{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:38:12Z","timestamp":1790793492093,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2017,1,3]],"date-time":"2017-01-03T00:00:00Z","timestamp":1483401600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>\n                      Respiratory disorders are a major cause of morbidity and mortality in multiple sclerosis (\n                      <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>\n                      ). Mainly reported in walking patients, they are poorly explored when walking is severely impaired. To characterize respiratory impairment in patients with advanced\n                      <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      From 2012 to 2015, patients with\n                      <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>\n                      with an Expanded Disability Status Scale (EDSS) score of \u22657 who were referred for functional and rehabilitation evaluation underwent pulmonary function tests to study lung volumes, cough efficacy and respiratory muscle pressures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 73 patients with a median\n                      <jats:styled-content style=\"fixed-case\">EDSS<\/jats:styled-content>\n                      score of 8 [7.5; 8.5], 72.6% had impaired respiratory function with a mean vital capacity (\n                      <jats:styled-content style=\"fixed-case\">VC<\/jats:styled-content>\n                      ) of 57.9 \u00b1 33.5% of theoretical value. Severe impairment (\n                      <jats:styled-content style=\"fixed-case\">VC<\/jats:styled-content>\n                      &lt; 50%) was found for 34 (46.6%) patients. Cough was impaired in 45 (61.6%) patients, with a mean cough peak flow of 3.14 \u00b1 1.9 L\/s and severe impairment (cough peak flow &lt; 2.67 L\/s) in 27 (37.0%) patients. Overall, the results suggested predominant expiratory muscle dysfunction and non\u2010predominant diaphragm impairment.\n                      <jats:styled-content style=\"fixed-case\">EDSS<\/jats:styled-content>\n                      score was correlated with\n                      <jats:styled-content style=\"fixed-case\">VC<\/jats:styled-content>\n                      but not with any other clinical data.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Restrictive respiratory failure is frequent in severely impaired patients with\n                      <jats:styled-content style=\"fixed-case\">MS<\/jats:styled-content>\n                      , predominantly involves expiratory muscles, does not involve diaphragm weakness and is associated with cough impairments.\n                    <\/jats:p>\n                  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