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Rhee JY, Brizzi K. Palliative Care for Polio and Postpolio Syndrome. Phys Med Rehabil Clin N Am 2021; 32:569-579. [PMID: 34175015 DOI: 10.1016/j.pmr.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Palliative care is a team-based approach focusing on relief of physical, psychosocial, and existential distress and communication about serious illness. Patients with poliomyelitis and postpolio syndrome are at risk for contractures and can benefit from involvement of physical and occupational therapy. Hypersialorrhea can be treated with anticholinergic medications, botox, or radiation. Patients with dyspnea may require noninvasive positive pressure ventilation ± opioids or benzodiazepines. Constipation is often due to autonomic dysfunction and decreased mobility. There is a higher burden of anxiety. Early conversations about patients' goals and values as it relates to their health may help frame future decision-making.
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Affiliation(s)
- John Y Rhee
- Wang Ambulatory Care Center, Suite 835, 15 Parkman Street, Boston, MA 02114, USA; Department of Neurology, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kate Brizzi
- Wang Ambulatory Care Center, Suite 835, 15 Parkman Street, Boston, MA 02114, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Division of Palliative Care, Massachusetts General Hospital, Boston, MA, USA.
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Li Hi Shing S, Lope J, McKenna MC, Chipika RH, Hardiman O, Bede P. Increased cerebral integrity metrics in poliomyelitis survivors: putative adaptation to longstanding lower motor neuron degeneration. J Neurol Sci 2021; 424:117361. [PMID: 33773768 DOI: 10.1016/j.jns.2021.117361] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Post-polio syndrome (PPS) has been traditionally considered a slowly progressive condition that affects poliomyelitis survivors decades after their initial infection. Cerebral changes in poliomyelitis survivors are poorly characterised and the few existing studies are strikingly conflicting. OBJECTIVE The overarching aim of this study is the comprehensive characterisation of cerebral grey and white matter alterations in poliomyelitis survivors with reference to healthy- and disease-controls using quantitative imaging metrics. METHODS Thirty-six poliomyelitis survivors, 88 patients with ALS and 117 healthy individuals were recruited in a prospective, single-centre neuroimaging study using uniform MRI acquisition parameters. All participants underwent standardised clinical assessments, T1-weighted structural and diffusion tensor imaging. Whole-brain and region-of-interest morphometric analyses were undertaken to evaluate patterns of grey matter changes. Tract-based spatial statistics were performed to evaluate diffusivity alterations in a study-specific whiter matter skeleton. RESULTS In contrast to healthy controls, poliomyelitis survivors exhibited increased grey matter partial volumes in the brainstem, cerebellum and occipital lobe, accompanied by increased FA in the corticospinal tracts, cerebellum, bilateral mesial temporal lobes and inferior frontal tracts. Polio survivors exhibited increased integrity metrics in the same anatomical regions where ALS patients showed degenerative changes. CONCLUSIONS Our findings indicate considerable cortical and white matter reorganisation in poliomyelitis survivors which may be interpreted as compensatory, adaptive change in response to severe lower motor neuron injury in infancy.
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Affiliation(s)
- Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Jasmin Lope
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Mary Clare McKenna
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Ireland.
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Sleep disorders in aging polio survivors: A systematic review. Ann Phys Rehabil Med 2020; 63:543-553. [DOI: 10.1016/j.rehab.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/16/2019] [Accepted: 10/15/2019] [Indexed: 01/28/2023]
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Li Hi Shing S, Chipika RH, Finegan E, Murray D, Hardiman O, Bede P. Post-polio Syndrome: More Than Just a Lower Motor Neuron Disease. Front Neurol 2019; 10:773. [PMID: 31379723 PMCID: PMC6646725 DOI: 10.3389/fneur.2019.00773] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
Post-polio syndrome (PPS) is a neurological condition that affects polio survivors decades after their initial infection. Despite its high prevalence, the etiology of PPS remains elusive, mechanisms of progression are poorly understood, and the condition is notoriously under-researched. While motor dysfunction is a hallmark feature of the condition, generalized fatigue, sleep disturbance, decreased endurance, neuropsychological deficits, sensory symptoms, and chronic pain are also often reported and have considerable quality of life implications in PPS. The non-motor aspects of PPS are particularly challenging to evaluate, quantify, and treat. Generalized fatigue is one of the most distressing symptoms of PPS and is likely to be multifactorial due to weight-gain, respiratory compromise, poor sleep, and polypharmacy. No validated diagnostic, monitoring, or prognostic markers have been developed in PPS to date and the mainstay of therapy centers on symptomatic relief and individualized rehabilitation strategies such as energy conservation and muscle strengthening exercise regimes. Despite a number of large clinical trials in PPS, no effective disease-modifying pharmacological treatments are currently available.
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Affiliation(s)
- Stacey Li Hi Shing
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Eoin Finegan
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Deirdre Murray
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Romigi A, Placidi F, Evangelista E, Desiato MT. Circadian variation of fatigue in paralytic poliomyelitis and postpolio syndrome: just fatigue or masked restless legs syndrome? ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:475-6. [PMID: 24964120 DOI: 10.1590/0004-282x20140046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 01/29/2014] [Indexed: 11/22/2022]
Affiliation(s)
- Andrea Romigi
- Sleep & Epilepsy Center, General Hospital, University of Rome ?Tor Vergata?, Rome, Italy
| | - Fabio Placidi
- Sleep & Epilepsy Center, General Hospital, University of Rome ?Tor Vergata?, Rome, Italy
| | - Elisa Evangelista
- Sleep & Epilepsy Center, General Hospital, University of Rome ?Tor Vergata?, Rome, Italy
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Romigi A, Pierantozzi M, Placidi F, Evangelista E, Albanese M, Liguori C, Nazzaro M, Risina BU, Simonelli V, Izzi F, Mercuri NB, Desiato MT. Restless legs syndrome and post polio syndrome: a case−control study. Eur J Neurol 2014; 22:472-8. [DOI: 10.1111/ene.12593] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 09/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
- A. Romigi
- Neurophysiopathology Unit; Sleep Medicine Centre; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
- IRCCS Neuromed Via Atinense 18, Pozzilli (IS); Italy
| | - M. Pierantozzi
- Department of Neuroscience; University of Rome Tor Vergata; Italy
| | - F. Placidi
- Neurophysiopathology Unit; Sleep Medicine Centre; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
| | - E. Evangelista
- Neurophysiopathology Unit; Sleep Medicine Centre; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
| | - M. Albanese
- Neurophysiopathology Unit; Sleep Medicine Centre; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
| | - C. Liguori
- Neurophysiopathology Unit; Sleep Medicine Centre; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
| | - M. Nazzaro
- UOC Governo Clinico in Riabilitazione Azienda Ospedaliera S. Camillo Forlanini; Rome Italy
| | - B. U. Risina
- Neuropsichiatra Infantile - Centro di Riabilitazione Vaclav Vojta; Rome Italy
| | - V. Simonelli
- UOC Neurologia Ospedale Monaldi - Napoli; Napoli Italy
| | - F. Izzi
- Neurophysiopathology Unit; Sleep Medicine Centre; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
| | - N. B. Mercuri
- Neurophysiopathology Unit; Sleep Medicine Centre; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
- IRCCS Santa Lucia Foundation; Rome Italy
| | - M. T. Desiato
- Division of Neurophysiopathology; Sant'Eugenio Hospital; Rome Italy
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Restless legs syndrome in patients with sequelae of poliomyelitis. Parkinsonism Relat Disord 2014; 20:1056-8. [DOI: 10.1016/j.parkreldis.2014.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 06/13/2014] [Accepted: 06/17/2014] [Indexed: 11/19/2022]
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Wolfe LF, Patwari PP, Mutlu GM. Sleep Hypoventilation in Neuromuscular and Chest Wall Disorders. Sleep Med Clin 2014. [DOI: 10.1016/j.jsmc.2014.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Romigi A, Maestri M. Circadian fatigue or unrecognized restless legs syndrome? The post-polio syndrome model. Front Neurol 2014; 5:115. [PMID: 25071703 PMCID: PMC4083448 DOI: 10.3389/fneur.2014.00115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/19/2014] [Indexed: 11/21/2022] Open
Affiliation(s)
- Andrea Romigi
- Neurophysiopathology Unit, Department of Systems Medicine, Sleep Medicine Centre, Tor Vergata University and Hospital , Rome , Italy ; IRCCS Neuromed , Pozzilli , Italy
| | - Michelangelo Maestri
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa , Pisa , Italy
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Kumru H, Portell E, Marti M, Albu S, Tormos JM, Vidal J, Valls-Sole J. Mechanical and thermal hyperalgesia in patients with poliomyelitis. Clin Neurophysiol 2013; 124:1431-8. [DOI: 10.1016/j.clinph.2013.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 12/28/2012] [Accepted: 01/01/2013] [Indexed: 11/15/2022]
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Zespół post-polio: Część I. „Dziedzictwo” zapomnianej choroby, wyzwanie dla lekarzy i pacjentów. Neurol Neurochir Pol 2012; 46:357-71. [DOI: 10.5114/ninp.2012.30269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cook KF, Molton IR, Jensen MP. Fatigue and Aging With a Disability. Arch Phys Med Rehabil 2011; 92:1126-33. [DOI: 10.1016/j.apmr.2011.02.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 02/17/2011] [Accepted: 02/27/2011] [Indexed: 01/17/2023]
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