Respiratory Involvement in Multiple Sclerosis

Abstract

Respiratory complications occur in advanced multiple sclerosis (MS) but may also complicate acute relapses earlier in the disease. We present 19 patients with MS who developed respiratory complications at a mean of 5.9 (range 1-12) yrs after the onset of neurological symptoms. Fourteen patients developed severe respiratory insufficiency presenting with a combination of reduced forced vital capacity (FVC), hypoxaemia or hypercapnia (12 patients) and respiratory arrest (four patients). Two patients presented with apneustic breathing, one with paroxysmal hyperventilation, one with obstructive sleep apnoea and one with bulbar weakness leading to aspiration pneumonia. Respiratory muscle weakness was a major factor in 14 patients (predominantly diaphragm involvement in six), bulbar weakness in seven patients, impaired voluntary control in three and impaired automatic control in three. Twelve patients received mechanical respiratory support of whom seven have subsequently died. The methods of support used were intermittent positive pressure ventilation (nine patients), iron lung (three), cuirass (two) and rocking bed (one). Six patients were maintained on respiratory support until they died after intervals varying from 24 h to 6 yrs (mean 17.7 mths). Five patients received temporary ventilation for between 6 d and 42 d: of these four remain alive at up to 4 yrs and one died after 16 yrs. One patient remains on domiciliary nasal intermittent positive pressure ventilation (IPPV) after 1 yr.

Subclinical respiratory dysfunction in chronic cervical cord compression: a pulmonary function test correlation

“…Ishibe and Takahashi 9 quote a study in which it is reported that %VC significantly decreased in patients with low neurological scores compared with those with moderate to high scores, and that respiratory and psychological complications were higher in the former group of patients. 8 Respiratory insufficiency has been cited as a major postoperative complication associated with cervical spine surgery, especially performed via an anterior cervical approach, 2,15 which was partly because the surgery compromised airway function. Additionally, in cases requiring posterior cervical surgery, placing a patient prone may compromise respiratory function.…”

Expiratory Muscle Strength Training in Persons With Multiple Sclerosis Having Mild to Moderate Disability: Effect on Maximal Expiratory Pressure, Pulmonary Function, and Maximal Voluntary Cough

“…Most studies examining respiratory status in patients with MS reported expiratory and/or inspira-tory muscle weakness only in persons with significant disability caused by paraplegia or quadriplegia. [1][2][3][4][5][6][7][8][9] Previous studies designed to assess the effects of expiratory and/or inspiratory muscle strength training in patients with MS with high level of disability have shown mixed results. 3,5,[7][8][9] Although training resulted in respiratory muscle strength gains, no change in pulmonary function was observed in some of the studies.…”

The Control of Breathing in Clinical Practice

“…Clinical information from patients with multiple sclerosis with brainstem involvement and clinical pathologic correlations suggest that the pneumotaxic center may function similarly in man. 35,36 The medullary center is divided into an inspiratory dorsal respiratory group (DRG) of neurons and an expiratory ventral respiratory group (VRG). The DRG is located in the nucleus of tractus solitarius in the medulla and is important in integrating impulses from visceral afferents from the upper airways, intraarterial chemoreceptors, and lung parenchyma through the fifth, ninth and 10th cranial nerves, respectively.…”