El Síndrome Post-Polio: Avances en la patogénesis y tratamiento

Neuropsychology of Post-Polio Syndrome
Anales de la Academia de Nueva York de Ciencias
Volumen 753, El Síndrome Post-Polio: Avances en la patogénesis y tratamiento delas páginas 103 a 110, mayo de 1995
  1. JORDAN GRAFMAN1,
  2. KIM CLARK1,
  3. DAVID RICHARDSON1
  4. STEVE DINSMORE2
  5. DANIEL STEIN2
  6. MARINOS C. DALAKAS2Article first published online: 17 DEC 2006 DOI: 10.1111/j.1749-6632.1995.tb27536.x
The Post-Polio Syndrome As an 

Evolved Clinical Entity

Definition and Clinical Description

  1. MARINOS C. DALAKAS
Article first published online: 17 DEC 2006
DOI: 10.1111/j.1749-6632.1995.tb27532.x

Post-polio syndrome (PPS) refers to the new neuromuscular symptoms that occur at least 15 years after stability in patients with prior acute paralytic poliomyelitis. They include: (1) new muscle weakness and atrophy in the limbs, the bulbar or the respiratory muscles [post-poliomyelitis muscular atrophy (PPMA)] and (2) excessive muscle fatigue and diminished physical endurance. PPS is a clinical diagnosis that requires exclusion of all other medical, neurological, orthopedic or psychiatric diseases that could explain the cause of the new symptoms. Routine electromyography is useful to confirm chronic and ongoing denervation and exclude neuropathies. Muscle biopsy, single fiber electromyography (EMG), macro-EMG, serum antibody titers to polio virus, and spinal fluid studies are very useful research tools but they are rarely needed to establish the clinical diagnosis. PPS is a slowly progressive phenomenon with periods of stability that vary from 3 to 10 years. Current evidence indicates that PPS is the evolution of a subclinically ongoing motor neuron dysfunction that begins after the time of the acute polio. It is clinically manifested as PPS when the well-compensated reinnervating process crosses a critical threshold beyond which the remaining motor neurons cannot maintain the innervation to all the muscle fibers within their motor unit territory.
 
Annals of the New York Academy of Sciences

Richard L. Bruno, Ph.D., Thomas Galski, Ph.D., John DeLuca, Ph.D.

Bruno RL, Galski T, DeLuca J. The neuropsychology of post-polio fatigue.

 Archives of Physical Medicine and Rehabilitation, 1993; 74: 1061-1065.

Lincolnshire Post-Polio Library copy by arrangement 

with the Harvest Center Library


J Rehabil Med 2008; 40: 709–714
ORIGINAL REPORT
VITALITY AMoNG SWEdISH PATIENTS WITH PoST-PoLIo: A PHYSIoLoGICAL PHENoMENoN*http://jrm.medicaljournals.se/article/pdf/10.2340/16501977-0253
Gunilla Östlund, MSci1, Åke Wahlin, PhD2, Katharina S. Sunnerhagen, MD, PhD3,4 and Kristian Borg, MD, PhD1
From the 1Divison of Rehabilitation Medicine, Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, 2Department of Psychology, Stockholm University, Stockholm, 3Institute for Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Göteborg University, Göteborg, Sweden and 4Sunnaas Rehabilitation Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
Objective: To evaluate vitality and fatigue in post-polio pa- tients, and the relative contributions of physiological and psychological parameters to the level of vitality. Design: Multi-centre study.

Subjects: One hundred and forty-three patients with post- polio syndrome.
Methods: Inventories of background, quality of life, fatigue and sleep quality were used. Pain was evaluated using a visual analogue scale. Descriptive statistics and correlations were used for all selected parameters. Hierarchical regres- sion models were constructed to examine predictors of varia- tions in vitality, pain, reduced activity and physical fatigue. 
Results: General fatigue accounted for 68% of the variation in vitality. Of this, 91% was accounted for by physiologi- cal indicators. After controlling for age, physiological para- meters accounted for 56.6% and 25%, if entered before and after the psychological parameters, respectively. The impact of the psychological parameters decreased after accounting for the physiological parameters. Physical fatigue, age and sleep quality were associated with variation in pain. Body mass index, pain and sleep quality accounted for differences in reduced activity and physical fatigue.
Conclusion: Vitality in post-polio patients depends on physio- logical parameters. Mental fatigue is not a prominent pre- dictor. Subgroups with or without fatigue, independent of age, need further study.
Key words: post-polio, fatigue, vitality, quality of life. J Rehabil Med 2008; 40: 709–714
Correspondence address: Gunilla Östlund, Department of Rehabilitation Medicine, Danderyd University Hospital, Building 39, 3rd Floor, SE-182 88 Stockholm, Sweden. E-mail: Gunilla.Ostlund@ki.se

Submitted September 21, 2007; accepted May 29, 2008
INTRoduCTIoN
Poliomyelitis leads to muscle weakness due to destruction of the anterior horn cells. After an initial recovery there is a phase
*This article has been fully handled by one of the Associate Editors, who has made the decision for acceptance, as it originates from the institute where the Editor-in-Chief is active.
© 2008 The Authors. doi: 10.2340/16501977-0253 Journal Compilation © 2008 Foundation of Rehabilitation Information.
of functional stability that usually lasts from 10 to 40 years. during this phase the life circumstances of polio survivors do not differ much from the general population with respect to work and family situation (1). However, after the stable phase deterioration may occur; a condition termed post-polio syndrome (PPS) (2). The most commonly reported symptoms of PPS are increased muscle weakness, fatigue and pain in the muscles and joints. The last epidemic of polio in Sweden was in 1953 when more than 5000 people contracted poliomyelitis. Today, the prevalence of polio-affected individuals in Sweden is estimated to be 186/100,000 (3). Reported estimates of polio survivors eventually developing PPS vary from 20% to 68% (2, 4). Thus, the majority of polio survivors in Sweden are now middle-aged or older, and consequently at risk of developing PPS. Risk factors for developing PPS include time since the acute polio infection (5), age at presentation of symptoms, muscle pain at exercise, recent weight gain, joint pain (6) and female gender.

During the last decade, increasing research interest has fo- cused on fatigue in patients with PPS (7). Jubelt & Agre (8) re- ported generalized fatigue as one of the most common symptoms in PPS. Mental, as well as physical, fatigue has been reported by both Bruno et al. (9) and Schanke & Stanghelle (10).
Interestingly, and related to mental fatigue, there are con- tradicting reports regarding cognitive dysfunction in patients with PPS. Difficulties with attention, word finding, maintaining wakefulness and ability to think clearly have been reported by Bruno et al. (11). However, in most other studies cognitive function is reported to be unaffected by mental fatigue (12, 13). Furthermore, fatigued polio survivors are reported to have more mental health problems than controls or polio survivors without severe fatigue (5). In a study by Conrady et al. (14) patients, both at a post polio-clinic and in a post-polio support group, experienced significantly elevated levels of psychologi- cal distress, such as somatization and depression. Gonzalez et al. (15) reported an increase in cytokines in the cerebrospinal fluid of patients with PPS, indicating an inflammatory proc- ess. The inflammatory processes were down-modulated by treatment with intravenous immunoglobulin followed by a clinical effect, especially on vitality, as evaluated by means of Short Form 36 (SF-36). This indicates that vitality has a central role in PPS that may be improved by means of phar- macological treatment. The subjective experience of vitality
ISSN 1650-1977J Rehabil Med 40
Neuropsychiatry, Neuropsychology, & Behavioral Neurology:
ORIGINAL ARTICLES: PDF Only

A Neuropsychological Study of the Postpolio Syndrome: Support for Depression Without Neuropsychological Impairment

Hazendonk, Kim M. B.BSc.; Crowe, Simon F. Ph.D.

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Abstract

Objective: This study aimed to examine cognitive functioning in postpolio syndrome (PPS) after controlling for the effects of depression and illness behavior.
Background: Few studies have investigated the possible cognitive sequelae of PPS, despite widespread documented subjective complaints of "mental fatigue."
Method: A total of 23 PPS sufferers, 20 polio survivors without PPS, and 22 matched controls were compared using the Beck Depression Inventory-II; the Illness Behaviour Questionnaire; a chronic fatigue syndrome symptom checklist; and several measures of memory, attention, and concentration, including the Brown-Petersen Task, Stroop Test, Austin Maze, California Verbal Learning Test, Trail Making Test, Controlled Oral Word Association Test, and Symbol-Digit Modalities Test.
Results: In those participants with a medically confirmed diagnosis of PPS, there was a significantly higher level of depressive and hypochondriacal symptomatology as compared with the other two groups. Nevertheless, no significant differences existed between the three groups on neuropsychological measures.
Conclusions: These results indicate that the attention and memory difficulties reported by PPS sufferers may be linked to the physical or psychological manifestations of the illness rather than to objective decrements in cognitive performance. (NNBN 2000;13:112-118)
Neuropsiquiatría, Neuropsicología, Neurología y del Comportamiento:
ARTÍCULOS ORIGINALES: Sólo PDF

Un estudio neuropsicológico del síndrome postpolio: Apoyo a la depresión sin deterioro neuropsicológico

Hazendonk, MBBSc Kim;. Crowe, Simon F. Ph D..

Resumen

Objetivo: El presente estudio tuvo como objetivo examinar el funcionamiento cognitivo en el síndrome postpolio (SPP) después de controlar por los efectos de la depresión y el comportamiento de la enfermedad.
Antecedentes: Pocos estudios han investigado las posibles secuelas cognitivas del SPP, a pesar de amplia documentado quejas subjetivas de "fatiga mental".
Método: Un total de 23 enfermos de PPS, 20 supervivientes de la polio sin PPS, y 22 controles emparejados se compararon mediante el Inventario de Depresión de Beck-II, la enfermedad Cuestionario de Comportamiento, un síndrome de fatiga crónica lista de síntomas, y varias medidas de la memoria, la atención y concentración, incluyendo la tarea de Brown-Petersen, prueba de Stroop, Laberinto de Austin, California Verbal Learning Test, Trail Making Test, controlada oral Palabra Test de Asociación, y el símbolo dígitos Modalidades de prueba.
Resultados: En los participantes con un diagnóstico médico confirmado de PPS, hubo un nivel significativamente mayor de depresión y sintomatología hipocondríaca, en comparación con los otros dos grupos. Sin embargo, no existen diferencias significativas entre los tres grupos en las medidas neuropsicológicas.
Conclusiones: Estos resultados indican que las dificultades de atención y la memoria reportado por las víctimas del PPS puede estar relacionado con las manifestaciones físicas o psicológicas de la enfermedad en lugar de decrementos objetivo en el rendimiento cognitivo. (NNBN 2000, 13:112-118)

Editor (s): 
 
El sistema límbico es el sistema cerebral que controla las respuestas a las emociones y que se asocia con la conducta. La actividad neurobiológica de las emociones está localizada en el sistema límbico (la estación central de las emociones cerebrales), el cual está compuesto por el hipotálamo, el tálamo, la amígdala y el hipocampo.
Emociones: localización. Importancia del control mental
Estas últimas son estructuras nerviosas que rodean el hipotálamo y se comunican con el tallo cerebral (órgano que está situado debajo de las anteriores) que es donde están localizados los centros neurovegetativos de la relajación.

Esto explica los mecanismos neurofisiológicos del control mental puesto que voluntariamente van a ser estimulados dichos centros mediante sus técnicas y métodos.
Una Opción para llevar acabo
IMPORTANCIA DEL CONTROL MENTAL

Por medio de la práctica continua del control mental se obtendrá respuesta de relajación, la cual tiene efectos acumulativos que producen automejoramiento físico y mental. Se puede utilizar el poder de la mente para cambiar la autoimagen negativa y controlar situaciones adversas físicas o emocionales. El control mental es una ciencia que contiene métodos y técnicas para educar la mente y así obtener beneficios psíquicos y físicos, facilitando que lo que uno crea o imagine llegue a ser una realidad.

Con las técnicas de control mental se aprende a utilizar el enorme poder de la mente para controlar un gran número de desórdenes psicosomáticos relacionados con el estrés, la ansiedad, la depresión y la angustia. Ayudan a controlar funciones involuntarias como el ritmo cardiaco, la digestión, las disfunciones sexuales y las urinarias e incluso a controlar ciertas emociones negativas como la ira, el temor y la timidez para obtener el equilibrio emocional.

Es una ciencia que le ayuda a conocer las técnicas para utilizar las células o circuitos cerebrales que normalmente no empleamos, pues está comprobado que en nuestra vida sólo utilizamos el 19% de nuestra capacidad mental.

Contiene fáciles técnicas donde voluntariamente estimulamos el cerebro para que entre en un estado de meditación y logre de una manera automática, sin ningún esfuerzo y fisiológicamente, una relajación psíquica y física independiente de la voluntad llamada por Benson respuesta de relajación.

Los métodos y técnicas de la ciencia del control mental pueden ser utilizados fácilmente a cualquier hora, en cualquier lugar y por cualquier persona, pero de ninguna manera reemplaza la ayuda médica. Es una disciplina que va ayudar a utilizar un mayor potencial de la mente en su propio beneficio, va a iniciarlo en una nueva vida de tranquilidad y progreso y en una nueva filosofía de paz interior y ecuanimidad. Aportará grandes beneficios por el resto de su vida.
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