PPS: Immune activated? Incident triggered?
Eddie Bollenbach

From several Posts to the Post-Polio-Med Email List, With Permission

Eddie Bollenbach Bio & Picture

Date: Mon, 21 Feb 2005 16:22:15 -0500
From: "Eddie Bollenbach"
Subject: Re:[PPM] Accident then PPS

I happen to believe that PPS is immune activated and also sustained by immune activity against damaged neurons of the central nervous system. There is a lot of evidence for this.

It has also been known for a long time that immune and autoimmune problems often follow a viral infection. We shall soon see for polio.

In our survey work we found a subgroup of polio survivors who had the onset of PPS clearly associated with physical or emotional stress. For example, as on this list recently, many people said they fell or broke a limb, or that they had a death in the family which served as a trigger for the start of PPS. This has been reported for years and may have even been reported by the early Red March of Dimes book on PPS edited by Halstead and Weichers in the early 1980s.

What we found further about this phenomenon, which is new, is that those who had their PPS begin with an event also had several other things in common with each other about their disease.

For example, this group clearly had more fatigue and a more aggressive form of PPS. They generally have a course that involves progression of weakness and then periods of leveling off of their downward spiral. These individuals also, when compared to the other group that had PPS not associated with an event, tended to have periods of illness, when they overdid or had, as we called it, polio crashes, where they felt generally ill as if they caught a bug. People who developed PPS without an associated event tended to have a more uniform slow progression of weakness.

So in summary, there is a subgroup of people with PPS who report its first appearance coincided with a stressful event or injury. These individuals in that subgroup seem to have a different progression sequence and often feel ill as if they have a mild flu when they overdue. In our opinion these differences are due to more immune/autoimmune events within the spinal cord.


Date: Tue, 22 Feb 2005 16:04:30 -0500
From: "Eddie Bollenbach"
Subject: Re: [PPM] Autoimmune component

When asked about possible treatments for PPS if PPS has an Autoimmune component:

The one that is receiving a lot of attention right now is intravenous immunoglobin. One session every few weeks seems to reduce the inflammatory biochemicals in the spinal cord of PPS patients to normal. Measured now they are of the same magnitude as those in an MS patient.

I think, if the reduction in inflammatory chemicals can add some resiliency to motor neurons under immune attack we may be able to improve strength and lessen fatigue levels both Central and Local.

There is also the possibility of anti inflammatory drugs that target the particular cytokines present in the cord for PPS. Ibuprofen and indomethecin seem both to target Tumor Necrosis Factor which seems to be there now. We know that from an understanding of the NSAIDS but there is no evidence that Ibuprofen or indomethecin can brighten the picture for PPS. I'm sure either the IVig or some other new anti-inflammatory could be a help.


Date: Tue, 22 Feb 2005 15:54:35 -0500
From: "Eddie Bollenbach"
Subject: Re: [PPM] Accident then PPS

When asked about research in this area:

Try these pointers and references. You will have to get them at a medical library or search medline for the abstracts:

Read these excerpts from the Karolinska Institute. They may peak your interest in reading the entire page at: Promising anti-inflammatory treatment for post-polio syndrome

Promising anti-inflammatory treatment for post-polio syndrome Patients with post-polio syndrome are shown to have significantly higher levels of cytokines TNF-a, IFN-g and IL-10 in CFS, compared to a control group. The values are at the same level as in patients with multiple sclerosis (MS), which is known to be a CNS inflammatory disease. Trials are going on now.

There are also several papers on the topic of inflammation within the cord causing PPS. Mentioned below are a few. Read this page too: Studies of patients with postpolio syndrome

Further References:

  1. Dalakas, Pro-inflammatory cytokines and motor neuron dysfunction: is there a connection in post-polio syndrome? J Neurolog Sci. 205:5-8, 2002. Comment to This paper - No Abstract On comment.

  2. Gonzalez et al. Prior poliomyelitis-IvIg treatment reduces proinflammatory cytokine production. J Neuroimmunol. 150:139-144, 2004. ABSTRACT

  3. Patarca, R. Cytokines and chronic fatigue syndrome. Ann NY Acad Sci. 933:185-200, 2001. ABSTRACT

  4. Black, PH. Stress and the inflammatory response: a review of neurogenic inflammation. Brain, Behavior and Immunity 16:622-653, 2002. ABSTRACT

  5. Farbu E, Rekand T, Gilhus NE, Strom V, Opheim A, Stanghelle JK, Aarli JA. Intravenous immunoglobulin in postpolio syndrome. Tidsskr Nor Laegeforen. 124:2357-2358, 2004. ABSTRACT

  6. Gonzalez et al. study in progress. (My Comments: A reference to an ongoing double blind multi-center placebo controlled study designed to stabilize the immune system of people with PPS is reported at Karolinska shows preliminarily (not published yet) to support an ongoing persistent poliovirus infection . Hopefully, results will be published soon.

Editor note: additional reference

Contact Professor Edward P. Bollenbach
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