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| COMMENTARY |
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| Year : 2015 | Volume
: 8
| Issue : 1 | Page : 60-61 |
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Postpolio syndrome and electrodiagnosis
Viroj Wiwanitkit
1Hainan Medical University, China; Faculty of Medicine, University of Nis, Serbia; Joseph Ayobabalola University, Nigeria; Surin Rajabhat University, Thailand
| Date of Web Publication | 8-Jan-2015 |
Correspondence Address:
Viroj Wiwanitkit
Hainan Medical University, China
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Wiwanitkit V. Postpolio syndrome and electrodiagnosis. Med J DY Patil Univ 2015;8:60-1 |
Polio is an important neurological infection. This infection can result in permanent disability and it is still an important global public health threat. This infection can be seen in some countries with existed problem on sanitation. The management of the symptomatic case is usually not satisfied and the disability is usually an important unwanted outcome. Postpolio syndrome (PPS), a clinical disorder affecting polio survivors with sequel years after the initial polio attack, is the focused in medical management. PPS can be seen in two-tenths to eight-tenths of the patients with polio. [1] The diagnosis of PPS is usually difficult. Basically, the ruling out of other possible causes of signs and symptoms is the basic practice before reaching the final diagnosis of PPS. [2,3] The using of criterion diagnosis is the widely used. The general diagnostic criteria include (a) confirmed history of polio, (b) recovery after the acute episode, (c) having a stable period of at least 15 years, (d) two or more of the following health problems after the stable period: Extensive fatigue, muscle and/or joint pain, new weakness in muscles previously affected or unaffected, new muscle atrophy, functional loss, cold intolerance and (e) no other disorders that can explain the newly occurred problem. [2,4] It is no doubt that the early diagnosis of PSS is very important. As published in the commented paper, [3] "management plans must be individualized and should focus on the fact that the patient with prior polio has fewer motoneurons than do healthy subjects."
The use of the new diagnostic tool to help diagnose PPS is a great challenge. Electromyography (EMG) and/or MRI are widely mentioned for its clinical usefulness. [5] Dalakas noted that " muscle biopsy, 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. [5]" Since progressive weakness and atrophy in postpolio syndrome symptoms (PPSS) is proposed to be due to a distal degeneration of postpolio motor units that leads to irreversible muscle fiber denervation, [3] the role of EMG can be expected. Physiologically, progressive weakness and atrophy from finding of includes fibrillation and fasciculation potentials can be seen by EMG in the cases with PPS. [6] Nevertheless, the main problem is no specific test is set as a gold standard for diagnosis of PPS. Trojan et al. concluded that "even though electrodiagnostic studies have provided insight into the possible causes of some PPSS, no specific electrodiagnostic test for the syndrome is currently available. [6]" Jubelt and Cashman also concluded that "EMG and muscle biopsy studies suffer from a lack of specificity as they do not appear to distinguish asymptomatic from symptomatic (new weakness) patients with prior poliomyelitis." [7] Ravits et al. noted that the EMG finding in the patients with PPS were similar to those observed in in progressive and stable postpoliomyelitis patients. [8] Ravits et al. concluded that "postpoliomyelitis muscular atrophy appears to be the clinically apparent end of the spectrum of abnormalities existing in all postpoliomyelitis patients." [8] However, Jubelt and Cashman mentioned that the studies could revealed a loss or dropout of axon terminals of reinnervated motor units in the cases. [7] Bromberg and Waring also proposed that "the lack of clear evidence for previous denervation after extensive electrodiagnostic testing is a valid means for excluding the diagnosis of PPS." [9] Based on these facts, although EMG might have some limitations in diagnosis of PPS, it can give some clues that can be useful for the practitioner for judgment a proper management to a suspected PPS case. It can be a choice in resource limited setting as in the present published article in Med J Dr DY Patil University. [3]
| References | |  |
| 1. | Nollet F, Beelen A, Twisk JW, Lankhorst GJ, De Visser M. Perceived health and physical functioning in postpoliomyelitis syndrome: A 6-year prospective follow-up study. Arch Phys Med Rehabil 2003;84:1048-56.  |
| 2. | Halstead LS, Rossi CD. New problems in old polio patients: Results of a survey of 539 polio survivors. Orthopedics 1985;8:845-50. |
| 3. | Sheth MS, Sharma SS, Bansal AB, Shah KJ. Case report of conventional electrodiagnosis of a subject with post polio syndrome. Med J Dr DY Patil Univ 2015;8:58-61. |
| 4. | Halstead LS. Assessment and differential diagnosis for post-polio syndrome. Orthopedics 1991;14:1209-17. |
| 5. | Dalakas MC. The post-polio syndrome as an evolved clinical entity. Definition and clinical description. Ann N Y Acad Sci 1995;753:68-80. |
| 6. | Trojan DA, Gendron D, Cashman NR. Electrophysiology and electrodiagnosis of the post-polio motor unit. Orthopedics 1991;14:1353-61. |
| 7. | Jubelt B, Cashman NR. Neurological manifestations of the post-polio syndrome. Crit Rev Neurobiol 1987;3:199-220. |
| 8. | Ravits J, Hallett M, Baker M, Nilsson J, Dalakas M. Clinical and electromyographic studies of postpoliomyelitis muscular atrophy. Muscle Nerve 1990;13:667-74. |
| 9. | Bromberg MB, Waring WP. Neurologically normal patients with suspected postpoliomyelitis syndrome: Electromyographic assessment of past denervation. Arch Phys Med Rehabil 1991;72:493-7. |
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