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. 2002 Feb;86(2):103–107. doi: 10.1136/adc.86.2.103

Critical illness neuromuscular disease: clinical, electrophysiological, and prognostic aspects

B Tabarki 1, A Coffinieres 1, P Van den Bergh 1, G Huault 1, P Landrieu 1, G Sebire 1
PMCID: PMC1761057  PMID: 11827903

Abstract

Background: Critical illness neuromuscular disease, which has been recognised as a distinct clinical entity in adults, remains poorly described in children.

Aims: To assess retrospectively the clinical, electrophysiological, and prognostic features of the disease.

Methods: Retrospective study in a children's university hospital.

Results: Five critically ill patients presented with generalised paralysis, associated with long lasting failure to breathe in three. The cause of the generalised paralysis was critical illness neuropathy in two, acute myopathy in two, and mixed neuromyopathy in one.

Conclusions: Neuromuscular disease should be suspected in critically ill children with muscle weakness. Because corticosteroids and muscle relaxants appear to trigger some types of intensive care unit neuromuscular disease in children, their use should be restricted or administered at the lowest doses possible.

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Selected References

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  1. Amato A. A., Barohn R. J., Sahenk Z., Tutschka P. J., Mendell J. R. Polyneuropathy complicating bone marrow and solid organ transplantation. Neurology. 1993 Aug;43(8):1513–1518. doi: 10.1212/wnl.43.8.1513. [DOI] [PubMed] [Google Scholar]
  2. Barat M., Brochet B., Vital C., Mazaux J. M., Arné L. Polyneuropathies au cours de séjours prolongés en réanimation. Rev Neurol (Paris) 1987;143(12):823–831. [PubMed] [Google Scholar]
  3. Barohn R. J., Jackson C. E., Rogers S. J., Ridings L. W., McVey A. L. Prolonged paralysis due to nondepolarizing neuromuscular blocking agents and corticosteroids. Muscle Nerve. 1994 Jun;17(6):647–654. doi: 10.1002/mus.880170613. [DOI] [PubMed] [Google Scholar]
  4. Benzing G., 3rd, Iannaccone S. T., Bove K. E., Keebler P. J., Shockley L. L. Prolonged myasthenic syndrome after one week of muscle relaxants. Pediatr Neurol. 1990 May-Jun;6(3):190–196. doi: 10.1016/0887-8994(90)90062-6. [DOI] [PubMed] [Google Scholar]
  5. Bolton C. F. Neuromuscular complications of sepsis. Intensive Care Med. 1993;19 (Suppl 2):S58–S63. doi: 10.1007/BF01708802. [DOI] [PubMed] [Google Scholar]
  6. Bolton C. F., Young G. B., Zochodne D. W. The neurological complications of sepsis. Ann Neurol. 1993 Jan;33(1):94–100. doi: 10.1002/ana.410330115. [DOI] [PubMed] [Google Scholar]
  7. Chad D. A., Lacomis D. Critically ill patients with newly acquired weakness: the clinicopathological spectrum. Ann Neurol. 1994 Mar;35(3):257–259. doi: 10.1002/ana.410350303. [DOI] [PubMed] [Google Scholar]
  8. Deconinck N., Van Parijs V., Beckers-Bleukx G., Van den Bergh P. Critical illness myopathy unrelated to corticosteroids or neuromuscular blocking agents. Neuromuscul Disord. 1998 May;8(3-4):186–192. doi: 10.1016/s0960-8966(98)00003-0. [DOI] [PubMed] [Google Scholar]
  9. Dimachkie M. M., Austin S. G., Slopis J. M., Vriesendorp F. J. Critical illness polyneuropathy in adolescence. J Child Neurol. 1995 Sep;10(5):409–411. doi: 10.1177/088307389501000515. [DOI] [PubMed] [Google Scholar]
  10. Gutmann L., Blumenthal D., Gutmann L., Schochet S. S. Acute type II myofiber atrophy in critical illness. Neurology. 1996 Mar;46(3):819–821. doi: 10.1212/wnl.46.3.819. [DOI] [PubMed] [Google Scholar]
  11. Heckmatt J. Z., Pitt M. C., Kirkham F. Peripheral neuropathy and neuromuscular blockade presenting as prolonged respiratory paralysis following critical illness. Neuropediatrics. 1993 Jun;24(3):123–125. doi: 10.1055/s-2008-1071527. [DOI] [PubMed] [Google Scholar]
  12. Hirano M., Ott B. R., Raps E. C., Minetti C., Lennihan L., Libbey N. P., Bonilla E., Hays A. P. Acute quadriplegic myopathy: a complication of treatment with steroids, nondepolarizing blocking agents, or both. Neurology. 1992 Nov;42(11):2082–2087. doi: 10.1212/wnl.42.11.2082. [DOI] [PubMed] [Google Scholar]
  13. Jago R. H. Arthrogryposis following treatment of maternal tetanus with muscle relaxants. Arch Dis Child. 1970 Apr;45(240):277–279. doi: 10.1136/adc.45.240.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Kaplan P. W., Rocha W., Sanders D. B., D'Souza B., Spock A. Acute steroid-induced tetraplegia following status asthmaticus. Pediatrics. 1986 Jul;78(1):121–123. [PubMed] [Google Scholar]
  15. Lacomis D., Giuliani M. J., Van Cott A., Kramer D. J. Acute myopathy of intensive care: clinical, electromyographic, and pathological aspects. Ann Neurol. 1996 Oct;40(4):645–654. doi: 10.1002/ana.410400415. [DOI] [PubMed] [Google Scholar]
  16. Leatherman J. W., Fluegel W. L., David W. S., Davies S. F., Iber C. Muscle weakness in mechanically ventilated patients with severe asthma. Am J Respir Crit Care Med. 1996 May;153(5):1686–1690. doi: 10.1164/ajrccm.153.5.8630621. [DOI] [PubMed] [Google Scholar]
  17. MacFarlane I. A., Rosenthal F. D. Severe myopathy after status asthmaticus. Lancet. 1977 Sep 17;2(8038):615–615. doi: 10.1016/s0140-6736(77)91471-4. [DOI] [PubMed] [Google Scholar]
  18. Pascucci R. C. Prolonged weakness after extended mechanical ventilation in a child. Crit Care Med. 1990 Oct;18(10):1181–1182. doi: 10.1097/00003246-199010000-00027. [DOI] [PubMed] [Google Scholar]
  19. Petersen B., Schneider C., Strassburg H. M., Schrod L. Critical illness neuropathy in pediatric intensive care patients. Pediatr Neurol. 1999 Oct;21(4):749–753. doi: 10.1016/s0887-8994(99)00076-4. [DOI] [PubMed] [Google Scholar]
  20. Ramsay D. A., Zochodne D. W., Robertson D. M., Nag S., Ludwin S. K. A syndrome of acute severe muscle necrosis in intensive care unit patients. J Neuropathol Exp Neurol. 1993 Jul;52(4):387–398. doi: 10.1097/00005072-199307000-00006. [DOI] [PubMed] [Google Scholar]
  21. Rutledge M. L., Hawkins E. P., Langston C. Skeletal muscle growth failure induced in premature newborn infants by prolonged pancuronium treatment. J Pediatr. 1986 Nov;109(5):883–886. doi: 10.1016/s0022-3476(86)80719-3. [DOI] [PubMed] [Google Scholar]
  22. Segredo V., Caldwell J. E., Matthay M. A., Sharma M. L., Gruenke L. D., Miller R. D. Persistent paralysis in critically ill patients after long-term administration of vecuronium. N Engl J Med. 1992 Aug 20;327(8):524–528. doi: 10.1056/NEJM199208203270804. [DOI] [PubMed] [Google Scholar]
  23. Selmaj K. W., Raine C. S. Tumor necrosis factor mediates myelin and oligodendrocyte damage in vitro. Ann Neurol. 1988 Apr;23(4):339–346. doi: 10.1002/ana.410230405. [DOI] [PubMed] [Google Scholar]
  24. Shahar E. M., Hwang P. A., Niesen C. E., Murphy E. G. Poliomyelitis-like paralysis during recovery from acute bronchial asthma: possible etiology and risk factors. Pediatrics. 1991 Aug;88(2):276–279. [PubMed] [Google Scholar]
  25. Sheth R. D., Bolton C. F. Neuromuscular complications of sepsis in children. J Child Neurol. 1995 Sep;10(5):346–352. doi: 10.1177/088307389501000502. [DOI] [PubMed] [Google Scholar]
  26. Sheth R. D., Pryse-Phillips W. E., Riggs J. E., Bodensteiner J. B. Critical illness neuromuscular disease in children manifested as ventilatory dependence. J Pediatr. 1995 Feb;126(2):259–261. doi: 10.1016/s0022-3476(95)70555-4. [DOI] [PubMed] [Google Scholar]
  27. Sinclair J. F., Malcolm G. A., Stephenson J. B., Halworth D. Prolonged neuromuscular blockade in an infant. Anaesthesia. 1987 Sep;42(9):1020–1020. doi: 10.1111/j.1365-2044.1987.tb05389.x. [DOI] [PubMed] [Google Scholar]
  28. Sinha S. K., Levene M. I. Pancuronium bromide induced joint contractures in the newborn. Arch Dis Child. 1984 Jan;59(1):73–75. doi: 10.1136/adc.59.1.73. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Tsao C. Y., Lo W. D., Mendell J. R., Batley R. J. Critical illness polyneuropathy in a 2-year-old girl with hemorrhagic shock encephalopathy syndrome. J Child Neurol. 1995 Nov;10(6):486–488. doi: 10.1177/088307389501000614. [DOI] [PubMed] [Google Scholar]
  30. Viby-Mogensen J. Monitoring neuromuscular function in the intensive care unit. Intensive Care Med. 1993;19 (Suppl 2):S74–S79. doi: 10.1007/BF01708805. [DOI] [PubMed] [Google Scholar]
  31. Wilkinson J. D., Pollack M. M., Ruttimann U. E., Glass N. L., Yeh T. S. Outcome of pediatric patients with multiple organ system failure. Crit Care Med. 1986 Apr;14(4):271–274. doi: 10.1097/00003246-198604000-00002. [DOI] [PubMed] [Google Scholar]
  32. Williams T. J., O'Hehir R. E., Czarny D., Horne M., Bowes G. Acute myopathy in severe acute asthma treated with intravenously administered corticosteroids. Am Rev Respir Dis. 1988 Feb;137(2):460–463. doi: 10.1164/ajrccm/137.2.460. [DOI] [PubMed] [Google Scholar]
  33. Witt N. J., Zochodne D. W., Bolton C. F., Grand'Maison F., Wells G., Young G. B., Sibbald W. J. Peripheral nerve function in sepsis and multiple organ failure. Chest. 1991 Jan;99(1):176–184. doi: 10.1378/chest.99.1.176. [DOI] [PubMed] [Google Scholar]
  34. Zochodne D. W., Bolton C. F., Wells G. A., Gilbert J. J., Hahn A. F., Brown J. D., Sibbald W. A. Critical illness polyneuropathy. A complication of sepsis and multiple organ failure. Brain. 1987 Aug;110(Pt 4):819–841. doi: 10.1093/brain/110.4.819. [DOI] [PubMed] [Google Scholar]

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