Semin Respir Crit Care Med 2002; 23(3): 191-200
DOI: 10.1055/s-2002-33027
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Overview of Neuromuscular Disorders Affecting Respiratory Function

James M. Gilchrist
  • Brown Medical School, Providence, Rhode Island, and Department of Neurology, Rhode Island Hospital, Providence, Rhode Island
Further Information

Publication History

Publication Date:
02 August 2002 (online)

ABSTRACT

A great many neuromuscular disorders affect respiratory function. This article focuses on neuropathic and myopathic disorders that weaken the diaphragm and respiratory muscles. This discussion gives a general overview and attempts to update the reader on recent pathophysiological insights and developments in therapy. Among the disorders discussed, amyotrophic lateral sclerosis, poliomyelitis, postpolio syndrome, Kennedy syndrome, and spinal muscular atrophy are motor neuron diseases. Brachial plexitis and isolated unilateral or bilateral phrenic neuropathies can also weaken the diaphragm significantly. Peripheral neuropathies affecting respiration are primarily acute disorders such as Guillain-Barré syndrome, porphyria, and critical illness neuropathy, but chronic diseases such as chronic inflammatory demyelinating polyneuropathy (CIDP) and Charcot-Marie-Tooth disease (CMT) can also cause respiratory insufficiency. Disorders of neuromuscular transmission such as Lambert-Eaton syndrome, botulism, and myasthenia gravis often affect respiration. Many muscle diseases also affect pulmonary function, including polymyositis/dermatomyositis, muscular dystrophy, hereditary channel disorders, mitochondrial encephalomyopathies, acid maltase deficiency, and congenital myopathy.

REFERENCES

  • 1 El Escorial World Federation of Neurology criteria for the diagnosis of amyotrophic lateral sclerosis. J Neurol Sci 1994 124(suppl): 63-107
  • 2 Ringel S P, Murphy J R, Alderson M K. The natural history of amyotrophic lateral sclerosis.  Neurology . 1993;  43 1316-1322
  • 3 Stambler N, Charatan M, Cedarbaum J M, ALS CNTF Treatment Study Group. Prognostic indicators of survival in ALS.  Neurology . 1998;  50 66-72
  • 4 Lyall R A, Donaldson N, Polkey M I, Leigh P N, Moxham J. Respiratory muscle strength and ventilatory failure in amyotrophic lateral sclerosis.  Brain . 2001;  124 2000-2013
  • 5 Cazzoli P A, Oppenheimer E A. Home mechanical ventilation for amyotrophic lateral sclerosis: nasal compared to tracheostomy-intermittent positive pressure ventilation.  J Neurol Sci . 1996;  139(suppl) 123-128
  • 6 Kleopa K A, Sherman M, Neal B, Romano G J, Heiman-Patterson T. Bipap improves survival and rate of pulmonary function decline in patients with ALS.  J Neurol Sci . 1999;  64 82-88
  • 7 Brown R H. Superoxide dismutase and familial amyotrophic lateral sclerosis: new insights into mechanisms and treatments.  Ann Neurol . 1996;  39 145-146
  • 8 Yang Y, Hentati A, Deng H-X. The gene encoding alsin, a protein with three guanine-nucleotide exchange factor domains, is mutated in a form of recessive amyotrophic lateral sclerosis.  Nature Genetics . 2001;  29 160-165
  • 9 Hanano S, Hand C K, Osuga H. A gene encoding a putative GTPase regulator is mutated in familial amyotrophic lateral sclerosis 2.  Nature Genetics . 2001;  29 166-173
  • 10 Lacomblez L, Bensimon G, Leigh P N. Dose ranging study of riluzole in amyotrophic lateral sclerosis.  Lancet . 1996;  347 1425-1431
  • 11 Mulder D W. Clinical observations on acute poliomyelitis.  Ann NY Acad Sci . 1995;  753 1-10
  • 12 Dalakas M C. The postpolio syndrome as an evolved clinical entity: definition and clinical description.  Ann NY Acad Sci . 1995;  753 68-80
  • 13 Sendter M. Molecular mechanisms in spinal muscular atrophy: models and perspectives.  Curr Opin Neurol . 2001;  14 629-634
  • 14 Thomas N H, Duboqitz V. The natural history of type 1 (severe) spinal muscular atrophy.  Neuromusc Disord . 1994;  4 497-502
  • 15 Zerres K, Rudnik-Schoneborn S, Forrest E, Lusakowska A, Borkowska J, Hausmanova-Petrusewicz I. A collaborative study on the natural history of childhood and juvenile onset proximal spinal muscular atrophy (type II and III SMA): 569 patients.  J Neurol Sci . 1997;  146 67-72
  • 16 Russman B S, Buncher C R, White M. Function changes in spinal muscular atrophy II and III.  Neurology . 1996;  47 973-977
  • 17 LaSpada A R, Wilson E M, Lubahn D B. Androgen receptor gene mutations in X-linked spinal and bulbar muscular atrophy.  Nature . 1991;  352 77-79
  • 18 Mariotti C, Castellotti B, Pareyson D. Phenotypic manifestations associated with CAG-repeat expansion in the androgen receptor gene in male patients and heterozygous females: a clinical and molecular study of 30 families.  Neuromuscul Disord . 2000;  10 391-397
  • 19 Wilbourn A. Plexopathies. In: Mendell JR, Kissel JT, Cornblath DR, eds. Diagnosis and Management of Peripheral Nerve Disorders New York: Oxford University Press 2001 : 660-663
  • 20 Pelligrino J E, George R A, Biegel J. Hereditary neuralgic amotrophy: evidence for genetic homogeneity and mapping to chromosome 17q25.  Nature Genetics . 1997;  101 277-283
  • 21 Nardone R, Bernhart H, Pozzera A, Taddei M, Tezzon F. Respiratory weakness in neuralgic amyotrophy: report of two cases with phrenic nerve involvement.  Neurol Sci . 2000;  21 177-181
  • 22 Stewart J D. Focal Peripheral Neuropathies. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000
  • 23 Boonyapisit K, Katirji B. Multifocal motor neuropathy presenting with respiratory failure.  Muscle Nerve . 2000;  23 1887-1890
  • 24 Ropper A H, Widjicks E FM, Truax B T. Guillain-Barré Syndrome.  Philadelphia: FA Davis 1991: 22
  • 25 McKhann G M, Griffin J W, Cornblath D R. Plasmapheresis and Guillain-Barré syndrome: analysis of prognostic factos and the effect of plasmapheresis.  Ann Neurol . 1988;  23 347-353
  • 26 Hartung H-P, Pollard J D, Harvey G K, Toyka K V. Immunopathogenesis and treatment of Guillain-Barré syndrome, II.  Muscle Nerve . 1995;  18 154-164
  • 27 Griffin J W, Li C Y, Ho T W. Pathology of the motor-sensory axonal Guillain-Barré syndrome.  Ann Neurol . 1996;  39 17-28
  • 28 Guillain-Barré Study Group. Plasmapheresis and acute Guillain-Barré syndrome.  Neurology . 1985;  35 1096-1104
  • 29 Van DerMeche G A F, Schmitz P IM, Dutch Guillain-Barré Study Group. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome.  N Engl J Med . 1992;  326 1123-1133
  • 30 Guillain-Barré Syndrome Steroid Trial Group. Double-blind trial of intravenous methylprednisone in Guillain-Barré syndrome.  Lancet . 1993;  341 586-590
  • 31 Albers J W. Porphyric neuropathy. In: Mendell JR, Kissel JT, Cornblath DR, eds. Diagnosis and Management of Peripheral Nerve Disorders New York: Oxford University Press; 2000: 344-366
  • 32 Lacomis D, Petrella J T, Giuliani M J. Causes of neuromuscular weakness in the intensive-care unit: a study of ninety-two patients.  Muscle Nerve . 1998;  21 610-617
  • 33 Yan W X, Archelos J J, Hartung H-P, Pollard J D. P0 protein is a target antigen in chronic inflammatory demyelinating polyradiculoneuropathy.  Ann Neurol . 2001;  50 286-292
  • 34 Gabriel C M, Gregson N A, Hughes R AC. Anti-PMP22 antibodies in patients with inflammatory neuropathy.  J Neuroimmunol . 2000;  104 139-146
  • 35 Hughes R, Bensa S, Willison H. Randomized controlled trial of intravenous immunoglobulin versus oral prednisolone in chronic inflammatory demyelinating polyradiculoneuropathy.  Ann Neurol . 2001;  50 195-201
  • 36 Pareyson D. Charcot-Marie-Tooth disease and related neuropathies: molecular basis for distinction and diagnosis.  Muscle Nerve . 1999;  22 1498-1509
  • 37 Dyck P J, Litchy W J, Minnerath S. Hereditary motor and sensory neuropathy with diaphragm and vocal cord paresis.  Ann Neurol . 1994;  35 608-615
  • 38 Lennon V A, Kryzer T J, Griesmann G E. Calcium-channel antibodies in the Lambert-Eaton syndrome and other paraneoplastic syndromes.  N Engl J Med . 1995;  332 1467-1471
  • 39 Gutmann L, Phillips L H, Gutmann L H. Trends in the association of Lambert-Eaton myasthenic syndrome with carcinoma.  Neurology . 1992;  42 848-850
  • 40 Sanders D B, Massey J M, Sanders L L, Edwards L J. A randomized trial of 3,4-diaminopyridine in Lambert-Eaton myasthenic syndrome.  Neurology . 2000;  54 603-607
  • 41 Sonnabend O A, Sonnabend W F, Krech U, Molz G, Sigrist T. Continuous microbiological and pathological study of 70 sudden and unexpected infant deaths: toxigenic intestinal clostridium botulinum infection in 9 cases of sudden infant death syndrome.  Lancet . 1985;  1 237-241
  • 42 Lindstrom J M, Seybold M E, Lennon V A, Whittingham S, Duane D D. Antibody to acetylcholine receptor in myasthenia gravis: prevalence, clinical correlates, and diagnostic value.  Neurology . 1976;  26 1054-1059
  • 43 Thomas C, Mayer S, Gungor Y. Myasthenic crisis: clinical features, mortality, complications and risk factors for prolonged intubation.  Neurology . 1997;  48 1253-1260
  • 44 Tan F C, Tim R W, Gilchrist J M, AAEM Quality Assurance Committee. Literature review of the usefulness of repetitive nerve stimulation and single fiber EMG in the electrodiagnostic evaluation of patients with suspected myasthenia gravis or Lambert-Eaton myasthenic syndrome.  Muscle Nerve . 2001;  24 1239-1247
  • 45 Hoch W, McConville J, Helms S, Newsom-Davis J, Melms A, Vincent A. Auto-antibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptor antibodies.  Nature Medicine . 2001;  7 365-368
  • 46 Seybold M E. Treatment of myasthenia gravis. In: Engel AG, ed. Myasthenia Gravis and Myasthenic Disorders New York: Oxford University Press 1999: 167-201
  • 47 Ciafaloni E, Massey J M, Tucker-Lipscomb B, Sanders D B. Mycophenolate mofetil for myasthenia gravis: an open-label pilot study.  Neurology . 2001;  56 97-99
  • 48 Sigurgeirsson B, Lindelof B, Edhag O, Allander E. Risk of cancer in patients with dermatomyositis or polymyositis: a population-based study.  N Engl J Med . 1992;  326 363-367
  • 49 Dalakas M C. Immunopathogenesis of inflammatory myopathies.  Ann Neurol . 1995;  37(suppl) S74-86
  • 50 Hochberg M C, Feldman D, Stevens M B. Adult onset polymyositis/dermatomyositis: an analysis of clinical and laboratory features and survival in 76 patients with a reviews of the literature.  Semin Arthritis Rheum . 1986;  15 168
  • 51 Hochberg M C, Feldman D, Stevens M D. Antibody to Jo-1 in polymyositis/dermatomyositis: association with interstitial pulmonary disease.  J Rheumatol . 1984;  11 663
  • 52 Dalakas M C, Illa I, Dambrosia J M. A controlled trial of high-dose intravenous immune globulin infusions as treatment of dermatomyositis.  N Engl J Med . 1993;  329 1993-2000
  • 53 London S F, Gross K F, Ringel S P. Cholesterol-lowering agent myopathy (CLAM).  Neurology . 1991;  41 1159-1160
  • 54 Urbano-Marquez A, Estruch R, Navarro-Lopez F. The effects of alcoholism in skeletal and cardiac muscle.  N Engl J Med . 1989;  320 409
  • 55 Cohn R D, Campbell K P. Molecular basis of muscular dystrophies.  Muscle Nerve . 2000;  23 1456-1471
  • 56 Barkhaus P E, Gilchrist J M. Manifesting carriers of Duchenne muscular dystrophy.  Arch Neurol . 1989;  46 673-675
  • 57 Den Duneen T J, Grootscholten P M, Bakker E. Topopgraphy of the Duchenne muscular dystrophy (DMD) gene: FIGE and cDNA analysis of 194 cases reveals 115 deletions and 13 duplications.  Am J Hum Genet . 1989;  45 835-847
  • 58 Monaco A P, Bertelson C J, Liechti-Gallati S. An explanation for the phenotypic differences between patients bearing partial deletions of the DMD locus.  Genomics . 1988;  2 90
  • 59 Grain L, Crotina-Boria M, Forfar C, Hilton-Jones D, Hopkin J, Burch M. Cardiac abnormalities and skeletal muscle weakness in carriers of Duchenne and Becker muscular dystrophies and controls.  Neuromuscul Disord . 2001;  11 186-191
  • 60 Fenichel G M, Mendell J R, Moxley R T. A comparison of daily and alternate-day prednisone therapy in the treatment of Duchenne muscular dystrophy.  Arch Neurol . 1991;  48 575-579
  • 61 Meola G. Clinical and genetic heterogeneity in myotonic dystrophies.  Muscle Nerve . 2000;  23 1789-1799
  • 62 Monckton D F, Wong L J, Ashizawa T, Caskey C T. Somatic mosaicism, germline expansions, germline reversions and intergenerational reductions in myotonic dystrophy males: small pool PCR.  Hum Mol Genet . 1995;  4 1-8
  • 63 Fisher J, Upadhaya M. Molecular genetics of facioscapulohumeral muscular dystrophy (FSH).  Neuromuscul Disord . 1997;  7 55-62
  • 64 Lehmann-Horn F, Rudel R. Hereditary nondystrophic myotonias and periodic paralyses.  Curr Opin Neurol . 1995;  8 402-410
  • 65 Martin R J, Sufit R L, Ringle S P, Hudgel D W, Hill P L. Respiratory improvement by muscle training in adult-onset acid maltase deficiency.  Muscle Nerve . 1983;  6 201-203
  • 66 Morgan-Hughes J A. The mitochondrial myopathies. In: Engle AD, Franzini-Armstrong C, eds. Myology 2nd ed. New York: McGraw-Hll 1994: 1610-1660
  • 67 Giles R E, Blanc H, Cann H M, Wallace D C. Maternal inheritance of human mitochonrial DNA.  Proc Natl Acad Sci USA . 1980;  77 6715
  • 68 Hirano M, Nishino I, DiMauro S. Mitochondrial myopathies. In: Pourmand R, ed. Neuromuscular Diseases Boston: Butterworth-Heinemann; 2001: 411-438
  • 69 Bodensteiner J B, Riggs J E, Schocet S S. Congenital myopathies. In: Pourmand R, ed. Neuromuscular Diseases Boston: Butterworth-Heinemann; 2001: 295-311