A Long-Term Follow-up Study of Patients with Post-Poliomyelitis Neuromuscular Symptoms

A “post-polio” syndrome characterized by new neuromuscular symptoms, including muscle weakness, may develop years after recovery from acute paralytic poliomyelitis. We studied 27 patients (mean age, 50.6 years) in whom new muscle weakness developed a mean of 28.8 years after recovery from acute polio. We reevaluated these patients during a mean follow-up period of 8.2 years (range, 4.5 to 20) after they were originally studied at the National Institutes of Health. The total mean follow-up period after the onset of new weakness was 12.2 years (range, 6 to 29). The patients were assessed with quantitative muscle testing, muscle biopsy, electromyography, and virologic and immunologic examination of the cerebrospinal fluid. Muscle strength had declined in all patients. The rate of decline averaged 1 percent per year. The decrease was irregular, with subjective plateau periods that ranged from 1 to 10 years. None of the patients had amyotrophic lateral sclerosis. Oligoclonal bands (IgG) were found in the cerebrospinal fluid of 7 of 13 patients studied, but no specific elevation of antibodies to poliovirus was observed in the cerebrospinal fluid. The newly affected muscles that were evaluated longitudinally with follow-up muscle biopsies and electromyography showed signs of chronic and new denervation. Groups of atrophic muscle fibers (group atrophy) and “neurogenic jitter” were not present. New post-polio muscle weakness is not a life-threatening form of motor-neuron deterioration. It appears that this weakness is not due to a loss of whole motor neurons, as in amyotrophic lateral sclerosis, but that it is due to a dysfunction of the surviving motor neurons that causes a slow disintegration of the terminals of individual nerve axons. (N Engl J Med 1986; 314:959–63.), MUCH anxiety has arisen among the estimated 300,000 survivors of polio in the United States because of recent reports about a new muscular weakness, often called the “post-polio syndrome,” that develops in some of these persons.¹ It is known that some people may experience new neuromuscular symptoms many years after their recovery from acute paralytic poliomyelitis.^{2 3 4 5 6 7 8} These symptoms vary from simple nonprogressive deterioration of function, with joint pain, fatigue, and subsequent stabilization,^{4 5 6} to atypical forms of spinal muscular atrophy^2,3 or to what appears to be a forme fruste of amyotrophic lateral sclerosis (ALS).^2,9,10 The new, slowly progressive muscle weakness, which…