1
|
Mateus T, Costa A, Viegas D, Marques A, Herdeiro MT, Rebelo S. Outcome measures frequently used to assess muscle strength in patients with myotonic dystrophy type 1: a systematic review. Neuromuscul Disord 2021; 32:99-115. [PMID: 35031191 DOI: 10.1016/j.nmd.2021.09.014] [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: 01/30/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
Measurement of muscle strength is fundamental for the management of patients with myotonic dystrophy type 1 (DM1). Nevertheless, guidance on this topic is somewhat limited due to heterogeneous outcome measures used. This systematic literature review aimed to summarize the most frequent outcome measures to assess muscle strength in patients with DM1. We searched on Pubmed, Web of Science and Embase databases. Observational studies using measures of muscle strength assessment in adult patients with DM1 were included. From a total of 80 included studies, 24 measured cardiac, 45 skeletal and 23 respiratory muscle strength. The most common method and outcome measures used to assess cardiac muscle strength were echocardiography and ejection fraction, for skeletal muscle strength were quantitative muscle test, manual muscle test and maximum isometric torque and medical research council and for respiratory muscle strength were manometry and maximal inspiratory and expiratory pressure. We successfully gathered the more consensual methods and measures to evaluate muscle strength in future clinical studies, particularly to test muscle strength response to treatments in patients with DM1. Future consensus on a set of measures to evaluate muscle strength (core outcome set), is important for these patients.
Collapse
Affiliation(s)
- Tiago Mateus
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Adriana Costa
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Diana Viegas
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory - Lab3R, Institute of Biomedicine (iBiMED), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Sandra Rebelo
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal.
| |
Collapse
|
2
|
Ciorba C, Gonzalez-Bermejo J, Salva MAQ, Annane D, Orlikowski D, Lofaso F, Prigent H. Flow and airway pressure analysis for detecting ineffective effort during mechanical ventilation in neuromuscular patients. Chron Respir Dis 2018; 16:1479972318790267. [PMID: 30064272 PMCID: PMC6302971 DOI: 10.1177/1479972318790267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Ineffective efforts (IEs) are among the most common types of patient–ventilator
asynchrony. The objective of this study is to validate IE detection during
expiration using pressure and flow signals, with respiratory effort detection by
esophageal pressure (Pes) measurement as the reference, in patients with
neuromuscular diseases (NMDs). We included 10 patients diagnosed with chronic
respiratory failure related to NMD. Twenty-eight 5-minute recordings of daytime
ventilation were studied for IE detection. Standard formulas were used to
calculate sensitivity, specificity, positive predictive value (PPV), and
negative predictive value (NPV) of IE detection using pressure and flow signals
compared to Pes measurement. Mean sensitivity and specificity of flow and
pressure signal-based IE detection versus Pes measurement were 97.5% ± 5.3% and
91.4% ± 13.7%, respectively. NPV was 98.1% ± 8.2% and PPV was 67.6% ± 33.8%.
Spearman’s rank correlation coefficient indicated a moderately significant
correlation between frequencies of IEs and controlled cycles (ρ
= 0.50 and p = 0.01). Among respiratory cycles, 311 (11.2%)
were false-positive IEs overall. Separating false-positive IEs according to
their mechanisms, we observed premature cycling in 1.2% of cycles, delayed
ventilator triggering in 0.1%, cardiac contraction in 9.2%, and upper airway
instability during expiration in 0.3%. Using flow and pressure signals to detect
IEs is a simple and rapid method that produces adequate data to support clinical
decisions.
Collapse
Affiliation(s)
- Cristina Ciorba
- 1 Service Physiologie et Explorations-Fonctionnelles, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Jesus Gonzalez-Bermejo
- 2 Service de Pneumologie et Réanimation Médicale ( Département " R3S"), INSERM UMRS1158, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Paris, France
| | - Maria-Antonia Quera Salva
- 1 Service Physiologie et Explorations-Fonctionnelles, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Djillali Annane
- 3 Service de Réanimation médicale et unité de ventilation à domicile, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - David Orlikowski
- 3 Service de Réanimation médicale et unité de ventilation à domicile, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France.,4 INSERM U 1179, Hôpital Raymond Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Frédéric Lofaso
- 1 Service Physiologie et Explorations-Fonctionnelles, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France.,4 INSERM U 1179, Hôpital Raymond Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France
| | - Hélène Prigent
- 1 Service Physiologie et Explorations-Fonctionnelles, INSERM CIC 1429, AP-HP, Hôpital Raymond Poincaré, Garches, France.,4 INSERM U 1179, Hôpital Raymond Poincaré, Université de Versailles Saint-Quentin-en-Yvelines, Garches, France
| |
Collapse
|
3
|
Poussel M, Kaminsky P, Renaud P, Laroppe J, Pruna L, Chenuel B. Supine changes in lung function correlate with chronic respiratory failure in myotonic dystrophy patients. Respir Physiol Neurobiol 2014; 193:43-51. [PMID: 24440340 DOI: 10.1016/j.resp.2014.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
Quality of life and prognosis of patients with myotonic dystrophy type 1 (MD1) often depend on the degree of lung function impairment. This study was designed to assess the respective prevalence of ventilatory restriction, hypoxaemia and hypercapnia in MD1 patients and to determine whether postural changes in lung function could contribute to the early diagnosis of poor respiratory outcome. Fifty-eight patients (42.6±12.9 years) with MD1 were prospectively evaluated from April 2008 to June 2010 to determine their supine and upright lung function and arterial blood gases. The prevalence of ventilatory restriction was 36% and increased with the severity of muscular disability (from 7.7% to 70.6%). The prevalence of hypoxaemia and hypercapnia was 37.9% and 25.9%, respectively. Multiple regression analysis showed that the supine fall in FEV1 was the only variable associated with ventilatory restriction, hypoxaemia and hypercapnia. Our data indicate that supine evaluation of lung function could be helpful to predict poor respiratory outcome, which is closely correlated with hypoxaemia and/or hypercapnia.
Collapse
Affiliation(s)
- Mathias Poussel
- Department of Pulmonary Function Testing and Exercise Testing, CHU Nancy, Nancy F-54000, France; EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory regulations and motor control, Université de Lorraine, F-54000, France.
| | - Pierre Kaminsky
- Department of Internal Medicine and Orphan Diseases, CHU Nancy, Nancy F-54000, France; Reference Centre in Inherited Metabolism Diseases, CHU Nancy, Nancy F-54000, France
| | - Pierre Renaud
- Department of Pulmonary Function Testing and Exercise Testing, CHU Nancy, Nancy F-54000, France; EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory regulations and motor control, Université de Lorraine, F-54000, France
| | - Julien Laroppe
- Department of Pulmonary Function Testing and Exercise Testing, CHU Nancy, Nancy F-54000, France; EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory regulations and motor control, Université de Lorraine, F-54000, France
| | - Lelia Pruna
- Department of Internal Medicine and Orphan Diseases, CHU Nancy, Nancy F-54000, France; Reference Centre in Inherited Metabolism Diseases, CHU Nancy, Nancy F-54000, France
| | - Bruno Chenuel
- Department of Pulmonary Function Testing and Exercise Testing, CHU Nancy, Nancy F-54000, France; EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory regulations and motor control, Université de Lorraine, F-54000, France
| |
Collapse
|
4
|
Louprasong AC, Light DJ, Diller RS. Spider dystrophy as an ocular manifestation of myotonic dystrophy. ACTA ACUST UNITED AC 2010; 81:188-93. [PMID: 20346890 DOI: 10.1016/j.optm.2009.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2009] [Accepted: 08/13/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Myotonic dystrophy is the most common adult-onset muscular dystrophy. It is an autosomal dominant inherited neuromuscular disease that is characterized by myotonia, muscle weakness, and atrophy. It affects multiple systems including skeletal muscular, gastrointestinal, cardiac, respiratory, central nervous, endocrine, and ocular. Ocular manifestations of myotonic dystrophy include cataract, ocular muscle changes, hypotony, and retinal pigmentary changes in the periphery or in the macula (known as pigment pattern dystrophy). This report presents and discusses the case of a pigmented pattern dystrophy known as spider dystrophy as an ocular manifestation of myotonic dystrophy. CASE REPORT A 44-year-old man with myotonic dystrophy presented to the eye clinic for routine examination. Ocular history included previous bilateral cataract surgery and mild bilateral ptosis for the last "few years." Dilated fundus examination was remarkable for bilateral macular pigmentary changes in an irregular "spider"-shaped pattern. The patient was asymptomatic without decrease in vision or Amsler grid defects. Optical coherence tomography was normal. A retinal consult concurred with the diagnosis of spider dystrophy. Photo documentation was obtained, and the patient is being monitored annually. CONCLUSION Pigmented pattern dystrophies, including spider dystrophy, have been associated with myotonic dystrophy. They are set apart from other retinal dystrophies because they rarely affect visual acuity, and the majority of patients are asymptomatic. Progression may lead to reduced vision and in rare cases choroidal neovascularization. Annual dilated examinations, photo documentation, optical coherence tomography, and home Amsler grid monitoring are recommended for follow-up care.
Collapse
Affiliation(s)
- Amber C Louprasong
- Dayton Veterans Affairs Medical Center, Optometry, Dayton, Ohio 45428, USA.
| | | | | |
Collapse
|
5
|
Nitz J, Burke B. A study of the facilitation of respiration in myotonic dystrophy. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2003; 7:228-38. [PMID: 12528578 DOI: 10.1002/pri.262] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Dystrophia myotonica or myotonic dystrophy is a progressive neuromuscular disorder in which patients demonstrate an irregular respiratory pattern and are particularly subject to cardiopulmonary compromise. The aim of the present study was to investigate the effects of both proprioceptive neuromuscular facilitation (PNF) and staged basal expansion (SBE) breathing exercises in subjects with myotonic dystrophy in two different positions: high support sitting and left side-lying. METHOD A randomized, double-blind study design was used. Seven non-congenital myotonic dystrophy subjects took part in the study. Six 'treatment' levels were applied to each subject: resting in high support sitting; resting in left side-lying; PNF of deep breathing in high support sitting; PNF of deep breathing in left side-lying; SBE in high support sitting and SBE in left side-lying. The outcome measures employed were arterial oxygen saturation (SpO2) and heart rate, as measured by oximetry and thoraco-abdominal motion (TAM), and respiratory rate, as measured by a pneumograph. RESULTS The PNF technique was found to be the main contributor to improvement in SpO2 for subjects with myotonic dystrophy, where a 2.2% increase was found in the high support sitting position and a 2.6% increase was found in the left side-lying position. There was an increase of between 377% and 556% in TAM during application of both treatment techniques, in either the high support sitting or left side-lying positions. Respiratory rate declined between 15% and 30% immediately after treatment application and heart rate dropped slightly by between 0.2% and 4.1%. CONCLUSION The present study provides objective evidence that application of these respiratory physiotherapy interventions elicits an improvement in respiratory function in subjects with myotonic dystrophy. Further research into the physiological effects of these techniques could explore the mechanisms responsible for improvement in respiratory indices.
Collapse
Affiliation(s)
- Jennifer Nitz
- Department of Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | | |
Collapse
|
6
|
Sleep breathing abnormalities in neuromuscular diseases. Sleep 2003. [DOI: 10.1007/978-1-4615-0217-3_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|