|
|
The association between clinical defects and ventilatory functions parameters in patients with multiple sclerosis
|
|
Noha Abo-Krysha1, Sahar Farahat2
|
|
Departments of Neurology1, Occupational Medicine2, Cairo University
|
ABSTRACT
|
|
Background: The respiratory motor pathways may be involved in multiple sclerosis because of the multi-focal nature of central nervous system affection in such disease, leading to respiratory muscle weakness (predominately expiratory muscles involvement), producing a restrictive ventilatory defect. Materials & Methods: Clinical pulmonary dysfunction index, Kurtzke MS rating scales, fatigue severity scale (FSS), fatigue descriptive scale (FDS) and Pulmonary function tests evaluated by means of a battery of measures, (including maximal voluntary ventilation (MVV), forced vital capacity (FVC), forced expiratory volume (FEV1) were used in 28 Egyptian patients with definite MS. Result: The clinical pulmonary dysfunction index was positive (abnormal) in 16 (57.1%) subjects [10 subjects (35.7%) with secondary progressive type and 6 subjects (21.4%) with relapsing remitting type]. Statistically significant positive correlations were found between the index and EDSS scores; FSS scores; and FDS scores. Statistically significant positive correlations were also found between cerebellum, brain stem, bladder and cerebral dysfunctions and pulmonary dysfunction index. Mean values of MVV (58.75percent ±16.77), FVC (72 percent ± 20.17) and FEV1 (77 percent ± 20.64), were lower than normal in our patients. The Respiratory function tests (MVV, FEV1, FVC) were significantly lower in secondary progressive MS than relapsing MS patients (33±0 vs. 67.33±6.3, p=0.001; 46±0 vs. 87.33±9.1, p=0.001; 42±0 vs. 82±9.4, p=0.001 respectively). Statistically significant negative correlations were found between the Respiratory function tests and; EDSS scores; FSS scores; and FDS scores. Statistically significant negative correlations were found between pyramidal and sensory dysfunctions and respiratory function tests (FVC, FEV1, and MVV). Statistically significant negative correlation was found between brainstem dysfunction and FVC. Statistically highly significant negative correlation was found between cerebellum dysfunction and FEV1/FVC. There was also a trend wise significant negative correlation was found between bladder dysfunction and FVC. Also trend wise significant negative correlations were found between brainstem, cerebral dysfunctions and MVV. Pulmonary function tests (FVC, FEV1, and MVV) were negatively correlated with FSS and FDS scores; and this may establish a physiological basis to multiple sclerosis-related fatigue. Those patients with medullary lesions (n=6, (21.4%); showed positive correlation with clinical pulmonary dysfunction index (p=0.01); and negative correlation with MVV(P=-0.04), FEV1(P=-0.04)and FVC (P=-0.04)). Also, those with pontine lesion (n=4, (14.3%)) showed trend wise positive correlation with pulmonary dysfunction index (p=0.06); and negative correlation with FEV1/FVC (P=-0.04).Those with periventricular lesions (n=22, 78.6%) showed negative correlation with FEV1/FVC (P=-0.01). Conclusion: It is concluded that impaired respiration in some MS patients is related to central defects, bladder dysfunction is associated with disturbed pulmonary function, almost certainly because the micturition and pneumotaxic center are closely related and severe cerebellar signs in patients with MS were related to a risk of occurrence of respiratory impairment. MS lesions in the brain stem can also interrupt the motor pathway to phrenic, intercostal and accessory respiratory muscle nerves. Therefore, respiratory dysfunctions were linked to brain stem disorder. Pyramidal dysfunction is associated with disturbed pulmonary function, because pathology in the corticospinal cord may produce not only paralysis of the limbs, but also weakness of the respiratory truncal muscles. Pulmonary function tests (FVC, FEV1, and MVV) were negatively correlated with FSS and FDS scores; and this may establish a physiological basis to multiple sclerosis-related fatigue This necessitates inclusion of respiratory function evaluation in clinical examination protocols of patients with MS to guide early intervention efforts. (Egypt J. Neurol. Psychiat. Neurosurg., 2007, 44(2): 449-459)
|
|
|