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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many people previously affected by polio complain of increased fatigue, weakness and pain many years after the initial illness. Although electromyographic abnormalities have been found in these patients, the cause of their increased weakness is not well understood. Previous studies have shown decreased strength and impaired exercise performance in those with prior polio, but the level of voluntary drive to the muscle has not been investigated. The present study investigated maximal voluntary activation without fatigue and both peripheral and central components of muscle fatigue during exercise in 21 subjects with poliomyelitis 20-40 years previously, and 20 healthy, age-matched control subjects. Voluntary activation and strength of the elbow flexors were quantified using twitch interpolation during maximal isometric voluntary contractions both at rest, and during fatigue induced by 45 min of repeated isometric contractions. Compared with the control subjects, patients with prior polio had impaired voluntary activation both when the elbow flexors were not fatigued and during fatiguing submaximal exercise. During exercise, polio subjects also had lower twitch amplitudes and increased subjective fatigue. Central and peripheral fatigue were more marked in those with the post-polio syndrome. The impaired voluntary activation with unfatigued muscles in polio subjects indicates that defective central or reflex drive may contribute to their new weakness.
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PMID:Muscle performance, voluntary activation and perceived effort in normal subjects and patients with prior poliomyelitis. 792 55

Post-polio syndrome (PPS) refers to the late development of new neuromuscular symptoms in previously stable poliomyelitis patients. Whether psychological disturbance plays a role in the manifestation of symptoms in these patients is unclear. We examined 22 patients fulfilling the clinical criteria for PPS with the Minnesota Multiphasic Personality Inventory-II (MMPI-II), Beck Depression Inventory, Spielberger State-Trait Anxiety Scales, Chapman and Chapman Psychosis-Proneness Scales, Fatigue Scales, a neurobehavioral rating scale, and Cognitive Symptoms Self-Report Scales. The overwhelming majority of scale scores were within normal limits, and there was no indication that psychopathologic symptoms were associated with the development or severity of new muscle weakness in PPS patients. Women with PPS had significantly more somatic complaints, but were less socially isolated than men with PPS. This study confirms that the development or severity of new muscle weakness in carefully diagnosed PPS patients is not due to, or influenced by, underlying psychopathology.
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PMID:A personality profile of patients diagnosed with post-polio syndrome. 793 26

Post-poliomyelitis syndrome (PPS) is generally defined as a clinical syndrome of new weakness, fatigue, and pain in individuals who have previously recovered from acute paralytic poliomyelitis. The purpose of this study was to identify, through a case-control study design, factors that predict subsequent PPS in patients with prior paralytic poliomyelitis. Among patients attending a university-affiliated hospital post-polio clinic, "cases" were patients with new weakness and fatigue, and "controls" were patients without these complaints. A chart review of 353 patients identified 127 cases and 39 controls. Logistic regression modeling was used to calculate adjusted and unadjusted odds ratios. In univariate analyses, significant risk factors for PPS were a greater age at time of presentation to clinic (p = 0.01), a longer time since acute polio (p = 0.01), and more weakness at acute polio (p = 0.02). Other significant associated, but not necessarily causal factors were a recent weight gain (p = 0.005), muscle pain (p = 0.01) particularly that associated with exercise (p = 0.005), and joint pain (p = 0.04). Multivariate analyses revealed that a model containing age at presentation to clinic, severity of weakness at acute polio, muscle pain with exercise, recent weight gain, and joint pain best distinguished cases from controls. Age at acute polio, degree of recovery after polio, weakness at best point after polio, physical activity, and sex were not contributing factors. These findings suggest that the degree of initial motor unit involvement as measured by weakness at acute polio, and possibly the aging process and overuse are important in predicting PPS.
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PMID:Predictive factors for post-poliomyelitis syndrome. 802 23

Outbreaks of illness variously identified by a number of terms, including epidemic neuromyasthenia, myalgic encephalomyelitis, Iceland disease, and atypical poliomyelitis, have been reported from many countries during the past 45 years. Since the first well-described outbreak occurring in 1934, > 60 outbreaks have been reported, but few of these have been described in considerable detail. These outbreaks are usually cited in historical reports of chronic fatigue syndrome (CFS) since each of these outbreaks appears to contain a number of cases meeting the current case definition of CFS. There has been inadequate attention given to the fact that epidemic neuromyasthenia and related clusters characterized by various complaints, including fatigue, do not have an accepted epidemiological or clinical definition, and only rarely have descriptions of these clusters included a specific case definition. When such case definitions have been applied, the occurrence of cases meeting the current case definition for CFS appears to be both variable and infrequent. This report utilizes examples of several well-documented outbreaks to emphasize specific aspects that should be considered in the investigation of future clusters.
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PMID:Epidemic neuromyasthenia and chronic fatigue syndrome: epidemiological importance of a cluster definition. 814 46

Patients who have been affected by poliomyelitis may develop new symptoms such as muscle weakness, muscle atrophy, muscle or joint pain, and unexplained fatigue several decades after the onset of their poliomyelitis (post-polio syndrome [PPS]). We report on the results of our study of 59 patients with poliomyelitis using a number of instruments for disability assessment, including a 4- to 5-year follow-up. The main impact of disability for most patients is in mobility-related activities. Dependence in personal activities of daily living is fairly rare, whereas dependence and difficulties in instrumental activities of daily living (eg, cooking, transportation, cleaning, shopping) are more common and also more severe in persons with PPS. Mental health, emotional reactions and social activity, interaction, and isolation are usually less affected, although considerable coping problems may occur, especially in persons with PPS who have new health problems and increasing disabilities. Examples of disabilities, intervention measures, and coping processes are given with case reports. The importance of a broad and interdisciplinary approach is emphasized, in which impairment as well as disability aspects should be considered in treatment and intervention programs.
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PMID:Disability in poliomyelitis sequelae. 817 Nov 3

Fatigue is the most commonly reported, most debilitating, and most poorly understood Post-Polio Sequelae (PPS). Postmortem studies of 50 years ago documented frequent and severe poliovirus-induced lesions within the Reticular Activating System (RAS). Recently, neuropsychological testing has documented marked attention deficits in polio survivors reporting severe fatigue. However, neither of these findings has yet been related to the pathophysiology of post-polio fatigue. Magnetic resonance imaging of the brain was performed in 22 polio survivors carefully screened to eliminate the effect of comorbidities. Subjects rated the severity of their daily fatigue and subjective problems with attention, cognition, and memory. Small discrete or multiple punctate areas of hyperintense signal (HS) in the reticular formation, putamen, medial leminiscus, or white matter tracts were imaged in 55% of the subjects reporting high fatigue and in none of those reporting low fatigue. The presence of HS significantly correlated with fatigue severity and subjective problems in attention, concentration, staying awake, recent memory, and thinking clearly. The lack of significant correlations between HS or fatigue severity and age, severity of the acute polio, depressive symptoms, or difficulty sleeping militates against these factors as either causing HS or producing fatigue. These preliminary findings suggest that poliovirus-induced lesions in the Brain Activating System may underlie the subjective fatigue and attention deficits reported by polio survivors.
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PMID:The neuroanatomy of post-polio fatigue. 818 40

To test the hypothesis that post-polio fatigue and its concomitant cognitive deficits are associated with an impairment of attention and not of higher-level cognitive processes, six carefully screened polio survivors were administered a battery of neuropsychological tests. Only subjects reporting severe fatigue, and not those with mild fatigue, demonstrated clinically significant deficits on all tests of attention, concentration, and information processing speed while showing no impairments of cognitive ability or verbal memory. These findings suggest that an impaired ability to maintain attention and rapidly process complex information appears to be a characteristic in polio survivors reporting severe fatigue, because these deficits were documented even when their subjective rating of fatigue was low. This finding supports the hypothesis that a polio-related impairment of selective attention underlies polio survivors' subjective experience of fatigue and cognitive problems.
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PMID:The neuropsychology of post-polio fatigue. 821 57

A 48-year-old woman started experiencing increased muscle weakness and fatigue at age 44, 40 years after the onset of acute poliomyelitis. The acute poliomyelitis resulted in severely weak lower limb muscles and as a result, she had used crutches for more than 40 years. Computer-aided force transducer systems were used to determine isometric muscle strength. Both quadriceps and left ankle dorsiflexors were severely weak and could not generate any measurable force. Isometric muscle strength of her right ankle dorsiflexors was 77 Newtons (N) (approximately 1/3 normal); isometric muscle strength of right elbow flexors (171N) and left elbow flexors (160N) were within normal range, although she complained of weakening based on her inability to climb two stairs at a time with crutches as she was used to. She underwent high-resistance weight training of her right ankle dorsiflexors and left elbow flexors for one year. Weight training was three times per week, five sets of ten repetitions per session; total duration of muscle contraction (excluding rest periods) was two and one half minutes per session, 30 minutes per month. Muscle strength (N) was remeasured after four, eight, and 12 months. Muscle strength of right ankle dorsiflexors increased by 61%, whereas that of the left elbow flexors increased by 32% after one year of weight training. She also expressed a subjective feeling of increased muscle strength. High-resistance, short duration muscle strengthening exercise programs should therefore be given a serious consideration in the rehabilitation management of moderately weak muscles of post-polio subjects.
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PMID:Muscle strengthening in a post-polio subject through a high-resistance weight-training program. 817 12

The PPS is now a well-recognized entity encompassing the late manifestations that occur because of previous poliomyelitis. Common signs and symptoms include fatigue, cold intolerance, joint deteriorations with pain, and prominent neurologic problems that include new weakness, muscle pain, atrophy, respiratory insufficiency, dysphagia, and sleep apnea. It is estimated that there are 1.63 million polio survivors in the United States and that half of them will develop PPS. PPS and PPMA usually begin 30 to 40 years after the acute illness and are very slowly progressive. The etiology is unclear, although premature exhaustion of the new sprouts that develop after acute poliomyelitis and of their motor neurons appears most likely. Less likely is a persistent polio-virus infection or an immune-mediated problem. Treatment is primarily supportive, although nonfatiguing strengthening exercise may improve strength over the short term. The long-term effects of this type of exercise remain to be clarified.
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PMID:Post-polio syndrome: an update. 827

Disabling generalized fatigue and muscle fatiguability are common features of post-poliomyelitis syndrome (PPS). In 17 fatigued PPS patients, we measured jitter on stimulation single-fiber electromyography (S-SFEMG) for at least 3.5 min before and after i.v. injection of 10 mg edrophonium. We observed reduction in jitter (defined as a significant difference in jitter means before and after edrophonium, unpaired t-test P < 0.05) in 7 patients, no change in 8, and a significant increase in 2 patients. Blinded to their edrophonium results, the 17 patients were treated with pyridostigmine 180 mg/day for 1 month, with a subjective improvement of fatigue in 9 patients, and with a significant reduction in mean Hare fatigue scores in the entire group of 17 patients (pre = 2.71, and post = 1.71; Wilcoxan signed rank sum test, P < 0.05). Edrophonium-induced reduction of jitter on S-SFEMG was significantly associated with pyridostigmine-induced subjective improvement of fatigue (Fisher's exact test, P < 0.04). A significant reduction in fatigue with pyridostigmine was observed only in the 7 patients who experienced a significant reduction in jitter with edrophonium (Wilcoxan signed rank sum test, P = 0.03). In addition, the 9 pyridostigmine responders experienced a significant reduction in jitter means pre- and post-edrophonium (100% vs. 88%, Bonferroni corrected, P < 0.01). We conclude that neuromuscular transmission as measured by jitter on S-SFEMG can improve with edrophonium in a proportion of PPS patients, and that generalized fatigue and muscle fatiguability in some patients with PPS may be due to anticholinesterase-responsive NMJ transmission defects.
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PMID:Anticholinesterase-responsive neuromuscular junction transmission defects in post-poliomyelitis fatigue. 838 88


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