Respiratory neuromuscular control system

Figure 2 Model of the respiratory neuromuscular control system. Potential mechanisms of respiratory failure are listed on the right side and afferent stimuli arising at each site are shown on the left side. Abbreviations Rrs, respiratory system resistance Ers, respiratory system elastance PV, pressure-volume V/Q, ventilation-perfusion ratio Qt, cardiac output PCO2 carbon dioxide tension PO2 oxygen tension. Source From Ref. 127.

Milic-EmUi, J. and Zin, W.A. 1986. Relationship between neuromuscular respiratory drive and ventilatory output. In P.T. Macklem and J. Mead (Eds.), Handbook of Physiology, sec 3, The Respiratory System, Vol. 3, Mechanics of Breathing, part 2, pp. 631-646, Washington, DC, American Physiological Society. Milsum, J.H. 1966. Biological Control Systems Analysis. New York, McGraw-Hill. 

Injection of botulinum toxin is a rather innovative way to control localized muscle hyperexcitability. Botulinum toxin is a purified version of the toxin that causes botulism. Systemic doses of this toxin can be extremely dangerous or fatal because botulinum toxin inhibits the release of acetylcholine from presynaptic terminals at the skeletal neuromuscular junction. Loss of presynaptic acetylcholine release results in paralysis of the muscle fiber supplied by that terminal. Systemic dissemination of botulinum toxin can therefore cause widespread paralysis, including loss of respiratory muscle function. Injection into specific muscles, however, can sequester the toxin within these muscles, thus producing localized effects that are beneficial in certain forms of muscle hyperexcitability. 

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