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Papadopoulou M, Papapostolou A, Dimakopoulos R, Salakou S, Koropouli E, Fanouraki S, Bakola E, Moschovos C, Tsivgoulis G. Non-Pharmacological Interventions on Pain in Amyotrophic Lateral Sclerosis Patients: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2024; 12:770. [PMID: 38610192 PMCID: PMC11011838 DOI: 10.3390/healthcare12070770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/24/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder affecting upper and lower motor neurons. Some ALS patients exhibit concomitant nonmotor signs; thus, ALS is considered a multisystemic disorder. Pain is an important nonmotor symptom. Observational and case-control studies report high frequency of pain in ALS patients and it has been correlated with depression and quality of life. There are no specific scales for the assessment of pain and no randomized controlled trials (RCTs) regarding the drug management of pain in ALS. AIM To systematically review the evidence for the nonpharmacological interventions (NPIs) in relieving pain in ALS, on March 2024, we searched the following databases: Pubmed, Scopus, Web of Science, and Cochrane. We also checked the bibliographies of trials identified to include further published or unpublished trials. MAIN RESULTS A total of 1003 records were identified. Finally, five RCTs including 131 patients (64 in the intervention group and 67 in the control group) were included for meta-analysis. The interventions of the included RCTs consisted of muscle exercise, combined aerobics-strength intervention, and osteopathic manual treatment. The meta-analysis did not find a statistically significant difference in favor of NPIs for alleviating pain in ALS patients. CONCLUSIONS ALS has a fulminant course and irreversibly leads to death. Pain in ALS patients, although a common nonmotor symptom, is often unrecognized and undertreated, and this is underlined by the lack of any RCTs on drug therapy for pain. Albeit NPIs are considered safe, as adverse effects are rarely reported, this systematic review did not provide sufficient evidence for a beneficial effect on pain. The scarceness of relevant literature highlights the need for future studies, with larger samples, more homogeneous in terms of interventions and population characteristics (stage of disease), and better choice of measurement scales to further investigate the efficacy, if any, of various pain interventions in ALS patients.
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Affiliation(s)
- Marianna Papadopoulou
- Department of Physiotherapy, University of West Attica, Ag. Spyridonos Str., 12243 Athens, Greece;
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Apostolos Papapostolou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Rigas Dimakopoulos
- Department of Physiotherapy, University of West Attica, Ag. Spyridonos Str., 12243 Athens, Greece;
| | - Stavroula Salakou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Eleftheria Koropouli
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Stella Fanouraki
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Eleni Bakola
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Christos Moschovos
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Rimini 1, 12462 Athens, Greece; (A.P.); (S.S.); (E.K.); (S.F.); (E.B.); (C.M.); (G.T.)
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Influence of Resistance Training on Neuromuscular Function and Physical Capacity in ALS Patients. JOURNAL OF NEURODEGENERATIVE DISEASES 2017; 2017:1436519. [PMID: 28596929 PMCID: PMC5449732 DOI: 10.1155/2017/1436519] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/24/2017] [Indexed: 12/14/2022]
Abstract
Objectives The present study aimed to explore the effect of resistance training in patients with amyotrophic lateral sclerosis (ALS), a disease characterized by progressive motor neuron loss and muscle weakness. Materials and Methods Following a 12-week “lead-in” control period, a population of ALS patients from Funen, Denmark, completed a 12-week resistance training program consisting of 2-3 sessions/week. Neuromuscular function (strength and power) and voluntary muscle activation (superimposed twitch technique) were evaluated before and after both control and training periods. Physical capacity tests (chair rise and timed up and go), the revised ALS functional rating scale (ALSFRS-R) scores, and muscle cross sectional area (histology) were also assessed. Results Of twelve ALS patients assessed for eligibility, six were included and five completed the study. Training did not significantly affect the ALSFRS-R score, and loss of neuromuscular function (strength and power) increased following the training period. However, an improved functionality (chair rise) and an increase in greatly hypertrophied type II fibres combined with an increase in atrophied fibres following the training period compared to the control period were observed. Conclusion In this small study, the present form of resistance training was unable to attenuate progressive loss of neuromuscular function in ALS, despite some changes in physical capacity and morphology.
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Crescimanno G, Greco F, Arrisicato S, Morana N, Marrone O. Effects of positive end expiratory pressure administration during non-invasive ventilation in patients affected by amyotrophic lateral sclerosis: A randomized crossover study. Respirology 2016; 21:1307-13. [DOI: 10.1111/resp.12836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/17/2016] [Accepted: 03/27/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Grazia Crescimanno
- Italian National Research Council; Institute of Biomedicine and Molecular Immunology; Palermo Italy
- Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases; Villa Sofia-Cervello Hospital; Palermo Italy
| | - Francesca Greco
- Italian Union Against Muscular Dystrophy (UILDM); Palermo Italy
| | - Salvo Arrisicato
- Regional Center for Prevention and Treatment of Respiratory Complications of Rare Genetic Neuromuscular Diseases; Villa Sofia-Cervello Hospital; Palermo Italy
| | - Noemi Morana
- Italian Union Against Muscular Dystrophy (UILDM); Palermo Italy
| | - Oreste Marrone
- Italian National Research Council; Institute of Biomedicine and Molecular Immunology; Palermo Italy
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Pinto S, de Carvalho M. Can inspiratory muscle training increase survival in early-affected amyotrophic lateral sclerosis patients? Amyotroph Lateral Scler Frontotemporal Degener 2012; 14:124-6. [PMID: 23035780 DOI: 10.3109/17482968.2012.726227] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Susana Pinto
- Translational and Clinical Physiology Unit, Institute of Molecular Medicine , Faculty of Lisbon, Lisbon, Portugal
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Lo Coco D, Cannizzaro E, Spataro R, Taiello AC, La Bella V. Sleep–wake problems in patients with amyotrophic lateral sclerosis: implications for patient management. Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.12.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Sleep–wake problems are frequent, although unrecognized, complications of amyotrophic lateral sclerosis (ALS). Sleep disorders such as insomnia, sleep-disordered breathing and restless legs syndrome have all been reported in patients with ALS, despite the limited number of studies and the small populations investigated so far. Sleep disturbances gradually worsen with disease progression, suggesting a relationship between the severity of disease and the neurodegenerative process. However, poor sleep can also be a consequence of several disturbances such as anxiety, depression, pain, choking, sialorrhea, fasciculations, cramps, nocturia and the inability to get comfortable and move freely in bed. Sleep disorders may have many reflections on patients with ALS, including excessive daytime somnolence, fatigue, impaired cognition, reduced quality of life and survival. This article reviews the recent literature on sleep–wake problems in patients with ALS, focusing on the implications for patient management.
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Affiliation(s)
- Daniele Lo Coco
- Sleep Disorders Clinic, Dipartimento di Neuroscienze, Ospedale Civico – ARNAS, Piazza N. Leotta, 4 – 90129, Palermo, Italy
| | - Emanuele Cannizzaro
- Dipartimento di Scienze Farmacologiche, Università di Palermo, Palermo, Italy
| | - Rossella Spataro
- ALS Clinical Research Center, Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), Università di Palermo, Palermo, Italy
| | - Alfonsa Claudia Taiello
- ALS Clinical Research Center, Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), Università di Palermo, Palermo, Italy
| | - Vincenzo La Bella
- ALS Clinical Research Center, Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BioNeC), Università di Palermo, Palermo, Italy
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Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive and fatal neurodegenerative disease in which much burden is geared towards end-of-life care. Particularly in the earlier stages of ALS, many people have found both physiological and psychological boosts from various types of physical exercise for disused muscles. Proper exercise is important for preventing atrophy of muscles from disuse-a key for remaining mobile for as long as possible-and as long as it is possible to exercise comfortably and safely, for preserving cardiovascular fitness. However, the typical neuromuscular patient features a great physical inactivity and disuse weakness, and for that reason many controversial authors have contested exercise in these patients during years, especially in ALS which is rapidly progressive. There is an urgent need for dissecting in detail the real risks or benefits of exercise in controlled clinical trials to demystify this ancient paradigm. Yet, recent research studies document significant benefits in terms of survival and quality of life in ALS, poor cooperation, small sample size, uncontrolled and short-duration trials, remain the main handicaps. Sedentary barriers such as early fatigue and inherent muscle misuse should be overcome, for instance with body-weight supporting systems or non-invasive ventilation, and exercise should be faced as a potential non-monotonous way for contributing to better health-related quality of life.
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Aboussouan LS. Mechanisms of exercise limitation and pulmonary rehabilitation for patients with neuromuscular disease. Chron Respir Dis 2010; 6:231-49. [PMID: 19858353 DOI: 10.1177/1479972309345927] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Indications for exercise and pulmonary rehabilitation extend to neuromuscular diseases tough these conditions pose particular challenges given the associated skeletal muscle impairment and respiratory muscle dysfunction. These challenges are compounded by the variety of exercise prescriptions (aerobic, muscle strengthening, and respiratory muscle training) and the variety of neuromuscular disorders (muscular, motor neuron, motor nerve root, and neuromuscular transmission disorders). Studies support a level II evidence of effectiveness (i.e., likely to be effective) for a combination of aerobic exercise and strengthening exercises in muscular disorders, and for strengthening exercises in amyotrophic lateral sclerosis. The potential deleterious effects of work overload in the dystrophinopathies have not been confirmed in Becker muscular dystrophy. Adjunctive pharmacologic interventions (e.g., theophylline, steroids, PDE5 inhibitors, creatine), training recommendations (e.g., interval or lower intensity training) and supportive techniques (e.g., noninvasive ventilation, neuromuscular electrical stimulation, and diaphragm pacing) may result in more effective training but require more study before formal recommendations can be made. The exercise prescription should include avoidance of inspiratory muscle training in hypercapnia or low vital capacity, and should match the desired outcome (e.g., extremity training for task-specific performance, exercise training to enhance exercise performance, respiratory muscle training where respiratory muscle involvement contributes to the impairment).
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Affiliation(s)
- L S Aboussouan
- Cleveland Clinic Foundation, Respiratory Institute, Cleveland, OH 44195, USA.
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De Carvalho M, Costa J, Pinto S, Pinto A. Percutaneous nocturnal oximetry in amyotrophic lateral sclerosis: Periodic desaturation. ACTA ACUST UNITED AC 2009; 10:154-61. [DOI: 10.1080/17482960802382305] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Atalaia A, De Carvalho M, Evangelista T, Pinto A. Sleep characteristics of amyotrophic lateral sclerosis in patients with preserved diaphragmatic function. ACTA ACUST UNITED AC 2009; 8:101-5. [PMID: 17453638 DOI: 10.1080/17482960601029883] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There are a number of sleep studies in amyotrophic lateral sclerosis (ALS), in general including a heterogeneous population of patients. We aimed to study sleep in a population of selected ALS patients by investigating nocturnal polysomnography (PSG) characteristics in ALS patients with normal respiratory function tests and preserved diaphragmatic innervation. Ninety-two ALS patients were screened by percutaneous nocturnal oximetry (PNO). Eleven ALS patients with normal respiratory function tests, phrenic motor responses and preserved motor units on needle electromyography of the diaphragm, but abnormal PNO, were selected for PSG. REM was present in eight patients, but normal in only three. Three patients had mixed apnoea-hypopnoea, severe in one. Seven showed a pattern of periodic mild O(2) desaturation, which occurred in REM 3, REM and NREM 3 and in NREM sleep 1. One patient studied six months later had more severe changes in the second evaluation. In conclusion, the most common sleep disordered breathing was periodic mild O(2) desaturation independent of the sleep stage (REM, NREM). This might represent central drive dysfunction or respiratory muscle fatigue in ALS.
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Affiliation(s)
- António Atalaia
- Laboratory of Clinical Neurophysiology, British Hospital--Lisbon XXI, Lisbon. Portugal.
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Pinto S, Turkman A, Pinto A, Swash M, de Carvalho M. Predicting respiratory insufficiency in amyotrophic lateral sclerosis: The role of phrenic nerve studies. Clin Neurophysiol 2009; 120:941-6. [DOI: 10.1016/j.clinph.2009.02.170] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2008] [Revised: 02/06/2009] [Accepted: 02/21/2009] [Indexed: 11/27/2022]
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Hadjikoutis S, Wiles CM. Respiratory complications related to bulbar dysfunction in motor neuron disease. Acta Neurol Scand 2008. [DOI: 10.1034/j.1600-0404.2001.d01-22.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pozza AM, Delamura MK, Ramirez C, Valério NI, Marino LHC, Lamari NM. Physiotherapeutic conduct in amyotrophic lateral sclerosis. SAO PAULO MED J 2006; 124:350-4. [PMID: 17322959 DOI: 10.1590/s1516-31802006000600011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2006] [Accepted: 11/21/2006] [Indexed: 12/13/2022] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a fatal progressive neurodegenerative disease with multifactorial etiology for which, so far, there is no effective medicinal treatment. However, by means of kinesiotherapy intervention and patient guidance and care, physiotherapy can delay physical functional losses, muscle fatigue and immobility of the joint-muscle system, thereby improving the quality of life. This survey had the aim of reviewing the physiotherapeutic conduct currently used in ALS cases. Monthly monitoring is recommended, with changes in goals and conduct at each stage of the disease, activities to be pursued around the home, and emphasis on stretching, muscle strengthening, posture adequacy and respiratory kinesiotherapy.
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Affiliation(s)
- Andreza Martinez Pozza
- Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil
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Évaluation des fonctions ventilatoires. Rev Neurol (Paris) 2006. [DOI: 10.1016/s0035-3787(06)75185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Most motor neurone disease (MND) patients die of respiratory system complications. When patients have advanced disease with symptoms of respiratory failure, management issues can become complicated by the introduction of assisted ventilatory devices. Therefore, care provision by a multidisciplinary team must be structured and co-ordinated in order to ensure that patients and their carers receive the optimal level of care. The objective of this article is to review the literature and explore the complex issues surrounding the use of non-invasive positive pressure ventilation (NIPPV) in home care MND patients as a justification for the development of a management guideline for medical practitioners. A guideline for multidisciplinary care of home ventilated MND patients will be proposed.
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Affiliation(s)
- Derek Eng
- Palliative Care Unit, Hollywood Private Hospital, Western Australia.
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Winhammar JMC, Rowe DB, Henderson RD, Kiernan MC. Assessment of disease progression in motor neuron disease. Lancet Neurol 2005; 4:229-38. [PMID: 15778102 DOI: 10.1016/s1474-4422(05)70042-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Motor neuron disease (MND) is characterised by progressive deterioration of the corticospinal tract, brainstem, and anterior horn cells of the spinal cord. There is no pathognomonic test for the diagnosis of MND, and physicians rely on clinical criteria-upper and lower motor neuron signs-for diagnosis. The presentations, clinical phenotypes, and outcomes of MND are diverse and have not been combined into a marker of disease progression. No single algorithm combines the findings of functional assessments and rating scales, such as those that assess quality of life, with biological markers of disease activity and findings from imaging and neurophysiological assessments. Here, we critically appraise developments in each of these areas and discuss the potential of such measures to be included in the future assessment of disease progression in patients with MND.
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Affiliation(s)
- Jennica M C Winhammar
- Department of Neurology and Multidisciplinary Motor Neurone Disease Clinic, Royal North Shore Hospital, NSW, Australia
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Abstract
Neuromuscular disorders are caused by the primary involvement of the motor unit. In these patients, sleep-disordered breathing (SDB) due to respiratory muscle weakness is often encountered during sleep. Because there is a tendency to overlook this disorder, all patients with neuromuscular disorders should be questioned about SDB. Overnight polysomnography is the best investigation for SDB and nocturnal desaturations. In the management of these patients, noninvasive intermittent positive pressure ventilation results in improvement of SDB and breathing.
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Affiliation(s)
- Ibrahim Oztura
- Stanford University Sleep Disorders Clinic, 401 Quarry Road, - Suite 3301, Palo Alto, CA 94305, USA.
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Couratier P, Desport JC, Antonini MT, Mabrouk T, Perna A, Vincent F, Melloni B. [Review of nutritional and respiratory support in ALS]. Rev Neurol (Paris) 2004; 160:243-50. [PMID: 15034484 DOI: 10.1016/s0035-3787(04)70898-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
During the evolution of amyotrophic lateral sclerosis (ALS), quality of life and survival of patients are related to respiratory and nutritional status. After diagnosis, a multidisciplinary care has to be promptly organized and coordinated by the referring neurologist. The nutritional and respiratory support imply that neurologists know their specific means of evaluation with their sensitivity and sensibility and be able to recognize clinical risk situations. The informations of patients on assisted-ventilation and nutritional support by using gastrostomy may be done early, precisely and trustfully. Well informed patient's choices must be respected. Nutritional and respiratory supports may be based on recommendations established by the American Academy of Neurology. This review will present and discuss their main aspects in patients with ALS.
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Affiliation(s)
- P Couratier
- Service de Neurologie, Faculté de Médécine, CHU Dupuytren 87042 Limoges cedex.
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Sonka K, Fiksa J, Horvath E, Kemlink D, Sussova J, Bohm J, Sebesta V, Volna J, Nevsimalova S. Sleep and Fasciculations in Amyotrophic Lateral Sclerosis. Schlaf und Faszikulationen bei amyotropher Lateralsklerose. SOMNOLOGIE 2004. [DOI: 10.1111/j.1439-054x.2003.00010.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Electrodiagnostic assessment of respiratory dysfunction in motor neuron disease. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/s1567-4231(04)04029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Elman LB, Siderowf AD, McCluskey LF. Nocturnal oximetry: utility in the respiratory management of amyotrophic lateral sclerosis. Am J Phys Med Rehabil 2003; 82:866-70. [PMID: 14566155 DOI: 10.1097/01.phm.0000091985.22659.30] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Current recommendations are to institute nocturnal nasal ventilation for amyotrophic lateral sclerosis patients with a forced vital capacity (FVC) of <50% of predicted normal. The purpose of this study was to determine whether this is appropriate. DESIGN A total of 87 nocturnal oximetry evaluations were performed on 78 consecutive amyotrophic lateral sclerosis patients symptomatic for sleep-disordered breathing. Nocturnal oximetry measurements were compared for those with FVC >50% vs. those with FVC of <50% of normal. FVC was measured sitting and supine. RESULTS A considerable number of these symptomatic patients manifested evidence of nocturnal hypoxemia as measured by oximetry. However, there was no significant difference between patients with sitting percentage-predicted FVC above and below 50% predicted in minimum oxygen saturation, mean oxygen saturation, percentage of time spent with oxygen saturation of <88%, and number of events per hour. There was no significant difference between patients with supine percentage-predicted FVC above and below 50% predicted in minimum oxygen saturation, mean oxygen saturation, percentage of time spent with oxygen saturation of <88%, and number of events per hour. CONCLUSION The recommendation that FVC be <50% of normal is inappropriate for justifying introduction of nocturnal nasal ventilation. Many patients are symptomatic at higher FVC and manifest evidence of nocturnal hypoxemia. Nocturnal oximetry adds additional practical information for justifying earlier respiratory intervention for symptomatic patients.
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Netzer N, Eliasson AH, Netzer C, Kristo DA. Overnight pulse oximetry for sleep-disordered breathing in adults: a review. Chest 2001; 120:625-33. [PMID: 11502669 DOI: 10.1378/chest.120.2.625] [Citation(s) in RCA: 239] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Pulse oximetry is a well-established tool routinely used in many settings of modern medicine to determine a patient's arterial oxygen saturation and heart rate. The decreasing size of pulse oximeters over recent years has broadened their spectrum of use. For diagnosis and treatment of sleep-disordered breathing, overnight pulse oximetry helps determine the severity of disease and is used as an economical means to detect sleep apnea. In this article, we outline the clinical utility and economical benefit of overnight pulse oximetry in sleep and breathing disorders in adults and highlight the controversies regarding its limitations as presented in published studies.
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Affiliation(s)
- N Netzer
- Pulmonary and Critical Care Medicine Service, Department of Medicine, Walter Reed Army Medical Center, Washington DC 20307, USA
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