Treatment of Type I Spinal Muscular Atrophy With Noninvasive Ventilation and Gastrostomy Feeding

• Published in: Pediatric neurology Vol. 18; no. 5; pp. 407 - 410
• Main Authors: Birnkrant, David J, Pope, John F, Martin, James E, Repucci, Anthony H, Eiben, Robert M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.1998; Elsevier
• Subjects: Biological and medical sciences; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Deglutition Disorders - etiology; Deglutition Disorders - therapy; Enteral Nutrition - adverse effects; Enteral Nutrition - methods; Fatal Outcome; Female; Gastrostomy; Humans; Infant; Intermittent Positive-Pressure Ventilation - methods; Intermittent Positive-Pressure Ventilation - standards; Male; Medical Futility; Medical sciences; Neurology; Pneumonia, Aspiration - prevention & control; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Spinal Muscular Atrophies of Childhood - complications; Human; Gastrostomy; Stomach; Neuromuscular diseases; Nervous system diseases; Respiratory disease; Esophageal disease; Werdnig Hoffmann disease; Artificial ventilation; Genetic disease; Feeding; Case study; Treatment; Respiratory failure; Positive pressure; Surgery; Central nervous system disease; Digestive diseases; Degenerative disease; Dysphagia; Spinal cord disease; Child
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/S0887-8994(97)00227-0

Type I spinal muscular atrophy (SMA) is a rapidly progressive, degenerative neuromuscular disease of infancy. In severe SMA, weakness, hypotonia, and bulbar involvement lead to progressive respiratory insufficiency and swallowing dysfunction, which are frequently complicated by aspirations. There are few studies reported in the literature that address the respiratory management of type I SMA. This article reports the results of treating four patients with infantile SMA with noninvasive positive pressure ventilation and gastrostomy feeding. All patients had gastroesophageal reflux disease, which was managed medically. Despite these therapies, survival was only 1 to 3.5 months after presenting with severe aspirations. The treatment strategy, which can be effective in less rapidly progressive neuromuscular diseases, did not alter the very poor prognosis of type I SMA. The treatment options are reviewed, and a strategy designed to optimize quality of life for infants with this fatal disease is presented.