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

Postviral fatigue syndrome (PFS) occurs both in epidemics and sporadically. Many of the original epidemics were related to poliomyelitis outbreaks which either preceded or followed them. The core clinical symptoms are always the same: severe fatigue made worse by exercise, myalgia, night sweats, atypical depression and excessive sleep. The other common symptoms include dysequilibrium disorders and irritable bowel syndrome. We have detected enteroviral genome sequences in muscle biopsies from cases of PFS, using specific enteroviral oligonucleotide primers in the polymerase chain reaction (PCR). In addition, whole virus particles can be demonstrated in PCR-positive muscle, using solid-phase immuno-electron microscopy. An increase in the number and size of muscle mitochondria was found in 70% of PFS cases, suggesting an abnormality in metabolic function. Evidence of hypothalamic dysfunction was present, particularly involving 5-hydroxytryptamine metabolism. A putative model of PFS, based on persistent enteroviral infection in laboratory mice, revealed resolving inflammatory lesions in muscle with, however, a marked increase in the production of certain cytokines in the brain. This model may help to explain the pathogenesis of PFS.
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PMID:Enteroviruses and postviral fatigue syndrome. 838 8

Poliomyelitis is an acute viral disease that attacks the brain and the ventral horn of the spinal cord. Damage to the lower motor neurons usually results in atrophy and weakness of muscle groups, perhaps paralysis and possibly deformity. A second type, bulbar poliomyelitis, infects the medulla oblongata and may result in dysfunction of the swallowing mechanism along with respiratory and circulatory distress. Minor forms of poliomyelitis result in fever, sore throat, headache, and upper body stiffness, but leave no significant atrophy or paralysis. The purpose of this paper is to review post-polio syndrome (PPS) as well as the effect of exercise on the symptoms and morphologic adaptations to PPS and where future research efforts should be directed. The most common features of PPS for over 350,000 afflicted survivors include general fatigue, weakness, and joint/muscle pain. The primary reasons for these symptoms include 1) destruction of the anterior horn cells by the polio virus, leaving fewer motor neurons to induce muscle contraction; 2) unaffected motor unit enlargement by reinnervation through terminal sprouting; and 3) defective transmission at the neuromuscular junction secondary to failure of terminal axonal sprout. Acute responses to resistive exercise suggest significant muscle strength decrements in the knee extensors compared with similar aged people without polio. However, limited training investigation indicates significant strength increases for the knee extensors following at least 6 wk of training. Acute aerobic responses also differ significantly from those observed in aged-matched control subjects. Chronic aerobic responses to limited training studies suggest significant elevations in maximal oxygen uptake.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Poliomyelitis and the post-polio syndrome: exercise capacities and adaptation--current research, future directions, and widespread applicability. 847

Chronic fatigue as a presenting complaint, in the absence of other evident organic illness, was seldom reported historically before the second half of the 19th century. Its first eruption was the so-called 'bed cases' or 'sofa cases' among middle-class females in the period from 1860 to about 1910. 'Neurasthenia' does not necessarily represent an early forerunner of chronic fatigue. Many patients receiving that diagnosis did not complain of fatigue. Others with functional fatigue did not receive the diagnosis 'neurasthenia'. Both medical-anecdotal and quantitative sources make it clear that by the time of the First World War, chronic fatigue was a common complaint in Europe and North America. Medical concepts of chronic fatigue since the 1930s have run along four separate lines: (1) 'postinfectious neuromyasthenia', going back to an atypical 'poliomyelitis' epidemic in 1934; (2) 'chronic Epstein-Barr virus' infection, an illness attribution that increased in frequency after the discovery in 1968 that this virus caused mononucleosis; (3) 'myalgic encephalomyelitis', dating from an epidemic at the Royal Free Hospital in London in 1955; and (4) 'fibrositis', or 'fibromyalgia', used as a rheumatological description since the turn of the century. Recently, these four separate paths have tended to converge into the diagnosis of 'chronic fatigue syndrome'.
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PMID:Chronic fatigue in historical perspective. 849 Nov 7

The post-polio syndrome is a late sequel of former poliomyelitis. Patients develop slowly progressive weakness, fatigue and pain. We report 13 cases.
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PMID:[Post-polio syndrome]. 850 12

We completed a prospective, population-based cohort study of polio survivors in Olmsted County, Minnesota, between 1986 and 1993. We identified 50 individuals who had had paralytic polio between 1935 and 1960, as representative of all 300 cases of paralytic polio in the county. We completed detailed quantitative clinical and electrophysiologic studies at entry and after 5 years. These studies demonstrated stable neuromuscular function within the cohort, although 60% of the individuals were symptomatic. In two-thirds of the symptomatic patients, the causes of their symptoms were unrelated to earlier polio. For the 20% of patients who had unexplained muscle pain, perception of weakness, and fatigue, a mechanical disorder most likely underlies their symptoms.
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PMID:Lack of progression of neurologic deficit in survivors of paralytic polio: a 5-year prospective population-based study. 896 Jul 65

A cohort study with initial and 4-year follow-up evaluations was performed in 78 post-polio volunteers aged 34-65 years at the time of enrolment in the study, which was made to compare post-polio individuals living in Sweden and the United States, to determine whether lower limb musculature becomes weaker over time, and to determine whether individuals with complaints of post-polio syndrome, new weakness, fatigue, walking or stair climbing difficulty were weaker or lost more strength over a 4-year interval than those individuals without such complaints. Dynametrically-measured knee extensor and flexor strength and questionnaire data were obtained initially and 4 years later. The two cohorts were fairly similar, though they differed in weight gain. The Americans gained significantly (p < 0.05) more weight than the Swedish subjects. Both groups lost significant (p < 0.05) knee extensor strength (approximately 8%), but the loss was not significantly (p < 0.05) different between the groups. Knee flexor strength did not change significantly (p < 0.05) over time. Subjects acknowledging new strength loss were not significantly (p < 0.05) weaker than those denying strength loss; however, they lost significantly (p < 0.05) more isometric knee extensor strength than the other individuals. Subjects acknowledging new fatigue, walking or stair climbing difficulty were significantly (p < 0.05) weaker in both muscle groups than those without such complaints. Subjects acknowledging post-polio syndrome were significantly (p < 0.05) weaker than those denying this symptom, but the amount of loss of strength over time was not significantly (p < 0.05) different. We conclude that the two cohorts were quite similar. Knee extensor strength decreased during the study interval. Individuals acknowledging post-polio syndrome had weaker knee extensor musculature. Subjects with new fatigue, walking difficulty, or stair climbing difficulty were weaker in both the knee extensors and the knee flexors than the other subjects. Subjects reporting new muscle weakness also had a greater decline in isometric knee extensor strength during the study interval than those without such complaint.
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PMID:A comparison of symptoms between Swedish and American post-polio individuals and assessment of lower limb strength--a four-year cohort study. 860 81

This study was undertaken to investigate the mechanisms underlying fatigue of chronically overused motor units (MUs). The force of the tibialis anterior muscle (TA) and the firing properties of single MUs were studied during prolonged maximum voluntary effort in 10 prior polio patients selected such that daily living required all residual TA power. Almost all TA fibers were hypertrophic type I. Activities of intermyofibrillar succinate dehydrogenase (SDH) and calcium-stimulated myofibrillar adenosine triphosphatase (ATPase) were measured in single TA fibers from a representative patient. Neither insufficient motoneuron activation nor peripheral blocking of the electrical impulse played a major role in the loss of force during prolonged contraction or for slow recovery after contraction. The ratio of SDH to calcium-stimulated ATPase, representing the relation between energy resynthesis and energy utilization, was significantly (P < 0.001) lower in prior polio patients (0.230 +/- 0.096) compared to control (0.515 +/- 0.097) type I fibers.
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PMID:Fatigue of chronically overused motor units in prior polio patients. 860 23

Forty-three former polio patients now complaining of new progressive muscle weakness (symptomatic patients) plus 13 former polio patients without new neuromuscular complaints were included in the study. The symptomatic patients reported high frequencies of other neuromuscular complaints and a decline in their functional level. Most frequent complaints were general fatigue, low backache, and muscle pain (97.7%, 86%, and 79.1%, respectively) and a decline in the ability to walk (80%). In a prospective follow-up averaging 2.1 years, the muscle strength of 26 muscles in all four limbs of each patient was assessed by manual muscle testing and was also measured isometrically using a handheld dynamometer. During the follow-up period, we did not find a significant decrease in muscle strength in the symptomatic patients as compared to patients without new neuromuscular complaints.
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PMID:Muscle strength in postpolio patients: a prospective follow-up study. 860 24

The disorder consists of fatigue accompanied by new muscle weakness and muscle pain or, for patients whose acute polio had included bulbar involvement, new difficulty in swallowing or change in voice. The epidemiology remains unclear, fueling anxiety among polio survivors. Yet its course is not drastically progressive, and impairment is usually limited.
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PMID:Recognizing post-polio syndrome. 863 51

Fatigue is the most commonly reported and most disabling of all post-polio sequelae (PPS). Bromocriptine mesylate (Parlodel) was employed in a placebo-controlled trial in five survivors of paralytic polio who continued to report moderate to severe daily fatigue after complying with the conservative treatments prescribed for PPS. Placebo was given for 4 wk followed by increasing doses of bromocriptine mesylate, administered at 12:00 pm for 28 days, which reached a total dose of 12.5 mg/day. Three subjects reported marked symptom improvement on bromocriptine but not on placebo. Their reported difficulty with attention, concentration, word finding, mind wandering, memory, thinking clearly, and fatigue on awakening was significantly negatively correlated with days on bromocriptine but not with days on placebo. Before the drug trial began, responders had clinically impaired performance on neuropsychologic tests of attention and information processing speed, more than twice as many hyperintensities on magnetic resonance imaging of the brain, abnormally low fasting adrenocorticotropic hormone levels, and nearly double the mean plasma prolactin level compared with nonresponders. The implications of these findings for the pathophysiology of fatigue are discussed. A double-blind, placebo-controlled, multicenter study will be needed to confirm bromocriptine's efficacy in treating attentionally and neurophysiologically impaired polio survivors whose severe and disabling fatigue does not respond to conservative therapies.
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PMID:Bromocriptine in the treatment of post-polio fatigue: a pilot study with implications for the pathophysiology of fatigue. 887


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