PPS: Possible Cause and Effect?
From Revised (by authors) Posts to the Post-Polio-Med Email List With Permission From
Henry Holland, M.D. and Professor Eddie Bollenbach
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Dr. Holland's Comments             Prof. Bollenbach's Comments

Date: Sun, 3 Sep 2000 16:51:53 EDT
From: Henry Holland <Henry4FDR@AOL.COM>

<< What is not known and has *never* been shown, however, is.. whether some or all of that damage didn't heal.. because the brain has a remarkable ability to do that, especially that part of the brain .. and/or whether *if* there is still damage, those lesions cause PPS.

Most "experts" think not probably because in part, if brain lesions from the original polio did cause PPS problems, these polio survivors should have had problems from the git go and these problems wouldn't be *new* symptoms showing up decades later. >>

I think what is happening is much more complex than is implied above. For example, in reference to the second paragraph, many polio victims did have problems from the "git go" with brain stem lesions and other brain lesions. Most of these patients died. Others survived the acute episode because of iron lungs and suctioning, and many "recovered" to varying degrees. If we can accept the overwork theory of motor neurons, what makes it less plausible to accept the overwork of other neurons that might have been affected by the poliovirus. I would like to know what has been "shown" to prove the overwork theory of motor neurons. EMGs reveal giant motor cells that provide some confirmation of a history of polio.

I am of the opinion that PPS comes in episodes or exacerbations followed by some leveling off and after some time, another exacerbation may occur. Various stresses such as illness, trauma, surgery, emotional conflict, and simple worry about what is happening can precipitate or intensify an exacerbation of PPS. Multiple Sclerosis has some of the same characteristics. Many patients have an acute episode of MS, get diagnosed, and get better for varying degrees of time before experiencing another episode of pronounced symptoms. I think PPS has some of this same pattern. I can't prove it; just a clinical observation. I have communicated with many patients both in my office and otherwise who report such a pattern with PPS. Some even refer to such an exacerbation as "polio flu" or a "PPS attack." Many report symptom clusters of low grade fever, generalized muscle aches, less energy, and brain fatigue that tends to pass in time, particularly with rest. Personally, I recall similar symptom clusters as far back as 1978, long before being diagnosed with PPS in 1991. Each time, I would have an SMA 18 (18 blood chemistries), EKG, arterial blood gases, CBC and diff (blood counts) etc. and everything would be normal. I would cut my long hours back and eventually I would feel better and go back to my old ways.

I guess what I am saying is that PPS is complex, has many biopsychosocial factors, and the only thing that I know that is proven is that something bad is happening to a majority of people who had polio forty or more years ago.

Henry

Dr. Henry Holland
Central Virginia Post-Polio Support Group


Date: Sun, 3 Sep 2000 17:38:07 -0400
From: Eddie Bollenbach <edward.bollenbach@snet.net>

On 9/3/00 at 4:51 PM Henry Holland wrote:
<< I would like to know what has been "shown" to prove the overwork theory of motor neurons. EMGs reveal giant motor cells that provide some confirmation of a history of polio.
<<

You are correct Henry, the overwork theory has not been proven. That's what Theory usually, although not always, means. What we do know is that the motor neuron end fibers die off first. This has been proven by microscopy where individual muscle fibers atrophy while the entire bundle is spared in PPS. The NIH has some of these photos and they are in Dr. Halstead's first book. The only reason why the overwork idea is such a strong idea is because the motor neurons compensated for the original damage by innervating many more fibers than they ordinarily would without polio. Somehow it is logical to guess that they are working harder than they evolved to because they cannot reproduce, as other cells, but must grow more extensions, and now are pooping out. So the loss of end fibers has been shown. We are currently trying to find out if overwork is quantitatively a significant predisposing factor for PPS. But even if we show that it doesn't necessarily "prove" that overwork is the cause. Pointing to the brain, though, while it may be at the root of some of these problems, it is much harder to prove this, in my opinion anyway.

<< I guess what I am saying is that PPS is complex, has many biopsychosocial factors, and the only thing that I know that is proven is that something bad is happening to a majority of people who had polio forty or more years ago.<<

I don't even know if its a majority.....but-----

As mentioned above we also know that the motor neurons are a big part of this loss and that over wired neurons may now be crapping out. On the other hand, no one has shown that the brain responds the same way as spinal neurons to damage, by putting out more end fibers. We have not seen the same pictures as we have of individual fiber atrophy in the periphery. And the brain has a greater capacity, as we have learned recently, to use stem cells within it to replace damaged cells. I would be surprised for an analogous repair mechanism to peripheral motor neurons although I suppose it is possible. Spinal neurons, unlike brain cells, cannot be replaced. To be fair, all injuries, even Traumatic Brain Injury, and Spinal Cord Injury, get worse over time, presenting often with fatigue.

Finally, I know the vogue term is Brain Fatigue but I prefer the older accepted term Central Fatigue. This preference comes from the fact that it hasn't been shown that the primary impetus for the fatigue is inside the brain's borders. On the other hand we do know, and have proven, that Central Fatigue can result directly from localized fatigue. It is a defense mechanism the body has evolved to prevent damage to itself from an overworked body.

Eddie
Contact Professor Edward P. Bollenbach
Academic Web Pages: Home: http://www.angelfire.com/mi/nccc/
Microbiology: http://www.angelfire.com/mi/nccc/mine.html
Chemistry: http://www.angelfire.com/mi/nccc/chem.html

Eddie Bollenbach Bio & Picture

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