in which the UMN is nonfunctional
while the LMN is still otherwise conductive.

 I have searched the Medline archives for "Amyotrophic Lateral
Sclerosis" and both "diaphragmatic" and "phrenic" pacing and did not
find any results.

 There is a study of a direct intramuscular (diaphragm AND
intercostal) stimulator which is placed laparoscopically. The focus of
this study was quadriplegia, and ALS was not specifically mentioned in
the article. Further more, even this device relies on conductive
phrenic nerve branches...
 http://www.vard.org/jour/01/38/6/marco386.htm 

 Unfortunately, the pathologic process of ALS seems to preclude the
use of pacing devices.

 -A. Segal, MD