May 6, 2010

Intravenous Immunoglobulin

Intravenous Immunoglobulin Treatment
for Improving Muscle Strength
Kristian Borg, MD, PhD, Division of Rehabilitation Medicine, Karolinska Institute,
Danderyd University Hospital, Stockholm, Sweden,
Post-Polio Syndrome, described as weakness and atrophy in
skeletal muscles, occurs when there is a failure in capacity of a
nerve cell body to maintain large motor units. The large motor
units are supported when the capacity for re-innervation is greater
than denervation. Eventually this mechanism reaches an upper limit
leading to muscle weakness. The cause of the denervation is unknown
at the moment.

An ongoing inflammatory process in
the central nervous systems of postpolio
patients has been described in
some studies, but has not been found
in other studies.

Our study in 2002 found an increase
of cytokine production in the central
nervous system of post-polio patients.
We know that:

􀀓 Cytokine levels are greater when
there is an inflammation.

􀀓 Cytokine levels are higher in people
with multiple sclerosis (MS), a
known neuroinflammatory disorder.
􀀓 The level of the increase in the
post-polio patients was almost the
same as in the MS patients.

We checked older studies to see what
work had been done.
􀀓 Dinsmore reported an effect of prednisone
in high doses and the effect
eroded as the doses were lowered.

􀀓 Ann Bailey, MD, at Warm Springs,
Georgia, in the early ‘80s, treated 80
patients with the oral vaccination,
and 50 of those patients reported a
positive effect on their symptoms.*

Due to her results and to the pattern
of the cytokine increase, we began an

Gonzalez, H., Khademi, M.,
Andersson, M., Wallström, E.,
Borg, K. & Olsson, T. Prior
poliomyelitis—evidence of cytokine
production in the central nervous
system. J Neurol Sci 2002; 205:
Gonzalez, H., Khademi, M. &
Andersson, M., et al. Prior
poliomyelitis-IvIg treatment
reduces proinflammatory cytokine
production. J Neuroimmunol
2004; 150(1-2):139-44.
Kaponides, G., Gonzalez, H.,
Olsson, T. & Borg, K. Effect of
intravenous immunoglobulin in
patients with post-polio syndrome—
an uncontrolled pilot
study. J Rehabil Med 2006, 38
(2); 138-40.

Gonzalez, H., Stibrant
Sunnerhagen, K., Sjöberg, I.,
Kaponides, G., Olsson, T. & Borg,
K. Intravenous immunoglobulin
for the post-polio syndrome; a
randomized controlled trial,
2006, Lancet Neurology, in press.
open, uncontrolled study using intravenous
immunoglobulin (IvIg) in 16
post-polio patients.

We were able to down modulate the
cytokines, but what is the gain for the
patient? We next developed a multicenter
placebo-controlled study, doubleblinded
in 135 post-polio patients.
(In the former study, we used 90 grams
of IvIg; 30 grams daily for 3 days.)
In this study, we used 30 grams for
3 days, repeated twice. We noted an
increase of muscle strength of 4.3% in
the post-polio patients. In the placebo
group, muscle strength was decreased
by 5.7%. This was statistically significant.

The natural course of decrease in
strength was 5.7% in one-half year.
The benefit: Post-polio patients selected
for the study had an increase in cytokine
levels, indicating inflammation
in the central nervous system. The
inflammation was down-modulated
by the intravenous immunoglobulin
(IvIg) and down-modulated inflammation
led to increased muscle
strength and should result in a better
quality of life. s

Cytokines are small secreted proteins which mediate and
regulate immunity, inflammation and hematopoiesis
(the development of blood cells).
*Using oral polio vaccine to treat PPS is not
an accepted practice

Clasificación Internacional de Enfermedades Codifico al Síndrome de Post Polio con el Código G14 Síndrome Postpolio   Incluye :  Síndrome postpoliomielítico  Excluyéndolo del código B91Secuelas de poliomielitis

May 4, 2010

My grandmother had polio when she was little

Q: My grandmother had polio when she was little, but except for some mild weakness in her right leg she had gotten better. The doctors think she is coming down with it again. How can she have gotten polio again here in the U.S.?
A: This sounds like post-polio syndrome (PPS), and that is what I will discuss in today's column.
Poliomyelitis is caused by a virus that is shed in the stool of infected people. Poor sanitary conditions and poor hygiene contribute to its spread. After ingestion, the virus replicates in the nose/throat mucosa and/or the gastrointestinal tract of the patient. It then invades the lymph nodes and possibly spreads to the blood; in some cases it can also invade the neurons in the patient's brain and/or spinal cord.
About 90 percent to 95 percent of those infected with the polio virus have minor non-specific symptoms such as low-grade fevers, malaise, sore throat and/or headache, and these people recover with no problems. Some people also have GI symptoms such as nausea, vomiting and/or abdominal pain, and again typically have a full recovery.
About 1 percent of those infected develop paralytic polio (damage to muscle innervating neurons), causing muscle weakness (most often in one limb or on one side of the body) which can progress to flaccidity and paralysis. About half of these patients recover fully, a quarter have mild residual weakness and about a quarter have severe permanent disability. Overall, the prognosis is better for younger children.
Polio infection is definitively diagnosed by cultures of certain body fluids or blood antibody tests. The only treatment for polio is supportive care, but a 95 percent effective preventative vaccine exists and is routinely given to all children in the U.S. This not only helps prevent infection from the polio virus, but also helps eradicate the disease from the population since polio is only transmitted from person to person by the fecal-oral route discussed above.
From this discussion it should not be surprising that new cases of polio in the U.S. are essentially all contracted outside the country. In fact, worldwide vaccination programs are attempting to eradicate polio completely, as was done for smallpox.
Post-polio syndrome occurs in people years after they have had paralytic polio. One theory as to why PPS occurs is that the partially damaged neurons from the initial infection "wear out." This explains why there is no active viral infection in people with PPS, and why their symptoms are typically fatigue and slowly progressive muscle weakness affecting the same muscles as in the initial infection.
There is no specific test for PPS. In fact, it may be difficult to diagnose since the slow onset and subtlety of initial symptoms may be caused by many other conditions. The criteria to diagnose PPS are:
  • A history of paralytic polio (even if there was an essentially complete recovery)
  • A stable period after the initial infection, which can be decades long
  • Gradual onset of persistent muscle weakness and sometimes muscle atrophy
  • Symptoms that persist for over a year
  • Other possible causes of the symptoms must be ruled out
PPS is actually pretty common in survivors of paralytic polio, affecting a quarter to half of these patients.
The slow progression of the symptoms, and the fact that they occur in a distribution that the patient survived in the past, make the prognosis for PPS good in the sense that it is rarely life threatening. However it can significantly impact the patient's quality of life.
Appropriate exercise to strengthen certain muscles to help offset the weakness from PPS can be beneficial in many patients; to date, no other treatments have been shown to be very effective.
Although new cases of polio are rare in the U.S., there are still about half a million Americans who are survivors of this disease (typically contracted before mass vaccination efforts helped minimize its occurrence) and, hence, are at risk for PPS; worldwide there are many millions of people at risk.
Although there is no known way to prevent PPS, regular exercise to keep muscles fit and strong as well as to stay healthy overall can help minimize the negative impact this condition may have.
Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at
Clasificación Internacional de Enfermedades Codifico al Síndrome de Post Polio con el Código G14 Síndrome Postpolio   Incluye :  Síndrome postpoliomielítico  Excluyéndolo del código B91Secuelas de poliomielitis

Apr 30, 2010

México Celebra el Segundo Aniversario De la Entrada En Vigor

Buenos dias.

El Consejo Nacional para las Personas con Discapacidad (CONADIS),
organismo reconocido
por la Oficina de las Naciones Unidas como el mecanismo gubernamental de
coordinación para facilitar la aplicación de la Convención sobre los
Derechos Humanos de las Personas con Discapacidad, tiene el honor de
invitarle al festival cultural

 *“Festvivo”,* evento que tiene como
principales objetivos el promover los derechos de las personas con
discapacidad; crear conciencia entre la población sobre la importancia que
representan las personas con discapacidad para el desarrollo de la nación, y
sensibilizar a la población sobre garantizar los derechos de las Personas
con Discapacidad bajo los principios de igualdad y no discriminación.

La inauguración de este evento se llevará a cabo el *30 de abril, a las
19:30 hrs., en el Centro Cultural del México Contemporáneo*, ubicado en la
calle de Leandro Valle 20, colonia Centro, con el siguiente programa:

  - Segundo aniversario de la entrada en vigor de la Convención sobre los
  Derechos Humanos de las Personas con Discapacidad de las Naciones Unidas e
  invitación al festival conmemorativo del esta celebración.
  - Presentación del Mtro. Carlos Ríos Espinosa, candidato de México para
  ocupar un lugar en el Comité de la Convención sobre los Derechos de las
  Personas con Discapacidad de la ONU. Y Presentación del C. Federico
  Fleischmann Loredo, como representante de México ante el Comité de la
  Convención sobre Discapacidad de la OEA.

Posteriormente, *el 1ro y 2 de mayo, a partir de las 10 de la mañana*, en la
explanada del Bosque de Chapultepec, ubicada en la primera sección (Puerta
de los Leones), colonia San Miguel Chapultepec, se realizarán diversas
actividades artísticas con la finalidad de generar un espacio de encuentro
entre las personas con discapacidad, artistas y la comunidad en general.
Cupo limitado, previa reservación.

Clasificación Internacional de Enfermedades Codifico al Síndrome de Post Polio con el Código G14 Síndrome Postpolio   Incluye :  Síndrome postpoliomielítico  Excluyéndolo del código B91Secuelas de poliomielitis

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Postpoliolitaff.- Asociación Post Polio Litaff A.C Primera Organización oficial sobre Síndrome de Post Poliomielitis En México.

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