The role of brain-controlled breathing patterns in neurological and neuropsychiatric disorders

This is a brand new field that scientist have never thought of studying. Perhaps because we all take our ability to breathe for granted, since it is automatically organized for us by the brain, specifically parts of the brain stem. I think that it is time that we learn more about brain controlled breathing patterns at rest when awake and effects on arousal and on higher brain executive function.

It is a fascinating and complicated subject. It will probably require teamwork between respiratory physiologists and neurologists and psychiatrists. It seems that there are a number of brain controlled abnormal breathing patterns in many patient populations. For example with patients with heart problems can develop brain controlled changes in breathing patterns. This is especially true in heart failure. Patients with neuromuscular problems will have brain controlled abnormal breathing patterns. Patients who have had strokes may develop this too. Not all of these abnormal breathing patterns will involve visible shortness of breathe. They may involve hypoventilation or slow breathing at rest when awake. They may involve sleep apnea. They may involve too fast or periodic breathing at rest when awake. We do not yet know much about brain controlled breathing disturbance because without careful measurement they are not visible and the patient is rarely aware of them. The brain simply controls breathing rate and depth according to the metabolic needs of the patient no matter what other physical problems they may have.

I think that this is very exciting.

Let me review what early respiratory physiologists discovered when they actually tried to measure breathing rate in healthy normal adults. Then we will review what a famous psychiatrist found in a common syndrome of insanity.

John Scott Haldane [ 1860– 1936) was a Scottish physician and physiologist famous for intrepid self-experimentation which led to many important discoveries about the human body and the nature of gases. He and others like him found that the range of breathing rates in normal healthy adults ranged from as low as 3 breathes per minute to as high as 28-30 breathes per minute when at rest and awake. The spirometer was invented in 1840 by John Hutchinson but was not recognized as an important tool to diagnose airflow obstruction in lung and heart disease until 1980. Interest in respiratory rates faded as doctors struggled to understand lung disease. Respiratory rate and the amount of air exchanged per minute is very important but has been completely forgotten. Counting respiration rate is easy and brings in no additional income for the doctor so……there you go.

Emil Kraepelin (1856 – 1926) was a German  psychiatrist. Kraepelin believed the chief origin of psychiatric disease to be biological  and genetic malfunction. The reason he believed this was because of his epidemiological studies on serious mental illness., 1921Topics Psychiatry — Early works to 1900Manic-depressive illnessParanoiaPublisher Edinburgh : LivingstoneCollection gersteintorontomedicalheritagelibraryuniversity_of_torontoDigitizing sponsor MSNContributor Gerstein – University of TorontoLanguage English

Epidemiology is a scientific discipline with sound methods of scientific inquiry at its foundation. Epidemiology is data-driven and relies on a systematic and unbiased approach to the collection, analysis, and interpretation of data. Basic epidemiologic methods tend to rely on careful observation and use of valid comparison groups to assess whether what was observed, such as the number of cases of disease in a particular area during a particular time period or the frequency of an exposure among persons with disease, differs from what might be expected. However, epidemiology also draws on methods from other scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioral sciences.…………In fact, epidemiology is often described as the basic science of public health, and for good reason. First, epidemiology is a quantitative discipline that relies on a working knowledge of probability, statistics, and sound research methods. Second, epidemiology is a method of causal reasoning based on developing and testing hypotheses grounded in such scientific fields as biology, behavioral sciences, physics, and ergonomics to explain health-related behaviors, states, and events. However, epidemiology is not just a research activity but an integral component of public health, providing the foundation for directing practical and appropriate public health action based on this science and causal reasoning…………..Epidemiology is also used to search for determinants, which are the causes and other factors that influence the occurrence of disease and other health-related events. Epidemiologists assume that illness does not occur randomly in a population, but happens only when the right accumulation of risk factors or determinants exists in an individual.” Division of Scientific Education and Professional Development (DSEPD) . Lesson 1: Introduction to Epidemiology.

Kraepelin carefully measured the vital signs of his manic depressive patients and found that respiratory rate ranged from too slow in depressive insanity to too fast and periodic in mania. The rest of the vital signs were also abnormal, the pattern being different in depressive in sanity [in response to the too slow breathing] and mania] in response to the periodic breathing, most likely. Kraepelin’s work needs to be replicated to se if his findings are still the same in unmedicated patients. “An attempt by a second researcher to replicate a previous study is an effort to determine whether applying the same methods to the same scientific question produces similar results. … Replication is one of the key ways scientists build confidence in the scientific merit of results.” Replicability | Reproducibility and Replicability in Science.

Kraepelin’s results have since been forgotten. Paula and I think that his results point to the cause of the syndrome. manic depressive insanity. We think that his work is the most careful and thoughtful work to date. It still stands, compared to the rigmarole that has been done since.

Brain controlled patterns of breathing are an important new area to study, especially, when a patient is not behaving normally. to be continued…..

Although breathing is generally thought of as an autonomic behavior, higher-order brain functions can exert exquisite control over breathing. ………. Our results show, conversely, that the breathing center has a direct and powerful influence on higher-order brain function. It will thus be important to map the full range of behaviors and functions the breathing center controls.” Breathing control center neurons that promote arousal in mice. Kevin Yackle et al, Science  31 Mar 2017: Vol. 355, Issue 6332, pp. 1411-1415
DOI: 10.1126/science.aai7984

to be continued………

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