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Prognosis of amyotrophic lateral sclerosis with respiratory onset
  1. Christen L Shoesmith,
  2. Karen Findlater,
  3. Ann Rowe,
  4. Michael J Strong
  1. Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
  1. Correspondence to:
 Dr C L Shoesmith
 Room C7-120, University Hospital, London Health Sciences Centre, 339 Windermere Road, London, Ontario, Canada N6A 5A5; cshoesmi{at}uwo.ca

Abstract

Respiratory muscle involvement is a recognised, but often late, complication of amyotrophic lateral sclerosis (ALS). The clinical features and prognosis of 21 patients with respiratory onset ALS are reported here. On a retrospective chart review, it was found that 2.7% of patients with ALS presenting to a tertiary care specialty clinic have respiratory symptoms as their first clinical symptom of ALS. Only 14% of these individuals presented acutely and required emergency intubation. The mean survival time of the total group from symptom onset to death or permanent ventilation was 27.0 (14.9) months, which was not significantly different from the survival time in patients with bulbar onset ALS. Non-invasive positive pressure ventilation (NIPPV) significantly improved survival compared with those who did not use NIPPV. This study suggests that ALS with respiratory onset does not necessarily follow a rapidly progressive course.

  • ALS, amyotrophic lateral sclerosis
  • FVC, forced vital capacity
  • NIPPV, non-invasive positive pressure ventilation
  • PFT, pulmonary function test

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Footnotes

  • Competing interests: None declared.

  • Published Online First 6 November 2006

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