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Abstract
Autoimmune neurogenic dysphagia refers to manifestation of dysphagia due to autoimmune diseases affecting muscle, neuromuscular junction, nerves, roots, brainstem, or cortex. Dysphagia is either part of the evolving clinical symptomatology of an underlying neurological autoimmunity or occurs as a sole manifestation, acutely or insidiously. This opinion article reviews the autoimmune neurological causes of dysphagia, highlights clinical clues and laboratory testing that facilitate early diagnosis, especially when dysphagia is the presenting symptom, and outlines the most effective immunotherapeutic approaches. Dysphagia is common in inflammatory myopathies, most prominently in inclusion body myositis, and is frequent in myasthenia gravis, occurring early in bulbar-onset disease or during the course of progressive, generalized disease. Acute-onset dysphagia is often seen in Guillain–Barre syndrome variants and slowly progressive dysphagia in paraneoplastic neuropathies highlighted by the presence of specific autoantibodies. The most common causes of CNS autoimmune dysphagia are demyelinating and inflammatory lesions in the brainstem, occurring in patients with multiple sclerosis and neuromyelitis optica spectrum disorders. Less common, but often overlooked, is dysphagia in stiff-person syndrome especially in conjunction with cerebellar ataxia and high anti-GAD autoantibodies, and in gastrointestinal dysmotility syndromes associated with autoantibodies against the ganglionic acetyl-choline receptor. In the setting of many neurological autoimmunities, acute-onset or progressive dysphagia is a potentially treatable condition, requiring increased awareness for prompt diagnosis and early immunotherapy initiation.
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Izumi M, Sonoki K, Ohta Y, Fukuhara M, Nagata M, Akifusa S. Tongue cleaning maintains respiratory function in older individuals: A 1-year randomised controlled trial. J Oral Rehabil 2021; 48:730-737. [PMID: 33687734 DOI: 10.1111/joor.13165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this 1-year longitudinal randomised controlled trial was to evaluate the effectiveness of tongue cleaning on the maintenance of respiratory function in older adults requiring care. METHODS The participants included 24 residents of two nursing homes in Kitakyushu, Japan. The participants were randomised to receive tongue cleaning with routine oral care (intervention group, n = 12), or routine oral care alone (control group, n = 12). Among the participants, three in the intervention group and four in the control group had cerebrovascular disease history, four in the intervention group and four in the control group had a history of cardiac disease, and five in the intervention group and four in the control group were without medical history. Respiratory function was assessed on the basis of the peak expiratory flow rate (PEFR). Tongue pressure, swallowing function, oral health status, activities of daily living and nutritional status were also measured at baseline and at the end of the 1-year follow-up period. RESULTS The number of analysed participants in each group was 12. In the control group, the PEFR (1.6 [0.4-4.2] L s-1 vs 1.4 [0.4-3.2] L s-1 , P = .034) and tongue pressure (16.4 [1.7-35.2] kPa vs 8.0 [1.4-38.6] kPa, P = .032) significantly declined after 1-year. However, the PEFR (1.5 [0.8-2.9] L s-1 vs 1.6 [0.7-4.2] L s-1 , P = .366) and tongue pressure (18.1 [4.2-37.1] kPa vs 16.1 [5.2-41] kPa, P = .307) were maintained in the intervention group. The change in the PEFR was significantly greater in the intervention group compared with the control group (0.130 [-0.45-1.70] L s-1 vs -1.70 [-10.00-10.00] L s-1 , P = .028). CONCLUSION Our findings suggest that tongue cleaning may help maintain tongue and respiratory function in older adults requiring care.
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Affiliation(s)
- Maya Izumi
- Faculty of Dentistry, School of Oral Health Sciences, Kyushu Dental University, Kitakyushu, Japan
| | - Kazuo Sonoki
- Faculty of Dentistry, School of Oral Health Sciences, Kyushu Dental University, Kitakyushu, Japan
| | - Yuko Ohta
- Division of Comprehensive Internal Medicine, Faculty of Dentistry, Kyushu Dental University, Kitakyushu, Japan
| | - Masayo Fukuhara
- Division of Comprehensive Internal Medicine, Faculty of Dentistry, Kyushu Dental University, Kitakyushu, Japan
| | | | - Sumio Akifusa
- Faculty of Dentistry, School of Oral Health Sciences, Kyushu Dental University, Kitakyushu, Japan
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Curtis JA, Laus J, Schneider SL, Troche MS. Examining the Relationships Between Lingual Strength, Perihyoid Strength, and Swallowing Kinematics in Dysphagic Adults: A Retrospective Cross-Sectional Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:405-416. [PMID: 33439740 DOI: 10.1044/2020_jslhr-20-00143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose The aim of this study was to examine the relationships of clinical measures of lingual and perihyoid strength with displacement swallowing kinematics and swallowing safety in a heterogenous group of dysphagic adults. Method A retrospective analysis was completed of videofluoroscopic swallow studies of consecutive dysphagic outpatient adults presenting to a tertiary swallowing center from January 1, 2015, to December 31, 2017. Videofluoroscopic swallow study records were included if containing displacement swallowing kinematics of a 20-ml single liquid swallow and clinical measures of anterior (L-MIPA) or posterior (L-MIPP) lingual maximal isometric press, saliva mean swallowing pressures (S-MSP), and/or open mouth-maximal isometric press (OM-MIP). Regression analyses were used to examine the relationships between clinical measures of lingual (L-MIPA, L-MIPP, S-MSP) and perihyoid (OM-MIP) strength and displacement swallowing kinematics, and binomial logistic regressions were used to examine the relationships between clinical measures of lingual and perihyoid strength and swallowing safety (Penetration-Aspiration Scale [PAS]). Results Multivariate regressions revealed significant relationships of L-MIPA, L-MIPP, S-MSP, and OM-MIP with group-level changes to the displacement swallowing kinematics. Univariate analyses revealed significant relationships of L-MIPA and L-MIPP with pharyngeal constriction ratio, maximal extent of upper esophageal segment opening, and PAS. Conclusions Weak relationships were identified of clinical measures of lingual and perihyoid strength with displacement swallowing kinematics. These findings suggest that clinical measures of lingual and perihyoid strength do not fully explain impairments in swallowing kinematics across a heterogenous group of dysphagic patients. Weak-to-moderate relationships were identified between clinical measures of lingual strength and PAS, suggesting that they may have value in predicting functional measures of swallowing safety. Further research is needed to examine how findings may differ between specific patient populations.
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Affiliation(s)
- James A Curtis
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Joey Laus
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Sarah L Schneider
- UCSF Voice and Swallowing Center, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
| | - Michelle S Troche
- Laboratory for the Study of Upper Airway Dysfunction, Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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Crary MA. Adult Neurologic Disorders. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00004-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ning P, Yang B, Yang X, Zhao Q, Huang H, Shen Q, Lu H, Tian S, Xu Y. A nomogram to predict mechanical ventilation in Guillain-Barré syndrome patients. Acta Neurol Scand 2020; 142:466-474. [PMID: 32497277 DOI: 10.1111/ane.13294] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/17/2020] [Accepted: 05/31/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is one of the most common causes of acute flaccid paralysis, with up to 20%-30% of patients requiring mechanical ventilation. The aim of our study was to develop and validate a mechanical ventilation risk nomogram in a Chinese population of patients with GBS. METHODS A total of 312 GBS patients were recruited from January 1, 2015, to June 31, 2018, of whom 17% received mechanical ventilation. The least absolute shrinkage and selection operator (LASSO) regression model was used to select clinicodemographic characteristics and blood markers that were then incorporated, using multivariate logistic regression, into a risk model to predict the need for mechanical ventilation. The model was characterized and assessed using the C-index, calibration plot, and decision curve analysis. The model was validated using bootstrap resampling in a prospective study of 114 patients recruited from July 1, 2018, to July 10, 2019. RESULTS The predictive model included hospital stay, glossopharyngeal and vagal nerve deficits, Hughes functional grading scale scores at admission, and neutrophil/lymphocyte ratio (NLR). The model showed good discrimination with a C-index value of 0.938 and good calibration. A high C-index value of 0.856 was reached in the validation group. Decision curve analysis demonstrated the clinical utility of the mechanical ventilation nomogram. CONCLUSIONS A nomogram incorporating hospital stay, glossopharyngeal and vagal nerve deficits, Hughes functional grading scale scores at admission, and NLR may reliably predict the probability of requiring mechanical ventilation in GBS patients.
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Affiliation(s)
- Pingping Ning
- Department of Neurology West China HospitalSichuan University Chengdu P.R. China
| | - Baiyuan Yang
- Department of Neurology Seventh People’s Hospital of Chengdu Chengdu P.R. China
| | - Xinglong Yang
- Department of Geriatric Neurology First Affiliated Hospital of Kunming Medical University Kunming P.R. China
| | - Quanzhen Zhao
- Department of Neurology West China HospitalSichuan University Chengdu P.R. China
| | - Hongyan Huang
- Department of Neurology West China HospitalSichuan University Chengdu P.R. China
| | - Qiuyan Shen
- Department of Neurology West China HospitalSichuan University Chengdu P.R. China
| | - Haitao Lu
- Department of Neurology West China HospitalSichuan University Chengdu P.R. China
| | - Sijia Tian
- Department of Neurology West China HospitalSichuan University Chengdu P.R. China
| | - Yanming Xu
- Department of Neurology West China HospitalSichuan University Chengdu P.R. China
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Khanna M, Rawat N, Gupta A, Nagappa M, Taly AB, Rukmani MR, Sathyaprabha TN, Haldar P. Pulmonary Involvement in Patients with Guillain-Barré Syndrome in Subacute Phase. J Neurosci Rural Pract 2019; 8:412-416. [PMID: 28694622 PMCID: PMC5488563 DOI: 10.4103/jnrp.jnrp_11_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate the pulmonary function in Guillain-Barre syndrome (GBS) patients in subacute phase and find clinical correlates of pulmonary dysfunction. METHODS This was a single-center, prospective, cross-sectional, hospital-based study in GBS patients performed in Department of Neurological Rehabilitation at a tertiary care institute. Clinical examination for pulmonary function was done by measuring chest expansion. The pulmonary function tests were carried out by Spirometry kit Microquark Cosmed, Italy. Fatigue was assessed by Fatigue Severity Scale, disability status by Hughes Disability Scale (HDS), and muscle weakness by Medical Research Council sum scores. STATISTICAL ANALYSIS Statistical analysis was performed by Stata 11. The significance of P value was adjudged against an alpha of 0.05. RESULTS Twenty-eight patients were included with 17 (61%) men and mean age of 31 years. Median duration of symptoms was 16.5 days. There were 10 (36%) demyelinating and 18 (64%) axonal variants. Twenty-six (93%) patients scored more than 2 on HDS. All study participants reported fatigue. Twenty-two (78.6%) patients had chest expansion of <2.5 cm. Spirometry showed restrictive pulmonary dysfunction in 23 (79%) patients. Significant correlation was found between abnormal pulmonary function test and chest expansion (P = 0.003). CONCLUSION Pulmonary dysfunction in GBS is common even during subacute phase. It needs to be identified and managed appropriately for better clinical outcome.
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Affiliation(s)
- Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nidhi Rawat
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Madhu Nagappa
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arun B Taly
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - M R Rukmani
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - T N Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Dysglycemia and Neurologic Outcome in Mechanically Ventilated Patients With Guillain-Barré Syndrome. Crit Care Med 2019; 47:e227-e233. [DOI: 10.1097/ccm.0000000000003635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Schröder JB, Marian T, Muhle P, Claus I, Thomas C, Ruck T, Wiendl H, Warnecke T, Suntrup-Krueger S, Meuth S, Dziewas R. Intubation, tracheostomy, and decannulation in patients with Guillain-Barré-syndrome-does dysphagia matter? Muscle Nerve 2018; 59:194-200. [PMID: 30390307 DOI: 10.1002/mus.26377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/18/2018] [Accepted: 10/28/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Although patients with Guillain-Barré syndrome frequently require orotracheal intubation and tracheostomy, the incidence and relevance of neurogenic dysphagia prior to intubation and risk factors for prolonged requirement for a tracheal cannula have not yet been identified. METHODS Retrospective analysis of the medical records of 88 patients was performed. Clinical characteristics were compared between intubated and nonintubated patients and between immediately decannulated and not immediately decannulated patients. RESULTS Thirty-five (39.7%) patients required tracheostomy. Neuromuscular weakness and related respiratory insufficiency were the main reasons for intubation. In the subgroup of tracheotomized patients, immediate decannulation after completed respiratory weaning was possible in 14 (40%) patients. The severity of dysphagia, in particular pharyngolaryngeal hypesthesia, was related to the length of cannulation. DISCUSSION Respiratory muscle weakness is the main reason for intubation, whereas neurogenic dysphagia is the main risk factor for persisting cannulation. Dysphagia after weaning is most frequently characterized by severe laryngeal sensory deficit. Muscle Nerve 59:194-200, 2019.
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Affiliation(s)
- Jens Burchard Schröder
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Thomas Marian
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Paul Muhle
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Inga Claus
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Christian Thomas
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Tobias Ruck
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Tobias Warnecke
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Sven Meuth
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Albert Schweitzer Campus 1, Building A1, 48149, Münster, Germany
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Liu S, Xiao Z, Lou M, Ji F, Shao B, Dai H, Luo C, Hu B, Zhou R, Zou Z, Li J, Li X, Xu J, Hu F, Qin C, Wang L, Liu T, Bai R, Chen Y, Lv H, Zhang R, Wang X, Wang Y, Ren S, He X, Jiang Z, Wu H, Yu D, Yang W, Luo W, Gong D, Chen B, Liu Y, Yao J, Yang Y, Guan J, Zhu M, Fu X, Gao G, Zhang H, Ding M, Fan S, Cao Q, Lu J, Lu Z. Guillain-Barré syndrome in southern China: retrospective analysis of hospitalised patients from 14 provinces in the area south of the Huaihe River. J Neurol Neurosurg Psychiatry 2018; 89:618-626. [PMID: 29326294 DOI: 10.1136/jnnp-2017-316930] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/02/2017] [Accepted: 11/22/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The clinical and epidemiological profiles of Guillain-Barré syndrome (GBS) in southern China have yet to be fully recognised. We aimed to investigate the subtypes of GBS in southern China, compare the clinical features of demyelinating form with that of axonal form and test whether preceding infections and age have influence on the clinical phenotype, disease course and severity of GBS. METHODS Medical records of patients with a diagnosis of GBS admitted to 31 tertiary hospitals, located in 14 provinces in southern China, from 1 January 2013 to 30 September 2016, were collected and retrospectively reviewed. RESULTS Finally. 1056 patients, including 887 classic GBS and 169 variants, were enrolled. The 661 classic patients with available electromyographic data were grouped as having acute inflammatory demyelinating polyneuropathy (AIDP, 49.0%), acute motor axonal neuropathy (AMAN, 18.8%), inexcitable (0.9%) and equivocal (31.3%). In contrast to AIDP, patients with AMAN were characterised by earlier nadir (P=0.000), higher Hughes score at nadir (P=0.003) and at discharge (P=0.000). Preceding upper respiratory infections were identified in 369 (34.9%) patients, who were more inclined to develop AIDP (P=0.000) and Miller-Fisher syndrome (P=0.027), whereas gastrointestinal infection were found in 89 (8.4%) patients, who were more prone to develop AMAN (P=0.000), with more severe illness (P=0.001) and longer hospital stay (P=0.009). Children (≤15 years) and the elderly (≥56 years) were more severe at nadir, the elderly had the longest hospital stay (P=0.023). CONCLUSION AIDP is the predominant form in southern China, which is different from data of northern China. The different subtypes, preceding infection and age of onset can partially determine the disease progression, severity and short-term recovery speed of GBS. CLINICAL TRIAL REGISTRATION ChiCTR-RRC-17014152.
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Affiliation(s)
- Shuping Liu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zheman Xiao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Fang Ji
- Department of Neurology, First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Bei Shao
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongyuan Dai
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Can Luo
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruiling Zhou
- Department of Neurology, Fujian Provincial Hospital, Fuzhou, China
| | - Zhangyu Zou
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jing Li
- Department of Neurology, Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoyi Li
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jun Xu
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Fan Hu
- Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China
| | - Chao Qin
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lian Wang
- Department of Geriatric Medicine, Kunming General Hospital of PLA, Kunming, China
| | - Tao Liu
- Department of Neurology, Hainan General Hospital, Haikou, China
| | - Runtao Bai
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyan Lv
- Department of Neurology, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai, China
| | - Ruxu Zhang
- Department of Neurology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaoming Wang
- Department of Neurology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yunfu Wang
- Department of Neurology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Shanling Ren
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoming He
- Department of Neurology, Xiangyang Central Hospital, Hubei University of Arts and Science, Xiangyang, China
| | - Zhenwei Jiang
- Department of Neurology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Huiwen Wu
- Department of Neurology, The First People's Hospital Of Yichang, China Three Gorges University, Yichang, China
| | - Donghui Yu
- Department of Neurology, XianNing Central hospital, The First Affiliated Hospital of Hubei University of Science and Technology, XianNing, China
| | - Wenqiong Yang
- Department of Neurology, Dongfeng General Hospital of Hubei University of Medicine, Shiyan, China
| | - Wenjing Luo
- Department of Neurology, Wuhan General Hospital of PLA, Wuhan, China
| | - Daokai Gong
- Department of Neurology, Jingzhou Central Hospital, Tongji Medical College, Huazhong University of Science Technology, Jingzhou, China
| | - Bin Chen
- Department of Neurology, Jingmen No. 1 People's Hospital, Jingmen, China
| | - Yin Liu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiajia Yao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yujie Yang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingxia Guan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Mingzhen Zhu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiujuan Fu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Genshan Gao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hong Zhang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Man Ding
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shanghua Fan
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qian Cao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingyi Lu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zuneng Lu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
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Ogna A, Prigent H, Lejaille M, Samb P, Sharshar T, Annane D, Lofaso F, Orlikowski D. Swallowing and swallowing-breathing interaction as predictors of intubation in Guillain-Barré syndrome. Brain Behav 2017; 7:e00611. [PMID: 28239521 PMCID: PMC5318364 DOI: 10.1002/brb3.611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/21/2016] [Accepted: 10/21/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Bulbar weakness and respiratory impairment have been associated with increased morbidity in retrospective studies of Guillain-Barré syndrome (GBS) patients. The aim of this study was to prospectively explore the relationship between subclinical swallowing impairment, respiratory function parameters, the necessity to intubate patients and the development of early postintubation pneumonia in patients with GBS in the intensive care unit (ICU). METHODS Respiratory, swallowing, and tongue strength parameters were measured in 30 consecutive adults (51.7 ± 18.1 years old), hospitalized for GBS in the ICU of a teaching hospital. Twenty healthy volunteers were recruited as a control group. The primary outcomes were intubation and pneumonia during the ICU stay. RESULTS Nineteen patients (65.5%) had piecemeal swallowing, and 19 (65.5%) had impaired breathing-swallowing interaction, of which, respectively, 47.4% and 52.6% had a clinically apparent swallowing impairment. Swallowing impairment was associated with lower values of respiratory function, but not with peripheral motor weakness. Tongue protrusion strength was correlated with respiratory parameters and swallowing impairment. Ten patients were intubated and six developed pneumonia. Age, BMI, severe axial involvement, respiratory parameters (vital capacity and respiratory muscle strength), tongue protrusion strength, and clinical swallowing impairment were predictors of intubation. CONCLUSIONS Swallowing impairment was present early after ICU admission in over 80% of patients and was an important predictor of intubation. A systematic clinical evaluation of swallowing should be carried out, eventually combined with an evaluation of tongue protrusion strength, along with the usual assessment of neurological and respiratory function, to determine the severity of the GBS.
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Affiliation(s)
- Adam Ogna
- Service de Réanimation médicale et unité de ventilation à domicile Hôpital Raymond Poincaré Garches France
| | - Helene Prigent
- Service de Physiologie-Explorations Fonctionnelles Hôpital Raymond Poincaré Garches France
| | | | - Patricia Samb
- Unité de Recherche Clinique Paris Ouest Département d'Information Hospitalière et de Santé Publique Hôpital Ambroise-Paré Boulogne France
| | - Tarek Sharshar
- Service de Réanimation médicale et unité de ventilation à domicile Hôpital Raymond Poincaré Garches France
| | - Djillali Annane
- Service de Réanimation médicale et unité de ventilation à domicile Hôpital Raymond Poincaré Garches France
| | - Frederic Lofaso
- Service de Physiologie-Explorations Fonctionnelles Hôpital Raymond Poincaré Garches France
| | - David Orlikowski
- Service de Réanimation médicale et unité de ventilation à domicile Hôpital Raymond Poincaré Garches France; INSERM CIC 14.29 Hôpital Raymond Poincaré Garches France
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Crary MA. Adult Neurologic Disorders. Dysphagia 2016. [DOI: 10.1016/b978-0-323-18701-5.00003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wu X, Li C, Zhang B, Shen D, Li T, Liu K, Zhang HL. Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndrome. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:310. [PMID: 26330143 PMCID: PMC4557605 DOI: 10.1186/s13054-015-1037-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/16/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system. Respiratory failure requiring mechanical ventilation (MV) is a serious complication of GBS. Identification of modifiable risk factors for MV and poor short-term prognosis in mechanically ventilated patients with GBS may contribute to the individualized management and may help improve the outcome of the patients. METHODS We retrospectively analyzed the clinical data of 541 patients who were diagnosed with GBS from 2003 to 2014. Independent predictors for MV and short-term prognosis in mechanically ventilated patients were identified via multivariate logistic regression analysis. RESULTS The mean age was 41.6 years with a male predilection (61.2%). Eighty patients (14.8%) required MV. Multivariate analysis revealed that shorter interval from onset to admission (p < 0.05), facial nerve palsy (p < 0.01), glossopharyngeal and vagal nerve deficits (p < 0.01) and lower Medical Research Council (MRC) sum score at nadir (p < 0.01) were risk factors for MV; disease occurrence in summer (p < 0.01) was a protective factor. As to prognostic factors, absence of antecedent infections (p < 0.01) and lower MRC sum score at nadir (p < 0.01) were predictors of poor short-term prognosis in mechanically ventilated patients regardless of treatment modality. We further investigated the predictors of poor short-term prognosis in patients requiring MV with different nadir MRC sum scores. Combined use of intravenous corticosteroids with intravenous immunoglobulin (odds ratio 10.200, 95% confidence interval 1.068-97.407, p < 0.05) was an independent predictor of poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points, regardless of existence of antecedent infection. CONCLUSIONS Clinical predictors of MV and poor short-term prognosis in mechanically ventilated GBS patients were distinct. Add-on use of intravenous corticosteroids was a risk factor for poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points.
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Affiliation(s)
- Xiujuan Wu
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China.
| | - Chunrong Li
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China.
| | - Bing Zhang
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China.
| | - Donghui Shen
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China.
| | - Ting Li
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China.
| | - Kangding Liu
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China.
| | - Hong-Liang Zhang
- Neuroscience Center, Department of Neurology, the First Hospital of Jilin University, Jilin University, Xinmin Street 71#, 130021, Changchun, China. .,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
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Wolfe LF, Patwari PP, Mutlu GM. Sleep Hypoventilation in Neuromuscular and Chest Wall Disorders. Sleep Med Clin 2014. [DOI: 10.1016/j.jsmc.2014.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Terzi N, Piquilloud L, Rozé H, Mercat A, Lofaso F, Delisle S, Jolliet P, Sottiaux T, Tassaux D, Roesler J, Demoule A, Jaber S, Mancebo J, Brochard L, Richard JCM. Clinical review: Update on neurally adjusted ventilatory assist--report of a round-table conference. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:225. [PMID: 22715815 PMCID: PMC3580602 DOI: 10.1186/cc11297] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Conventional mechanical ventilators rely on pneumatic pressure and flow sensors and controllers to detect breaths. New modes of mechanical ventilation have been developed to better match the assistance delivered by the ventilator to the patient's needs. Among these modes, neurally adjusted ventilatory assist (NAVA) delivers a pressure that is directly proportional to the integral of the electrical activity of the diaphragm recorded continuously through an esophageal probe. In clinical settings, NAVA has been chiefly compared with pressure-support ventilation, one of the most popular modes used during the weaning phase, which delivers a constant pressure from breath to breath. Comparisons with proportional-assist ventilation, which has numerous similarities, are lacking. Because of the constant level of assistance, pressure-support ventilation reduces the natural variability of the breathing pattern and can be associated with asynchrony and/or overinflation. The ability of NAVA to circumvent these limitations has been addressed in clinical studies and is discussed in this report. Although the underlying concept is fascinating, several important questions regarding the clinical applications of NAVA remain unanswered. Among these questions, determining the optimal NAVA settings according to the patient's ventilatory needs and/or acceptable level of work of breathing is a key issue. In this report, based on an investigator-initiated round table, we review the most recent literature on this topic and discuss the theoretical advantages and disadvantages of NAVA compared with other modes, as well as the risks and limitations of NAVA.
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Orlikowski D, Porcher R, Sivadon-Tardy V, Quincampoix JC, Raphael JC, Durand MC, Sharshar T, Roussi J, Caudie C, Annane D, Rozenberg F, Leruez-Ville M, Gaillard JL, Gault E. Guillain-Barre Syndrome following Primary Cytomegalovirus Infection: A Prospective Cohort Study. Clin Infect Dis 2011; 52:837-44. [DOI: 10.1093/cid/cir074] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Measures of bulbar and spinal motor function, muscle innervation, and mitochondrial function in ALS rats. Behav Brain Res 2010; 211:48-57. [PMID: 20211206 DOI: 10.1016/j.bbr.2010.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 02/19/2010] [Accepted: 03/02/2010] [Indexed: 01/31/2023]
Abstract
Symptom onset in amyotrophic lateral sclerosis (ALS) may occur in the muscles of the limbs (spinal onset) or those of the head and neck (bulbar onset). Most preclinical studies have focused on spinal symptoms, despite the prevalence of and increased morbidity and mortality associated with bulbar disease. We measured lick rhythm and tongue force to evaluate bulbar disease in the SOD1-G93A rat model of familial ALS. Body weight and grip strength were measured concomitantly. Testing spanned the early (maturation), middle (pre-symptomatic), and late (symptomatic and end-stage) phases of the disease. We measured a persistent tongue motility deficit that became apparent in the early phase of the disease, providing behavioral evidence of bulbar pathology. At end-stage, however, cytochrome oxidase (CO) activity was normal in the hypoglossal nucleus, and in the tongue, neuromuscular innervation, citrate synthase (CS) protein levels and activity, and uncoupling protein 3 (UCP3) protein levels remained unchanged. Interestingly, significant denervation and atrophy were evident in the end-stage sternomastoid muscle, providing peripheral anatomical evidence of bulbar pathology. Changes in body weight and grip strength occurred in the late phase of the disease. Extensive atrophy and denervation were observed in the end-stage gastrocnemius muscle. In contrast to our findings in the tongue, CS protein levels were decreased in the extensor digitorum longus (EDL) and soleus, although CS activity was maintained or increased. UCP3 protein was decreased also in the EDL. These data provide evidence of differential effects in muscles that were more or less affected by disease.
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