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Neuromuscular Disorders in the ICU

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Textbook of Neurointensive Care

Abstract

Neuromuscular diseases are conditions of the motor unit affecting the nervous system, inclusively between the anterior horn cells and the muscle. The occurrence of some of these conditions can lead to admission to the intensive care unit (ICU): weakness can impair breathing and disrupt airway protection. Many neuromuscular diseases are also associated with autonomic instability. Furthermore, critically ill patients may develop neuromuscular involvement as a consequence of long ICU stays. In this chapter, we describe a general approach to the problems of the neuromuscular disease in the neurological ICU.

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References

  1. Logan LR. Rehabilitation techniques to maximize spasticity management. Top Stroke Rehabil. 2011;18(3):203–11.

    Article  PubMed  Google Scholar 

  2. Campbell WW. DeJong’s the neurologic examination. Philadelphia: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  3. Walker HK. The plantar reflex. In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations. 3rd ed. Boston: Butterworths; 1990, Chapter 73.

    Google Scholar 

  4. Barohn RJ. Approach to peripheral neuropathy and neuronopathy. Semin Neurol. 1998;18(1):7–18.

    Article  PubMed  CAS  Google Scholar 

  5. England JD, Asbury AK. Peripheral neuropathy. Lancet. 2004;363:2151.

    Article  PubMed  Google Scholar 

  6. Ropper AH, Samuels MA. Chapter 46. Diseases of the peripheral nerves. In: Ropper AH, Samuels MA, editors. Adams and Victor’s principles of neurology, 9e. 2009. http://www.accessmedicine.com/content.aspx?aID=3641268.

  7. Amato AA, Russell JA. Neuromuscular disorders. New York: McGraw-Hill; 2008.

    Google Scholar 

  8. Engel AG, Franzini-Armstrong C, editors. Myology. 3rd ed. New York: McGraw-Hill; 2004.

    Google Scholar 

  9. Smith EC, El-Gharbawy A, Koeberl DD. Metabolic myopathies: clinical features and diagnostic approach. Rheum Dis Clin North Am. 2011;37(2):201–17, vi.

    Article  PubMed  Google Scholar 

  10. Amato AA, Griggs RC. Overview of the muscular dystrophies. Handb Clin Neurol. 2011;101:1–9.

    Article  PubMed  Google Scholar 

  11. Ashizawa T, Sarkar PS. Myotonic dystrophy types 1 and 2. Handb Clin Neurol. 2011;101:193–237.

    Article  PubMed  Google Scholar 

  12. Meininger V. ALS, what new 144 years after Charcot? Arch Ital Biol. 2011;149(1):29–37.

    PubMed  Google Scholar 

  13. Alexopoulos H, Dalakas MC. A critical update on the immunopathogenesis of Stiff Person Syndrome. Eur J Clin Invest. 2010;40(11):1018–25.

    Article  PubMed  CAS  Google Scholar 

  14. Reisner-Sénélar L. The birth of intensive care medicine: Björn Ibsen’s records. Intensive Care Med. 2011;37(7):1084–6.

    Article  PubMed  Google Scholar 

  15. Wilcox PG, Pardy RL. Diaphragmatic weakness and paralysis. Lung. 1989;167(6):323–41. Review.

    Article  PubMed  CAS  Google Scholar 

  16. Ali SS, O’Connell C, Kass L, Graff G. Single-breath counting: a pilot study of a novel technique for measuring pulmonary function in children. Am J Emerg Med. 2011;29(1):33–6.

    Article  PubMed  Google Scholar 

  17. Guarantors of Brain. Aids to the examination of the peripheral nervous system. 2nd ed. London: Baillière-Tindall; 1986.

    Google Scholar 

  18. Sharshar T, Chevret S, Bourdain F, et al. Early predictors of mechanical ventilation in Guillain-Barré syndrome. Crit Care Med. 2003;31:278.

    Article  PubMed  Google Scholar 

  19. Mehta S. Neuromuscular disease causing acute respiratory failure. Respir Care. 2006;51:1016.

    PubMed  Google Scholar 

  20. Severinghaus JW, Astrup P, Murray JF. Blood gas analysis and critical care medicine. Am J Respir Crit Care Med. 1998;157(4 Pt 2):S114–22.

    Article  PubMed  CAS  Google Scholar 

  21. Vianello A, Bevilacqua M, Arcaro G, et al. Non-invasive ventilatory approach to treatment of acute respiratory failure in neuromuscular disorders. A comparison with endotracheal intubation. Intensive Care Med. 2000;26:384.

    Article  PubMed  CAS  Google Scholar 

  22. Nguyen TN, Badjatia N, Malhotra A, et al. Factors predicting extubation success in patients with Guillain-Barré syndrome. Neurocrit Care. 2006;5:230.

    Article  PubMed  Google Scholar 

  23. Rabinstein AA, Mueller-Kronast N. Risk of extubation failure in patients with myasthenic crisis. Neurocrit Care. 2005;3:213.

    Article  PubMed  Google Scholar 

  24. Reid C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet. 2006;19(1):13–22.

    Article  PubMed  CAS  Google Scholar 

  25. Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med. 2002;29(12):2264–70. Review. Erratum in: Crit Care Med. 2002;30(3):725.

    Article  Google Scholar 

  26. Sud S, Mittmann N, Cook DJ, Geerts W, Chan B, Dodek P, Gould MK, Guyatt G, Arabi Y, Fowler RA, E-PROTECT Investigators and the Canadian Critical Care Trials Group. Screening and prevention of venous thromboembolism in critically ill patients: a decision analysis and economic evaluation. Am J Respir Crit Care Med. 2011;184(11):1289–98.

    Article  PubMed  Google Scholar 

  27. Zochodne DW. Autonomic involvement in Guillain-Barré syndrome: a review. Muscle Nerve. 1994;17:1145–55.

    Article  PubMed  CAS  Google Scholar 

  28. Neroutsos E, et al. Guillain-Barre syndrome and mood disorders. Ann Gen Psychiatry. 2010;9 Suppl 1:S204.

    Article  Google Scholar 

  29. Sejvar JJ. West Nile virus and “poliomyelitis”. Neurology. 2004;63(2):206–7.

    Article  PubMed  Google Scholar 

  30. Gorson KC, Ropper AH. Nonpoliovirus poliomyelitis simulating Guillain-Barré syndrome. Arch Neurol. 2001;58(9):1460–4.

    Article  PubMed  CAS  Google Scholar 

  31. Corrales-Medina VF, Shandera WX. Chapter 32. Viral and Rickettsial infections. In: McPhee SJ, Papadakis MA, editors. Current medical diagnosis and treatment. 2011. http://www.accessmedicine.com/content.aspx?aID=17051.

  32. Winer JB. Guillain Barré syndrome. Mol Pathol. 2001;54(6):381–5.

    PubMed  CAS  Google Scholar 

  33. Ropper AH, Wijdicks EFM, Truax BT. Guillain-Barré syndrome. Philadelphia: Davis; 1991.

    Google Scholar 

  34. Ropper AH. Intensive care of acute Guillain-Barré syndrome. Can J Neurol Sci. 1994;21:S23.

    PubMed  CAS  Google Scholar 

  35. Hadden RD, Cornblath DR, Hughes RA, Zielasek J, Hartung HP, Toyka KV, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol. 1998;44(5):780–8.

    Article  PubMed  CAS  Google Scholar 

  36. Triggs WJ, Cros D, Gominak SC, Zuniga G, Beric A, Shahani BT, Ropper AH, Roongta SM. Motor nerve inexcitability in Guillain-Barré syndrome. The spectrum of distal conduction block and axonal degeneration. Brain. 1992;115:11–302.

    Google Scholar 

  37. Cros D, Triggs WJ. There are no neurophysiologic features characteristic of “axonal” Guillain-Barré syndrome. Muscle Nerve. 1994;17(6):675–7.

    Article  PubMed  CAS  Google Scholar 

  38. Guillain-Barré Syndrome Study Group. Plasmapheresis and acute Guillain-Barré syndrome. Neurology. 1985;35:1096–104.

    Article  Google Scholar 

  39. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Randomised trial of plasma exchange, intravenous immunoglobulin, and combined treatments in Guillain-Barré syndrome. Lancet. 1997;349(9047):225–30.

    Google Scholar 

  40. van der Meché FG, Schmitz PI. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barré syndrome. Dutch Guillain-Barré Study Group. N Engl J Med. 1992;326(17):1123–9.

    Article  PubMed  Google Scholar 

  41. Meyer UA, Schuurmans MM, Lindberg RL. Acute porphyrias: pathogenesis of neurological manifestations. Semin Liver Dis. 1998;18(1):43–52.

    Article  PubMed  CAS  Google Scholar 

  42. Kauppinen R. Porphyrias. Lancet. 2005;365(9455):241–52.

    PubMed  CAS  Google Scholar 

  43. Engel AG. Acquired autoimmune myasthenia gravis. In: Engel AG, Franzini-Armstrong C, editors. Myology: basic and clinical. 2nd ed. New York: McGraw-Hill; 1994. p. 1769–97.

    Google Scholar 

  44. Thomas CS, Mayer SA, Gungor Y, et al. Myasthenic crisis: clinical features, mortality, complications and risk factors for prolonged mechanical ventilation. Neurology. 1997;48:1253–60.

    Article  PubMed  CAS  Google Scholar 

  45. Lisak RP. Myasthenia gravis. Curr Treat Options Neurol. 1999;1(3):239–50.

    Article  PubMed  Google Scholar 

  46. Takanami I, Abiko T, Koizumi S. Therapeutic outcomes in thymectomied patients with myasthenia gravis. Ann Thorac Cardiovasc Surg. 2009;15(6):373–7.

    PubMed  Google Scholar 

  47. Wirtz PW, Sotodeh M, Nijnuis M, Van Doorn PA, Van Engelen BG, Hintzen RQ, et al. Difference in distribution of muscle weakness between myasthenia gravis and the Lambert-Eaton myasthenic syndrome. J Neurol Neurosurg Psychiatry. 2002;73(6):766–8.

    Article  PubMed  CAS  Google Scholar 

  48. Keogh M, Sedehizadeh S, Maddison P. Treatment for Lambert-Eaton myasthenic syndrome. Cochrane Database Syst Rev. 2011;(2):CD003279.

    Google Scholar 

  49. Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States: a clinical and epidemiologic review. Ann Intern Med. 1998;129(3):221–8.

    Article  PubMed  CAS  Google Scholar 

  50. Cherington M. Botulism: update and review. Semin Neurol. 2004;24(2):155–63.

    Article  PubMed  Google Scholar 

  51. Diaz JH. A 60-year meta-analysis of tick paralysis in the United States: a predictable, preventable, and often misdiagnosed poisoning. J Med Toxicol. 2010;6(1):15–21.

    Article  PubMed  Google Scholar 

  52. Isbister GK, Kiernan MC. Neurotoxic marine poisoning. Lancet Neurol. 2005;4(4):219–28.

    Article  PubMed  CAS  Google Scholar 

  53. Bishai WR, Murphy JR. Chapter 138. Diphtheria and other infections caused by corynebacteria and related species. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Harrison’s principles of internal medicine, 18e. 2011. http://www.accessmedicine.com/content.aspx?aID=9120730.

  54. Bleck TP. Clostridium tetani. In: Mandell GL, Bennett JE, Dolin R, editors. Bennett’s principles and practice of infectious diseases. Philadelphia: Churchill Livingstone; 1995. p. 2373–8.

    Google Scholar 

  55. Venance SL, Cannon SC, Fialho D, et al. The primary periodic paralyses: diagnosis, pathogenesis and treatment. Brain. 2006;129(Pt 1):8–17.

    PubMed  CAS  Google Scholar 

  56. Levitt JO. Practical aspects in the management of hypokalemic periodic paralysis. J Transl Med. 2008;6:18.

    Article  PubMed  Google Scholar 

  57. Amato AA, Barohn RJ. Evaluation and treatment of inflammatory myopathies. J Neurol Neurosurg Psychiatry. 2009;80(10):1060–8.

    Article  PubMed  CAS  Google Scholar 

  58. Hengstman GJ, van den Hoogen FH, van Engelen BG. Treatment of the inflammatory myopathies: update and practical recommendations. Expert Opin Pharmacother. 2009;10(7):1183–90.

    Article  PubMed  Google Scholar 

  59. Marinelli WA, Leatherman JW. Neuromuscular disorders in the intensive care unit. Crit Care Clin. 2002;18(4):915–29.

    Article  PubMed  Google Scholar 

  60. Annane D, Chevrolet JC, Chevret S, Raphael JC. Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders. Cochrane Database Syst Rev. 2007;(4):CD001941. PubMed: 10796839.

    Google Scholar 

  61. Bourke SC, Tomlinson M, Williams TL, et al. Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. Lancet Neurol. 2006;5:140.

    Article  PubMed  Google Scholar 

  62. Lacomis D, Zochodne DW, Bird SJ. Critical illness myopathy. Muscle Nerve. 2000;23:1785–8.

    Article  PubMed  CAS  Google Scholar 

  63. Latronico N, Peli E, Botteri M. Critical illness myopathy and neuropathy. Curr Opin Crit Care. 2005;11:126–32.

    Article  PubMed  Google Scholar 

  64. de Letter MA, Schmitz PI, Visser LH, et al. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med. 2001;29:2281–6.

    Article  PubMed  Google Scholar 

  65. Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006;354:449–61.

    Article  PubMed  Google Scholar 

  66. Rouleau G, Karpati G, Carpenter S, et al. Glucocorticoid excess induces preferential depletion of myosin in denervated skeletal muscle fibers. Muscle Nerve. 1987;10:428–38.

    Article  PubMed  CAS  Google Scholar 

  67. Ropper AH, Samuels MA. Chapter 48. Principles of clinical myology: diagnosis and classification of diseases of muscle and neuromuscular junction. In: Ropper AH, Samuels MA, editors. Adams and Victor’s principles of neurology, 9e. 2009. http://www.accessmedicine.com/content.aspx?aID=3642131.

  68. DiMauro S, Tonin P, Servidei S. Metabolic myopathies. In: Vinken PJ, Bruyn GW, editors. Handbook of clinical neurology, vol. 18. Amsterdam: North Holland; 1992. p. 479–526.

    Google Scholar 

  69. Ahmed A, Simmons A. Drugs which may exacerbate or induce myasthenia gravis: a clinician’s guide. Int J Neurol. 2009;10(2):11.

    Google Scholar 

  70. Olesen LL, Jensen TS. Prevention and management of drug-induced peripheral neuropathy. Drug Saf. 1991;6(4):302–14. PubMed: 1653573.

    Article  PubMed  CAS  Google Scholar 

  71. Goldberger JJ, Challapalli S, Tung R, Parker MA, Kadish AH. Relationship of heart rate variability to parasympathetic effect. Circulation. 2001;103(15):1977–83.

    Article  PubMed  CAS  Google Scholar 

  72. Czaplinski A, Steck AJ. Antibody testing in peripheral neuropathies: a critical approach. Schweizer Archiv für Neurologie und Psychiatrie. 1985 (A. 2002);153(7):301–7.

    Google Scholar 

  73. Agius MA, Richman DP, Vincent A. Myasthenia gravis and related disorders. In: Autoantibody testing in the diagnosis and management of autoimmune disorders of neuromuscular transmission and related diseases. Davis: Humana Press; 2009. p. 143–56.

    Google Scholar 

  74. Ropper AH, Samuels MA. Chapter 45. Electrophysiologic and laboratory aids in the diagnosis of neuromuscular disease. In: Ropper AH, Samuels MA, editors. Adams and Victor’s principles of neurology, 9e. 2009. http://www.accessmedicine.com/content.aspx?aID=3641085.

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Correspondence to William J. Triggs MD .

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Salardini, A., Triggs, W.J. (2013). Neuromuscular Disorders in the ICU. In: Layon, A., Gabrielli, A., Friedman, W. (eds) Textbook of Neurointensive Care. Springer, London. https://doi.org/10.1007/978-1-4471-5226-2_38

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