What internists need to know about postpolio syndrome. (1/72)

Decades after recovery from polio, many patients develop new muscle weakness and other symptoms that can lead to increased debility. Treatment is aimed at the most prominent symptoms. Medications may help, as well as physical therapy and a carefully paced exercise program. Screening for osteopenia and osteoporosis is recommended.  (+info)

Fcgamma receptor IIIA polymorphism as a risk factor for acute poliomyelitis. (2/72)

Poliomyelitis is a viral infection that causes flaccid paralysis in approximately 1% of cases. The Fc receptors for immunoglobulin G (FcgammaR) are associated with modifying effects of several infectious and autoimmune diseases. To assess the influence of FcgammaR polymorphisms on the acute and late course of poliomyelitis, 110 Norwegian patients with well-defined histories of acute poliomyelitis were genotyped, of whom 50 suffered from the postpolio syndrome (PPS). In comparison with healthy control subjects without a history of poliomyelitis, significantly fewer patients had the FcgammaRIIIA genotype V/V (P<.01). However, this genotype was not an independent risk factor for PPS. The FcgammaRIIA and IIIB genotypes and allele frequencies did not differ between the patients and control subjects. The FcgammaRIIIA V/V genotype may lower the risk for contracting acute poliomyelitis through better clearance of poliovirus.  (+info)

Long term outcome after poliomyelitis in different health and social conditions. (3/72)

OBJECTIVE: To examine and compare the long term outcome after polio in an east European and a west European country with different access to rehabilitation and with different medical and social conditions. DESIGN AND SETTING: The patients who were acutely hospitalised for polio 1950-54 in the University Hospital in Bergen, Norway and 1958 in the University Hospital in Tartu, Estonia received the mailed questionnaire in the period between January 1998 and December 1998. PATIENTS: Patient files concerning 334 patients hospitalised in Tartu and 243 patients hospitalised in Bergen were obtained; of these 128 Estonian and 148 Norwegian patients were re-examined. MAIN RESULTS: Despite more pronounced disability in the acute stage, significantly more Norwegian patients were working full time and part time in 1998 (p<0.0001) and also through the period 1958-1998. In both countries, 30% of patients had manual work and 18% changed profession during their career. Low income (below 50% of national average) was reported by 73% of Estonian and 35% of Norwegian patients (p<0.0001). Except for the odds ratio for muscular pain of 1.89 (95%CI =1.14 to 3.14) for Norwegian patients, new symptoms indicating late progression did not differ. Norwegian patients were more independent with significantly less need for assistance in housekeeping (p=0.02), whereas the use of orthopaedic devices did not differ. CONCLUSIONS: The long term outcome after polio is different in eastern and western Europe. Access to continuous rehabilitation seems to maintain physical independence in polio patients, improves their ability to earn their own income, and lessens the need for disability pensions.  (+info)

Pyridostigmine in postpolio syndrome: no decline in fatigue and limited functional improvement. (4/72)

OBJECTIVES: To investigate the effect of pyridostigmine on fatigue, physical performance, and muscle function in subjects with postpoliomyelitis syndrome. METHODS: 67 subjects with increased fatigue and new weakness in one quadriceps muscle showing neuromuscular transmission defects, were included in a randomised, double blind, placebo controlled trial of 60 mg pyridostigmine four times a day for 14 weeks. Primary outcome was fatigue (on the "energy" category of the Nottingham health profile). Secondary outcomes included two minute walking distance and quadriceps strength and jitter. Motor unit size of the quadriceps was studied as a potential effect modifier. The primary data analysis compared the changes from baseline in the outcomes in the last week of treatment between groups. RESULTS: 31 subjects treated with pyridostigmine and 31 subjects treated with placebo completed the trial. No significant effect of pyridostigmine was found on fatigue. The walking distance improved more in the pyridostigmine group than in the placebo group (by 7.2 m (6.0%); p<0.01). Subgroup analysis showed that a significant improvement in walking performance was only found in subjects with normal sized motor units. Quadriceps strength improved more in the pyridostigmine group than in the placebo group (by 6.7 Nm (7.2%); p = 0.15). No effect of pyridostigmine was found on jitter. CONCLUSIONS: Pyridostigmine in the prescribed dose did not reduce fatigue in subjects with postpoliomyelitis syndrome. However, it may have a limited beneficial effect on physical performance, especially in subjects with neuromuscular transmission defects in normal sized motor units.  (+info)

How to interpret normal electromyographic findings in patients with an alleged history of polio. (5/72)

OBJECTIVE: In some patients with a history of polio, the electromyography is normal, not showing the typical neurogenic signs. The aim of this study was to explain the normal findings in electromyography, especially in paralytic polio. DESIGN: Retrospective study. SUBJECTS/METHODS: Concentric needle electromyography, macro electromyography (including single fibre electromyography) and neurography were performed in various combinations in 688 patients with an alleged history of polio. RESULTS: Thirty-five patients with paralytic polio had normal or minimally abnormal neurophysiology. In 6 patients the diagnosis of polio was rejected and was instead found to be other diagnoses. Three patients had a very atypical history. Of the 26 with possible paralytic polio, 17 showed a strong suspicion of previous paralytic polio without any neurophysiological signs of degeneration of the anterior horn cells. CONCLUSION: If neurophysiological findings are normal in patients with a history of polio, the original diagnosis may be incorrect. However, the absence of electromyography changes does not entirely exclude a previous history of polio with transient functional loss without degeneration of anterior horn cells vulnerable for later functional impairment.  (+info)

Rehabilitation for postpolio sequelae. (6/72)

BACKGROUND: Postpolio sequelae (PPS) are new, late manifestations that occur many years after the initial poliomyelitis infection. Recurrence of symptoms and fear of reactivation of the polio virus is particularly distressing to polio survivors. OBJECTIVE: This article outlines the diagnosis, pathophysiology, and management of PPS disabilities using a case vignette. DISCUSSION: Clinical features of PPS include fatigue, joint and muscle pain, new muscular weakness and bulbar symptoms. Diagnosis can be complicated particularly in nonparalytic cases of poliomyelitis. Disabilities in PPS may not be obvious to the observer but significantly affect the quality of life of the PPS patient. Previous rehabilitation intervention focussed on physical effort and determination to overcome disability at all costs. The treatment in PPS is now modified, and aggressive physical measures that may exacerbate muscle weakness are avoided. Most disabilities in PPS can be well managed with rehabilitation interventions that address limitations in patient activities of daily living, mobility and cardiopulmonary fitness.  (+info)

Walking in postpoliomyelitis syndrome: the relationships between time-scored tests, walking in daily life and perceived mobility problems. (7/72)

OBJECTIVE: To compare walking test results with walking in daily life, and to investigate the relationships between walking tests, walking activity in daily life, and perceived mobility problems in patients with post-poliomyelitis syndrome. SUBJECTS: Twenty-four ambulant patients with post-poliomyelitis syndrome. METHODS: Walking tests were performed at self-preferred and maximal speed. Walking activity was measured with an ambulatory activity monitor. Heart rate, step cadence and walking speed in the test and in daily life were compared. Walking speed in daily life was represented by the intensity of walking. Perceived mobility problems were assessed with the Nottingham Health Profile. RESULTS: Heart rate during walking was lower in the test at self-preferred speed than in daily life (mean difference: 11.3+/-10.4; p=0.001). Self-preferred walking speed in the test and in daily life correlated significantly (r=0.55; p=0.04). In a sub-group with a test performance below the median value, test performance correlated significantly with walking activity. No significant correlation was found between perceived mobility problems and walking activity. CONCLUSION: Walking in daily life may be more demanding than walking under standardized conditions. Patients with post-poliomyelitis syndrome with the lowest test performance walked less in daily life. Patients do not necessarily match their activity pattern to their perceived mobility problems.  (+info)

Cognitive functioning in post-polio patients with and without general fatigue. (8/72)

OBJECTIVE AND DESIGN: This study examined 2 main hypotheses. First, whether patients with post-polio suffering from general fatigue (n=10) demonstrate cognitive deficits compared with patients with post-polio without general fatigue (n=10). Secondly, by systematically varied test order administration we examined whether such differences varied as a function of increasing cognitive load during cognitive testing. SUBJECTS: Twenty patients diagnosed with post-polio syndrome, 10 with general fatigue and 10 without fatigue. RESULTS: Neither of the 2 hypotheses were confirmed. The group with general fatigue reported elevated levels of depression. However, no systematic association between level of depression and cognitive performance could be detected. CONCLUSION: The results of this study provide no evidence that general fatigue or cognitive load affects cognitive functioning in post-polio.  (+info)

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