In article <001d01be16c9$d42848c0$2298fea9@pcgenk6>, dated Mon, 23 Nov
1998 at 23:12:48, Jon Wilcox <[log in to unmask]> writes
>I have over the last 3 weeks observed a frightening episode of sub-acute
>spinal myelitis in my 8 year old (just turned 9 but too crook to have a
>party this year) with quite bizarre upper and lower limb neurological
>symptoms/signs. The Epstein Barr virus DNA-amplification (polymerase chain
>reaction) came back positive today (can be taken from whole blood cells or
>preferably CSF). I have not witnessed anything similar in any of my own
>paediatric 'clientele' over the last 15+ years. Has anybody experienced any
>similar conditions in their paediatric patients in recent times ?

I have left in the above as I have no wish to divert attention from Dr.
Wilcox's question for obvious reasons. Nevertheless, I have to comment
on the unfortunate use of the phrase "old fashioned" in describing
poliomyelitis syndrome, perhaps an unintentional ambiguity in the
circumstances. 

>It seems very much like the old fashioned poliomyelitis syndrome.

In the first place poliomyelitis itself is not "old fashioned". While
the wild form is now rare in the developed world, it is still a
significant problem in third world countries. The WHO's polio
eradication target of the year 2000 has in the last year or so slipped
to 2003/4.

Additionally, in those countries supposedly free of polio there are
still cases of Vaccine Associated Polio (VAP). While small in number
they are of concern as they are largely avoidable by the use of
inactivated polio virus (IPV) vaccine, i.e. Salk, either alone or as
part of a mixed schedule with Oral Polio Vaccine (OPV) i.e. Sabin. The
US CDC has changed its recommendations to reflect the new situation of
OPV cases outnumbering the zero cases of reported and confirmed wild
polio. In other countries in a similar situation, and that includes the
UK, OPV is still the norm. Thus polio vaccine schedules are a current
though not well publicised issue. I should make clear that OPV is still
the preferred polio vaccine for mass vaccination in areas where wild
polio continues to prevail.

Although Dr. Wilcox refers to poliomyelitis syndrome, which I assume he
means the symptoms associated with the initial poliomyelitis infection,
the term syndrome is more commonly used to describe 'new' symptoms
presenting often decades following initial recovery from the polio
infection. Post-Poliomyelitis Syndrome (PPS), or the Late Effects of
Polio (LEOP), presents as new muscle weakness, muscle fatigue, central
fatigue and a number of other symptoms. Effectively, it is a significant
albeit long-delayed relapse in recovery from polio. The degree of
'relapse' varies but can be significant with previously ambulatory polio
survivors requiring assistive devices such as wheelchairs. New pulmonary
weakness may also lead to the use of assisted ventilation devices. While
there is much that can be done to limit and stabilise the onset of these
new symptoms, currently there is no 'cure'. It is also becoming apparent
that PPS is not limited to those previously diagnosed as having the
paralytic form of polio. The polio virus can cause considerable damage
to motor neurones without any clinical paralysis presenting. The most
compelling theory for the development of PPS involves compensatory
axonal sprouting of surviving motor neurones to do the work of those
destroyed by the polio virus. Individual motor units may end up reaching
7 to 8 times the normal innervation ration of motor neurones. It is also
believed that the denervation - reinnervation cycle continues over time
until overworked motor units begin to fail once and for all. In other
words the compensatory mechanism has a finite life. As 'non-paralytic'
polio may involve some hidden motor neuron loss, it is becoming apparent
that PPS is not limited to paralytic polio cases. Diagnosis of PPS,
which is only by exclusion of other conditions as there is no test for
PPS, is thus further complicated in that potential cases may have no
prior history of paralytic polio or even non-paralytic polio. Not only
is the accuracy of historical records of reported cases of polio open to
question in that reporting and verification procedures are likely to
have been less than comprehensive in epidemic situations, many cases of
mild polio will have passed undiagnosed. Taking as a benchmark the 1991
US CDC national survey which estimated the number of surviving
*paralytic* poliomyelitis cases in the US at that time to be 640,000 you
can begin to see that the potential cases of PPS world-wide may well run
to millions.

So, one way or another, poliomyelitis is far from "old fashioned". As I
said in the beginning, it is not my intention to divert attention from
Dr. Wilcox's request for any information regarding his daughters sub-
acute spinal myelitis nor is there any implied criticism. The mistaken
idea that polio is history is unfortunately quite common in medical
circles. Anyone who wishes to find out more is more than welcome to
access our online library which contains the full text of over eighty
medical articles, many from peer reviewed medical journals.

http://www.zynet.co.uk/ott/polio/lincolnshire/library.html

Chris 
-- 
Chris Salter (Vice Chairman)             Lincolnshire Post-Polio Network
                    Registered Charity No. 1064177
          <URL:http://www.zynet.co.uk/ott/polio/lincolnshire/>
     Web Site & Vice Chairman Email: [log in to unmask]
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