MND – Non-Invasive Ventilation — SCE Neurology MCQ

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EasyPeripheral Neuropathy & NeuromuscularMND – Non-Invasive VentilationSCE Neurology

A 60-year-old man with MND has an FVC of 45% predicted. He is experiencing orthopnoea and morning headaches. What intervention improves both quality of life and survival in MND with respiratory compromise?

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Correct answer: E — Non-invasive ventilation (NIV)

NIV improves survival and quality of life in MND patients with respiratory insufficiency. NICE NG42 recommends offering NIV when symptoms of respiratory impairment develop (orthopnoea, morning headaches from nocturnal hypercapnia, daytime somnolence) and/or FVC falls below 50% predicted. A: Invasive ventilation is a last resort and not routinely offered in MND. C: CPAP does not assist ventilation and may worsen hypoventilation. D: Diaphragmatic pacing (the DiPALS trial) showed no benefit and potential harm in MND. E: Supplemental oxygen alone may suppress respiratory drive.

Reference: NICE NG42 Motor Neurone Disease (2016); Bourke et al. Lancet Neurol (2006)