28 dic. 2017

Is 2018 the Year for Polio’s Extinction?




Lallan, a 16-year-old Indian boy, contracted polio when he was 7. In the rural area where he lives, the vaccine was unknown
 
Debsuddha Banerjee—Barcroft Images/Getty Images

For more, visit TIME Health.

There isn’t a big market for poliovirus plush toys. They’re not much to look at–about the size of a softball and a sort of ashen gray. That’s a fitting color: polios is Greek for gray, and it’s the gray matter in the central nervous system that the virus attacks, robbing children of the ability to walk, if it doesn’t kill them first. It would be the rare parent who would want even a cuddly likeness of so lethal a thing anywhere near a healthy baby.
But the plush toys were much in demand at the headquarters of the Bill & Melinda Gates Foundation on World Polio Day in October. They were tucked into gift bags, stashed in purses, playfully tossed from person to person. If that seems unserious, well, the 400 people in attendance and the 150,000 more who watched the presentations online had a right to let themselves go.
As recently as 1988, there were 350,000 cases of polio each year, and the disease was endemic in 125 countries. In 2017 there have been only 16 cases, in just two countries: Afghanistan and Pakistan. With a case count so low, the question now is a straightforward one: Will 2018 be the year we get to zero?
“We’ve never seen this level of progress, this level of restricted transmission,” says Jalaa’ Abdelwahab, deputy director of UNICEF’s polio-eradication initiative. “We’re hoping that by the end of the next transmission season, we will see zero.”
If that happens, polio will join smallpox as the only other human disease to be driven over the cliff to extinction. The 16th case in 2017 could, at least in theory, be the last case ever.
The road to almost zero has been a long one–and a lot of the credit has rightly gone to Rotary International, the global service organization that made polio eradication its mission in 1979. That year the group began a five-year campaign to vaccinate upwards of 6 million children in the Philippines. In 1988, Rotary joined hands with UNICEF, the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention to form the Global Polio Eradication Initiative. In 2007 the Bill & Melinda Gates Foundation came aboard. Today 2.5 billion children have been vaccinated worldwide at a cost of $15 billion.
One thing that has made so mammoth an undertaking possible is the type of vaccine used. There are two varieties: one administered orally and one by injection. The oral polio vaccine (OPV)–which is easier, cheaper and less scary for the children who receive it–has been the go-to choice for eradication. It takes an average of three doses at different times to confer full immunity; as long as the poliovirus is still at large, that will have to continue.
“Each year we vaccinate 450 million children under 5 years old,” says Abdelwahab. “OPV is an amazing tool for stopping acute cases.”
While OPV can cost as little as 18 cents per dose, inoculating nearly half a billion kids each year is not cheap–especially when you add the cost of field workers and delivery chains. In a world where diseases like malaria and HIV claim millions of lives, pouring so much money into eradicating a disease with fewer than two dozen victims this year raises questions. Health experts concede the seeming disconnect.
“The cost per case at this point seems ludicrous,” admits Mark Suzman, chief strategy officer for the Bill & Melinda Gates Foundation. The fact is, however, that spending the money now means saving much more later.
For every child paralyzed by polio, there are 200 others who carry the virus without symptoms. A person from an endemic country can thus get on a plane and unknowingly spread the virus elsewhere. WHO estimates that if all polio vaccinations stopped today, the case count would soar to 200,000 per year within a decade. That makes eradicating the virus imperative–and it’s a realistic goal.
“Humans are the only reservoir for polio,” says Abdelwahab. Wipe the virus out in us, in other words, and you wipe it out everywhere.
One obstacle is the vaccine itself. OPV uses a live, weakened poliovirus to stimulate the immune system and confer immunity. But the weakened virus can occasionally mutate and be shed in its infectious form.
The result is what’s known as vaccine-derived polio. It’s rare; there are far fewer incidents of it than there would be of so-called wild polio if there were no vaccine, but in 2017 that still meant 80 vaccine-derived cases. Of those, 70 were in Syria, where war makes vaccination coverage spotty, leaving people susceptible to the mutated virus. “Displaced populations are a high-risk group,” says Carol Pandak, a polio-eradication director for Rotary.
Eliminating vaccine-derived polio requires eventually dropping the oral vaccine and instead using the injection-administered inactivated polio vaccine (IPV), which uses a killed virus that is unable to cause the disease. After the case count reaches zero and holds there for three years, OPV will be withdrawn and IPV alone will be used for about 10 years as part of routine childhood checkups. Ultimately even that won’t be necessary.
Once the disease is no more, the money and resources used for vaccine drives will be freed up for other health challenges. The war against polio has taken the kind of global coordination an actual war does. But while battles in a shooting war claim lives, battles in the polio war save them.
This appears in the December 25, 2017 issue of TIME.

Post Polio Litaff, Association A.C _APPLAC Mexico

19 dic. 2017

Six Strange Things Acupuncture Can Treat



 
The ancient Chinese practice of acupuncture has gained a lot of popularity in the Western world in recent years. There are good reasons for this, as acupuncture has been linked to many diverse health benefits. Still, a lot of people may shudder or cringe when they think about acupuncture treatments. The idea of tiny needles boring into your skin may be off-putting to many.
If this is you, it may be worth looking more deeply into everything acupuncture has to offer. When performed by a trained and experienced practitioner, acupuncture can be soothing and healing in a multitude of ways. It’s not just being stabbed with needles – the needles are gently inserted into specific points for healing purposes. 
Acupuncture may be able to help heal more ailments than you may think. The following are six conditions that acupuncture may help remedy, conditions you may never have thought could improve with this practice. 
Pain (even if it’s severe)
A body of research has found that acupuncture treatments can help to relieve various types of pain. It may even be used as a potent analgesic in emergency situations. A recent study published in the Medical Journal of Australia tested the effects of acupuncture on the pain levels of people who went to the emergency room for migraines, lower back pain and sprained ankles. 
On the results of their study, the authors concluded: “The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy.”
Depression
Researchers have found that acupuncture can treat both chronic pain and depression.
Another recent study, performed by researchers at the University of York in England, tested the effects of acupuncture on both chronic pain and depression. For the depression portion of the study, just over 750 people suffering from depression were provided with both counseling and acupuncture treatments, with some highly positive results. According to Professor Hugh MacPherson: “The frontline treatment for depression in primary care usually involves antidepressants; however, they do not work well for more than half of patients… In the largest study of its kind, we have now provided a solid evidence base to show that not only can acupuncture and counseling bring patients out of an episode of depression, but it can keep the condition at bay for up to a year on average.”
For the record, the chronic pain part of the study has positive results, as well. 
Hypertension
A 2015 study performed by researchers at the University of California surveyed how acupuncture treatments affected people with hypertension, also known as high blood pressure. Results showed that 70 percent of study participants experienced significant drops in blood pressure after the treatments, and that these effects lasted for up to 45 days after the study. 
On these results, cardiologist Dr. John Longhurst started: “By using Western scientific rigor to validate an ancient Eastern therapy, we feel we have integrated Chinese and Western medicine and provided a beneficial guideline for treating a disease that affects millions in the U.S… Because electroacupuncture decreases both peak and average systolic blood pressure over 24 hours, this therapy may decrease the risk of stroke, peripheral artery disease, heart failure and myocardial infarction in hypertensive patients.” 
Fibromyalgia symptoms
Stiff joints may benefit from acupuncture treatment.
Fibromyalgia is a disease characterized by chronic pain of the musculoskeletal system. It can be accompanied by stiff joints, trouble sleeping, and lingering fatigue. Acupuncture may be able to help. A 2006 study performed by the Mayo Clinic found that fibromyalgia patients experienced significantly positive results from acupuncture treatments. According to lead author, Dr. David Martin: “The results of the study convince me there is something more than the placebo effect to acupuncture. It affirms a lot of clinical impressions that this complementary medical technique is helpful for patients.”
Muscle atrophy
Due to age, immobility or a number of diseases, the muscles of our skeletal systems can atrophy over time. A 2012 mouse study published in the journal FASEB has found that acupuncture treatments may help to prevent this from occurring. According to Akiko Onda of the Waseda University School of Sports Sciences: “Our results have uncovered one molecular mechanism responsible for the efficacy of acupuncture treatment and clarified its usefulness in preventing skeletal muscle atrophy in mice. We hope to introduce acupuncture as a new strategy for preventing skeletal muscle atrophy in the future. Further investigations into its molecular mechanisms will help to decrease the medical community’s suspicion of acupuncture and provide us with a better understanding of how acupuncture treatment prevents skeletal muscle atrophy.”
Hot flashes
During menopause and perimenopause, many women experience uncomfortable hot flashes. A 2016 study performed by researchers at Wake Forest Baptist Medical Center found that acupuncture treatments helped to reduce hot flashes by about 50 percent for about half of the women in the study. According to the study’s lead author, Nancy Avis: “Women bothered by hot flashes and night sweats may want to give acupuncture a try as a relatively low-cost, low-risk treatment. Women will know pretty quickly if acupuncture will work for them. Women who had a reduction in their hot flashes saw a benefit beginning after about three to four weeks of weekly treatments.”

12 dic. 2017

5 Great Reasons Why You Should Not Take Statins



Story at-a-glance 

  • There is evidence showing that statins may actually make your heart health worse and only appear effective due to statistical deception
  • Statins deplete your body of CoQ10, inhibit synthesis of vitamin K2, and reduce the production of ketone bodies
  • Statins increase your risk of serious diseases including cancer, diabetes, neurodegenerative diseases, musculoskeletal disorders and cataracts
By Dr. Mercola
Statin cholesterol-lowering drugs are widely touted as the best way to lower your cholesterol and thereby prevent a heart attack. They're recommended to people who have "high cholesterol," those who have heart disease, and even for some healthy people as a form of preventive medicine.
Statins are among the most widely prescribed drugs on the market, with more than 1 in 4 Americans over 45 taking them. This already inflated number is set to increase significantly due to draft recommendations issued earlier this year by the U.S. Preventive Services Task Force (USPSTF).
This federal advisory board recommended statin treatment for people between the ages of 40 and 75 with a 10 percent or greater risk of heart problems in the next 10 years (based on the 2013 AHA-ACC online calculator1) — even if they have not had a previous heart attack or stroke.
Needless to say, if you're a U.S. adult aged 40 or beyond, there's a good chance your doctor may bring up statins at your next visit, so you need to do your homework to determine if these drugs are truly right for you —  and there's a good chance they're not.

5 Reasons Why You Should Not Take Statins

1. They Don't Work
Statin drugs work to lower cholesterol, and as your levels fall, you may assume that is proof that you're getting healthier and lowering your risk of heart disease and heart attack. But that would be far from the truth. 
There is far more that goes into your risk of heart disease than your cholesterol levels. Further, there is evidence showing that statins may actually make your heart health worse and only appear effective due to statistical deception. 
One report published in the Expert Review of Clinical Pharmacology concluded that statin advocates used a statistical tool called relative risk reduction (RRR) to amplify statins' trivial beneficial effects.2
If you look at absolute risk, statin drugs benefit just 1 percent of the population. This means that out of 100 people treated with the drugs, one person will have one less heart attack. This doesn't sound so impressive, so statin supporters use a different statistic called relative risk. 
Just by making this statistical sleight of hand, statins suddenly become beneficial for 30 to 50 percent of the population. As STATS at George Mason University explained, "An important feature of relative risk is that it tells you nothing about the actual risk."3
2. Statins Reduce CoQ10
Statins deplete your body of coenzyme Q10 (CoQ10), which accounts for many of their devastating results. Although it was proposed to add a black box warning to statins stating this, the U.S. Food and Drug Administration (FDA) decided against it in 2014.
CoQ10 is used for energy production by every cell in your body, and is therefore vital for good health, high energy levels, longevity, and general quality of life. CoQ10's reduced form, ubiquinol, is a critical component of cellular respiration and production of adenosine triphosphate (ATP).
ATP is a coenzyme used as an energy carrier in every cell of your body. When you consider that your heart is the most energy-demanding organ in your body, you can surmise how potentially devastating it can be to deplete your body's main source of cellular energy.
So while one of statins' claims to fame is warding off heart disease, you're actually increasing your risk when you deplete your body of CoQ10. The depletion of CoQ10 caused by the drug is why statins can increase your risk of acute heart failure. 
So if you're taking a statin drug, you MUST take Coenzyme Q10 as a supplement. If you're over 40, I would strongly recommend taking ubiquinol instead of CoQ10, as it's far more effectively absorbed by your body. 
In every study conducted so far, ubiquinol has been shown to be far more bioavailable than the non-reduced form (CoQ10). Dr. Steven Sinatra,cardiologist and founder of the New England Heart Center, recommends taking at least 100 milligrams (mg), but preferably 200 mg of high-quality CoQ10 or ubiquinol daily. 
One study in the European Journal of Pharmacology showed that ubiquinol effectively rescued cells from the damage caused by the statin drug simvastatin, thereby protecting muscle cells from myopathies.4
The other part most people don't realize is that CoQ10 and ubiquinol are lipid-soluble materials biosynthesized in your blood. The carrier is the blood lipid cholesterol
The ubiquinol actually keeps your LDL (often referred to as the "bad" cholesterol) reduced, as it's an exceptionally potent antioxidant. 
Reduced LDL cholesterol isn't bad cholesterol at all. Only the oxidized version will cause a problem. So by reducing CoQ10 production in your body, you're also removing the mechanism that keeps your LDL cholesterol from doing harm in your body.
3. Statins Reduce Vitamin K2
A new finding was published in March 2015, and it is not yet widely known. 
Research published in Expert Review of Clinical Pharmacology revealed that, in contrast to the current belief that cholesterol reduction with statins decreases atherosclerosis, the drugs may instead actually stimulate atherosclerosis and heart failure.5
There were several physiological mechanisms discussed in the study that show how statin drugs may make your heart health worse, one being that they inhibit the synthesis of vitamin K2. Vitamin K2 protects your arteries from calcification. Without it, plaque levels worsen. 
Vitamin K2's biological role is to help move calcium into the proper areas in your body, such as your bones and teeth. It also plays a role in removing calcium from areas where it shouldn't be, such as in your arteries and soft tissues. 
According to a 2009 Dutch study, vitamin K2 is associated with reduced vascular calcification even at small dietary intakes.6
Statin drugs inhibit the function of vitamin K2 in your body, which means taking them may put you at risk of vitamin K2 deficiency, a condition known to contribute to a number of chronic diseases, including:
Osteoporosis 
Heart disease 
Heart attack and stroke 
Inappropriate calcification, from heel spurs to kidney stones 
Brain disease 
Cancer 
4. Statins Reduce Ketone Production
Statins lower cholesterol by inhibiting the enzyme in your liver that produces cholesterol (HMG coenzyme A reductase). Unfortunately this is the same enzyme that produces not only CoQ10 but also ketones, which are crucial nutrients to feed your mitochondria. 
Ketones are vitally important biological signaling molecules. There are three ketone bodies, acetoacetate, beta hydroxybutyrate, and acetone. 
They're produced in your liver (they're byproducts of the breakdown of fatty acids) and production increases during fasting.7 As noted in the journal Trends in Endocrinology & Metabolism:8
"Ketone bodies are emerging as crucial regulators of metabolic health and longevity, via their ability to regulate HDAC [histone deacetylases] activity and thereby epigenetic gene regulation."
Ketone bodies appear to inhibit HDAC function, which is implicated in the regulation of aging. Further, researchers noted "ketone bodies may link environmental cues such as diet to the regulation of aging."9
5. Increased Risk of Serious Diseases
Because statins deplete your body of CoQ10, inhibit synthesis of vitamin K2, and reduce the production of ketone bodies, they increase your risk of other serious diseases. This includes:
Cancer
Research has shown that long-term statin use (10 years or longer) more than doubles women's risk of two major types of breast cancer: invasive ductal carcinoma and invasive lobular carcinoma.10 According to Dr. Sinatra, statins block the squalene pathway (squalene is the precursor to cholesterol), which he believes is essential in preventing breast cancer.
In addition, the use of any statin drug, in any amount, was associated with a significantly increased risk for prostate cancer in a separate study, and there was an increasing risk that came along with an increasing cumulative dose.11
According to a letter to the editor published in the Journal of Clinical Oncology:12
"Several cholesterol-lowering drugs, including statins, have been found to be carcinogenic in rodents in doses that produce blood concentrations of the drugs similar to those attained in treating patients. 
In accordance, breast cancer occurred in 12 of 286 women in the treatment group of the CARE (Cholesterol and Recurrent Events) trial, but only in one of 290 in the placebo group … In the PROSPER (Prospective Study of Pravastatin in the Elderly at Risk) trial, cancer occurred in 245 of 2,891 patients in the treatment group, but only in 199 of 2,913 in the placebo group …
In the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) trial, cancer occurred in 39 of 944 patients in the treatment group, but only in 23 of 929 in the placebo group … 
In the two first simvastatin trials, nonmelanoma skin cancer was seen more often as well, and with statistical significance if the results are calculated together … The latter finding may explain the current so-called epidemic of nonmelanoma skin cancer."
Diabetes
Statins have also been shown to increase your risk of diabetes via a number of different mechanisms. The most important one is that they increase insulin resistance, which can be extremely harmful to your health. Secondly, statins increase your diabetes risk by raising your blood sugar. Statins work by preventing your liver from making cholesterol. 
As a result, your liver returns the sugar to your bloodstream, which raises your blood sugar levels. These drugs also rob your body of certain valuable nutrients, which can also impact your blood sugar levels. Two nutrients in particular, vitamin D and CoQ10, are both needed to maintain ideal blood glucose levels. A 2011 meta-analysis confirmed the higher the dosage of statin drugs being taken, the greater the diabetes risk. 
The "number needed to harm" for intensive-dose statin therapy was 498 for new-onset diabetes — that's the number of people who need to take the drug in order for one person to develop diabetes.13 In even simpler terms, 1 out of every 498 people who are on a high-dose statin regimen will develop diabetes. 
The following scientific reviews also reached the conclusion that statin use is associated with increased incidence of new-onset diabetes:
• A 2010 meta-analysis of 13 statin trials, consisting of 91,140 participants, found that statin therapy was associated with a 9 percent increased risk for incident diabetes.14 Here, the number needed to harm was 255 over four years, meaning for every 255 people on the drug, one developed diabetes as a result of the drug in that period of time. 
• In a 2009 study, statin use was associated with a rise of fasting plasma glucose in patients with and without diabetes, independently of other factors such as age, and use of aspirin, β-blockers, or angiotensin-converting enzyme inhibitors.15
The study included data from more than 345,400 patients over a period of two years. On average, statins increased fasting plasma glucose in non-diabetic statin users by 7 mg/dL, and in diabetics, statins increased glucose levels by 39 mg/dL.
Neurodegenerative Diseases
Cholesterol is also essential for your brain, which contains about 25 percent of the cholesterol in your body. It is critical for synapse formation, i.e. the connections between your neurons, which allow you to think, learn new things, and form memories. So perhaps it's not surprising that memory loss is widely reported in association with statin use. 
Further, remember that statins reduce ketone production. Ketone bodies are used as fuel by your brain, and they have also demonstrated the capacity to protect against neuronal disease, seizures, and age-related brain diseases, such as Alzheimer's, Huntington's, and Parkinson's. Researchers from Penn State College of Medicine even found statins were associated with an increased Parkinson's risk.16
High total cholesterol and LDL were also associated with a lower risk of Parkinson's disease. The study concluded, "Statin use may be associated with a higher PD [Parkinson's disease] risk, whereas higher total cholesterol may be associated with lower risk."
Musculoskeletal Disorders
Statin users are more likely to suffer from musculoskeletal conditions, injuries and pain than non-users.17 Myalgia, muscle weakness, muscle cramps, rhabdomyolysis, autoimmune muscle disease, and tendinous diseases have all been reported in association with statin use.
One reason for this may be statins' interference with selenium-containing proteins. Selenoproteins such as glutathione peroxidase are crucial for preventing oxidative damage in your muscle tissue. As reported by Wellness Resources:18
"Blocking the selenoprotein enzyme glutathione peroxidase is akin to pouring gasoline on the fire of inflammation and free radicals, which damages muscle tissue. In fact, the scientists described this blocking of the selenoproteins reminiscent of selenium deficiency induced heart failure, known as Keshan's disease first identified in the 1930s."
Further, according to a study published in JAMA Internal Medicine:19
" … [S]tatin use is associated with an increased likelihood of diagnoses of musculoskeletal conditions, arthropathies, and injuries … Several factors may explain the musculoskeletal AEs [adverse events] of statin therapy, including the inhibitory effect on coenzyme Q10 synthesis, selenoprotein synthesis, and the mitochondrial respiratory chain. 
In addition, in vitro studies indicated that statins may affect apoptosis genes; misregulation of apoptosis is associated with myopathy. Pathologic studies also have shown that statin use may be associated with myopathy in the presence of normal creatine kinase levels, even in the absence of symptoms. 
Statin-associated necrotizing autoimmune myopathy was noted to persist or progress despite cessation of statin therapy."
Cataracts
An objective review of PubMed, EMBASE, and Cochrane review databases found that for every 10,000 people taking a statin, there were 307 extra patients with cataracts.20 This was supported by a separate JAMA study, which further revealed that the risk of cataracts is increased among statin users compared with non-users.21 Cataract is a clouding of your eye lens and is a main cause of low vision among the elderly.

If You Take Statins, Be Sure You Also Take Vitamin K2 and CoQ10

If you decide to take a statin, a vitamin K2 supplement is highly recommended. MK-7 is the form you'll want to look for in supplements; it's extracted from the Japanese fermented soy product called natto. Professor Cees Vermeer, one of the world's top vitamin K2 researchers, recommends between 45 mcg and 185 mcg daily for adults. 
You must use caution on the higher doses if you take anticoagulants, but if you are generally healthy and not on these types of medicationsI suggest 150 mcg daily. You'll also need to make sure you take CoQ10 or ubiquinol (the reduced form) with it. One study evaluated the benefits of CoQ10 and selenium supplementation for patients with statin-associated myopathy.22
Compared to those given a placebo, the treatment group experienced significantly less pain, decreased muscle weakness and cramps, and less fatigue. 

How to Protect Your Heart Health

Are you looking for a non-drug way to boost your heart health? Here are some of my top recommendations:
  • Reduce, with the plan of eliminating, grains and sugars in your diet. It is vitally important to eliminate gluten-containing grains and sugars, especially fructose. 
  • Consume a good portion of your food raw. 
  • Make sure you are getting plenty of high-quality, animal-based omega-3 fats, such as krill oil. Research suggests that as little as 500 mg of krill per day may improve your total cholesterol and triglycerides and will likely increase your HDL cholesterol. 
  • Replace harmful vegetable oils and synthetic trans fats with healthy fats, such as olive oil, butter and coconut oil (remember olive oil should be used cold only; use coconut oil for cooking and baking). 
  • Include fermented foods in your daily diet. These will not only optimize your intestinal microflora, which will boost your overall immunity, but will also introduce beneficial bacteria into your mouth. Poor oral health is another powerful indicator of increased heart disease risk. 
  • Optimize your vitamin D levels, ideally through appropriate sun exposure as this will allow your body to also create vitamin D sulfate — another factor that may play a crucial role in preventing the formation of arterial plaque. 
  • Exercise regularly. Make sure you incorporate high-intensity interval exercises, which also optimize your human growth hormone (HGH) production. 
  • Stop smoking and drinking alcohol excessively. 
  • Be sure to get plenty of high-quality, restorative sleep

https://articles.mercola.com/sites/articles/archive/2013/04/17/statin-side-effects.aspx


Post Polio Litaff, Association A.C _APPLAC Mexico

24 nov. 2017

Syndrome Post Polio Définitions et caractéristiques



Introduction

30 à 40 ans, en moyenne, après l’attaque initiale de polio peuvent apparaître de nouveaux problèmes. Il semblerait, en effet, que  70 % des polios paralytiques et 40 % des non-paralytiques développent un syndrome post-polio (SPP).

Définition

Plusieurs appellations ont été utilisées pour définir le syndrome post-polio : atrophie musculaire post-polio (AMPP), effets tardifs de la polio, séquelles post-polio. Le SPP est un terme plus hétérogène et donc plus pratique au point de vue de la clinique. Il ne doit pourtant pas être utilisé sans discernement pour toute personne ayant un historique de polio paralytique avec de nouvelles plaintes. Les critères de ce diagnostic sont les suivants :
  1. Episode préalable de polio paralytique confirmé par un historique, un examen physique et des conclusions typiques sue électromyogramme (EMG).
  2. Evaluation EMG standard qui montre des changements conséquents.
  3. Période de récupération neurologique suivie d’un intervalle prolongé de stabilité neurologique et fonctionnelle précédant la venue de nouveaux problèmes : l’intervalle de stabilité neurologique et fonctionnelle dure habituellement 20 ans ou plus.
  4. Arrivée progressive ou soudaine d’un nouvel affaiblissement neurogénique, non dû à la mauvaise utilisation des muscles précédemment affectés. De plus, peuvent apparaître une fatigue excessive, une douleur musculaire ou articulaire, une diminution de l’endurance, un abaissement du fonctionnement et une atrophie.
  5. Exclusions de conditions médicales, orthopédiques et neurologiques qui pourraient être la cause des problèmes mentionnés ci-dessus.
D’autres symptômes ne montrent pas l’évidence d’un véritable nouveau dysfonctionnement de l’unité motrice.

Ces symptômes

  1. peuvent être attribués directement au dommage causé par le poliovirus, tel que l’intolérance au froid ou le déséquilibre musculo-squelettique
  2. sont supposés être reliés à l’impossibilité du corps à maintenir le niveau de récupération qui a été obtenu, un nouvel affaiblissement peut alors apparaître
  3. proviennent de traumatismes secondaires (syndrome du canal carpien, arthrose, etc.).

Pathophysiologie de la poliomyélite

Elle est nécessaire à la compréhension des causes possibles du syndrome post-polio ainsi qu’à l’élaboration de son traitement.
A) Processus de récupération après la poliomyélite aiguë
Après l’invasion du SNC par le poliovirus, on assiste à une perte neurologique et fonctionnelle due à l’atteinte des cellules de la corne antérieure qui laissent les fibres musculaires qu’elles innervaient orphelines. La récupération atteint un plateau en 6 à 8 mois. L’étendue de la récupération neurologique et fonctionnelle est déterminée par trois facteurs majeurs :
La récupération des motoneurones atteints de manière temporaire et la poursuite de leur activité normale.
L’augmentation de taille (hypertrophie musculaire) des fibres musculaires innervées par les cellules nerveuses survivantes et leur renforcement grâce à des exercices de renforcement traditionnels.
Le nombre de neurones moteurs qui développent des bourgeons axones terminaux pour ré innerver les fibres musculaires laissées orphelines par la mort de leur neurone moteur original.
Le phénomène de bourgeonnement axone terminal rend possible l’adoption des fibres musculaires orphelines par un neurone moteur sain ou récupéré. Une cellule de neurone moteur peut adopter 5 à 7 fibres musculaires additionnelles, jusqu’à 20 pour chaque cellule musculaire innervée originellement. On peut donc en conclure qu’un neurone moteur qui innervait à l’origine 100 fibres musculaires peut innerver 700 à 2000 fibres. Il en résulte que les anciens patients atteints de polio peuvent conserver quelques unités motrices agrandies qui sont capables de faire le travail préalablement effectué par beaucoup d’unités. De plus, les fibres musculaires restantes s’hypertrophient pour augmenter la résistance du groupe musculaire. Grâce à ce mécanisme de compensation neurophysiologique, un muscle peut conserver une résistance normale même après que 50 % des neurones moteurs atteints aient été perdus.
B) La période de stabilité :
Elle peut durer plusieurs décennies et est caractérisée par un processus continu de remodelage ainsi qu’une condition neurologique et fonctionnelle stable. On note parfois la mort de quelques terminaisons nerveuses qui sont automatiquement remplacées par la formation de nouvelles terminaisons.

Étiologie du syndrome Post-Polio

Les changements pathologiques occasionnant le syndrome post-polio sont toujours inconnus.
Ces dernières années, plusieurs théories ont été avancées.
– Dysfonctionnement de l’unité motrice dû à un travail excessif ou à un vieillissement prématuré des unités motrices affectées par la polio
Cette hypothèse semble être la plus probable.
D’après des études morphologique, clinique et électromyographique, le SPP serait le résultat d’une instabilité, nouvelle ou peut-être permanente, des unités motrices précédemment touchées par la polio. Il serait causé par une dénervation nouvelle et continue des muscles affectés par la polio mais également de ceux pensés asymptomatiques. En effet, les motoneurones ayant adopté les fibres musculaires laissées orphelines par le poliovirus sont exposés à des demandes métaboliques accrues en raison d’un territoire d’unités motrices accru. Les neurones moteurs géants ne sont pas capables de supporter indéfiniment la demande métabolique de leurs bourgeons et il résulte que les terminaux individuels se détériorent lentement et que les fibres musculaires ré innervées diminuent.
Lors de ces études, il est apparu clairement que, chez les patients présentant le SPP, les neurones moteurs sont instables et subissent constamment une altération ultérieure nécessitant une réparation et une restructuration des unités motrices. On note également une perte continue, mais heureusement lente, de l’ordre de 1% par an, de la force musculaire qui ne peut être expliquée totalement par les modifications normales liées à la sénescence. Cependant, il est évident que ce problème lié au vieillissement des différentes structures du corps entraînera une perte plus importante du nombre de motoneurones et donc de perte de force musculaire d’autant plus grande. En conséquence, le nombre de fibres musculaires conduites par chaque neurone moteur décline et les anciens polios expérimentent un nouvel affaiblissement ainsi que d’autres symptômes de dysfonctionnement neurologique.
fibresmuscul
Légende de l’illustration (de gauche à droite).
La normale : représentation de trois unités motrices normales.
Phase aiguë de la polio ; l’invasion d’un neurone moteur par le poliovirus entraîne la dégénérescence du neurone affecté et la dénervation des fibres musculaires associées.
Guérison : le rétablissement à la suite d’une polio paralytique se produit par le bourgeonnement axonal des neurones moteurs et la ré innervation des fibres musculaires.
Syndrome post-polio : la cause la plus probable du SPP serait la dégénérescence des unités motrices, accompagnées de la dénervation des fibres musculaires.
– Autre étiologies discutées :
D’autres hypothèses ont été proposées pour expliquer le SPP mais non pas été retenues. Ce sont la sur-utilisation musculaire, la non-utilisation musculaire, la prédisposition à la dégénérescence des neurones moteurs due à des dommages gliaux, vasculaires et lymphatiques, la réactivation du virus ou infection permanente, le syndrome immune intermédiaire et l’influence du vieillissement de l’hormone de croissance.

Caractéristique clinique du Syndrome Post-Polio

Ces 10 dernières années, une série d’études a démontré que la majorité des patients post-polios développent des symptômes similaires, dont la fréquence et la place relative sont tirées d’un certain nombre d’études et rassemblées dans le tableau ci-dessous:
symptomes_ postpolio
Le plus souvent, l’arrivée de ces nouveaux symptômes est insidieuse, mais elle peut être précédée par des événements spécifiques tels qu’un accident mineur, une période de repos au lit ou un gain de poids. Il est probable que de nouveaux problèmes puissent surgir quand des problèmes médicaux coexistants, tels que le diabète, se développent ou s’aggravent.
Les facteurs associés au développement de l’affaiblissement progressif sont les suivants :
– âge du patient lord de l’infection initiale : plus de 10 ans
– historique de l’hospitalisation
– utilisation d’un respirateur
– implication paralytique des 4 membres
– un affaiblissement plus important au moment de la polio aiguë
– un plus grand laps de temps depuis l’infection aiguë
– une prise de poids récente
– douleur musculaire associée aux exercices
L’intervalle moyen entre l’épisode initial et l’arrivée des symptômes se situe en moyenne autour de 35 ans.

Caractère morphologiques du syndrome Post-Polio

Suivant une étude menée par Dalakas et al., basée sur une population de 27 post-polios pendant 8 ans, de nouvelles constatations sur le nouvel affaiblissement ont vu le jour. Les conclusions des biopsies comprenaient les changements dans la morphologie cellulaire, les groupements de types de fibres, les petites fibres angulées et l’hypertrophie des muscles qui étaient le moins touchés. Suivant la sévérité de l’implication de la polio, il a placé ces muscles dans quatre sous-groupes:
  1. Le sous-groupe I
    Il comprend les muscles originellement touchés mais ayant partiellement récupéré et présentant un nouvel affaiblissement. Ces muscles montrent :
    – des caractéristiques myopathiques : augmentation du tissu conjonctif; des fibres occasionnelles phagocytées; des variations de dimensions de fibres
    – des changements neurogéniques anciens
    – des changements neurogéniques nouveaux.
  2. Le sous-groupe II
    Il comprend les muscles originellement affectés mais ayant pleinement récupérés, avec un nouvel affaiblissement. Ceux-ci présentaient l’évidence d’une ré innervation extensive avec des répartitions de fibres de taille normale, plus petites et plus angulées.
  3. Le sous-groupe III
    Il inclut les muscles cliniquement épargnés à l’origine mais atteints d’un nouvel affaiblissement. Ces muscles comme ceux du groupe II, montrent une énervation/innervation chronique avec des répartitions types de fibres.
  4. Le sous-groupe IV
    Il contient les muscles asymptomatiques qui présentent une répartition par type de fibres à l’exception de petites fibres angulées et d’évidence d’inflammation.

En conclusion

La nature imprévisible et la grande variabilité avec laquelle la polio affecte les muscles démontrent que deux personnes, voire même deux muscles d’une même personne, ne peuvent être soignés avec un traitement identique. Ceci pose le problème du traitement d’une personne présentant le SPP.

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Enlaces

México Post Polio Una Vida Un Camino Una Experiencia
http://postpoliosinmex.blogspot.com/

Post Polio LITAFF A.C.

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


Polio y Efectos Secundarios SPP
http://polioyspp.blogspot.com/
- See more at: http://polioamigossinfronteras.blogspot.mx/#sthash.6PkHAkfM.dpuf

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