Chest
Clinical Investigations: Pulmonary FunctionDyspnea in Dystonia: A Functional Evaluation
Section snippets
Methods
Twenty-six dystonic patients with dysphonia (strangled quality of speech, with interruptions) and dyspnea were referred for respiratory assessment from the Movement Disorders Center of the Neurological Institute of Columbia Presbyterian Medical Center, New York. Dystonia was primary (idiopathic) in 22 patients and secondary in 4 patients (Table 2). All described an awareness of or an increased effort for breathing. They were assigned a dyspnea score, depending on their perception of difficulty
Results
There were 12 women and 14 men (Table 2). Their ages ranged from 14 to 70 years (mean, 52.3 ± 13.8). They were grouped into three categories, based on the results of their spirometry and lung volumes: group 1 with normal PFT (n=19), group 2 with obstructive PFT (n=3), and group 3 with restrictive PFT (n=4). Flow volume loops were assessed for interruptions and/or irregularities and noted separately for each group. The etiology and classification of dystonia was determined by the referring
Discussion
Dyspnea in dystonia appears to be associated with spasmodic contractions of the upper airways and/or the diaphragm in most patients. Since maximum efforts are necessary for optimal performance of PFT, and increased efforts tend to worsen any volitional muscular contractions causing spasms, these efforts appear to be perceived as discomfort or dyspnea. Although patients showed a desire to comply with testing, extra efforts were necessary to overcome the spasmodic muscular contractions to produce
Acknowledgments
The authors gratefully acknowledge Dr. Joseph Ghassibi's help with exercise testing, and Beverly Cayetano's assistance with manuscript preparation.
References (21)
The varied clinical expressions of dystonia
Neurol Clin
(1984)- et al.
Respiratory dyskinesia: an underrecognized phenomenon
Chest
(1994) - et al.
Respiratory dyskinesia presenting as acute respiratory distress
Chest
(1993) - et al.
Respiratory dysrhythmias in patients with tardive dyskinesia
Chest
(1994) - et al.
The irregularly irregular pattern of respiratory dyskinesia
Chest
(1986) - et al.
Epidemiology of focal and generalized dystonia in Rochester, Minnesota
Mov Disord
(1988) - et al.
Respiratory and obstructive laryngeal dystonia treatment with botulinum toxin
Neurology
(1991) - et al.
Spirometric standards for healthy non smoking adults
Am Rev Respir Dis
(1971) - American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am Rev...
- et al.
Maximal respiratory pressures: normal values and relationship to age and sex
Am Rev Respir Dis
(1969)
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