RESUMEN
Sleep disorders in amyotrophic lateral sclerosis (ALS) present a significant challenge to the management of patients. Issues include the maintenance of adequate ventilatory status through techniques such as non-invasive ventilation, which has the ability to modulate survival and improve patient quality of life. Here, a multidisciplinary approach to the management of these disorders is reviewed, from concepts about the underlying neurobiological basis, through to current management approaches and future directions for research.
Asunto(s)
Esclerosis Amiotrófica Lateral/complicaciones , Insuficiencia Respiratoria/fisiopatología , Trastornos del Sueño-Vigilia/fisiopatología , Esclerosis Amiotrófica Lateral/fisiopatología , Progresión de la Enfermedad , Humanos , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Trastornos del Sueño-Vigilia/etiología , Trastornos del Sueño-Vigilia/terapiaRESUMEN
STUDY DESIGN: Immunohistochemical assessment of apoptotic markers in human cases of compressive myelopathy due to neoplastic compression. OBJECTIVE: To characterize the role of apoptosis in neoplastic compressive myelopathy in human postmortem tissue with extramedullary tumor involvement. SUMMARY OF BACKGROUND DATA: Neoplasms, whether primary or metastatic, may lead to compression of the spinal cord and development of a compressive myelopathy syndrome. Apoptotic processes of cell death are thought to contribute to cell death in chronic compressive myelopathy because of degenerative spondylosis, but this has not previously been described in neoplastic compression. METHODS: Six postmortem cases of human neoplastic compressive myelopathy were assessed for apoptosis using a panel of immunohistochemical markers including Fas, B-cell lymphoma 2 (Bcl-2), caspase-3 and 9, DNA-dependent protein kinase catalytic subunit (DNA-PKcs), poly (ADP-ribose) polymerase (PARP), apoptosis-inducing factor (AIF), and terminal deoxynucleotide transferase dUTP Nick End Labeling (TUNEL). RESULTS: Apoptosis was maximal at the site of tumor compression. Glial cells, predominantly oligodendrocytes, were immunopositive for DNA-PKcs, PARP, AIF, and TUNEL. Axons were immunopositive for caspase 3, DNA-PKcs, and AIF. Neurons were immunopositive for DNA-PKcs, PARP, AIF, and TUNEL. CONCLUSION: The current study demonstrates that apoptosis plays a role in human neoplastic compressive myelopathy. Necrosis dominates the severe end of the spectrum of compression. The prominent oligodendroglial involvement is suggestive that apoptosis may be important in the ongoing remodeling of white matter due to sustained compression. LEVEL OF EVIDENCE: 4.