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Laffont I, Duflos C, Hirtz C, Bakhti K, Gelis A, Palayer C, Macioce V, Soler M, Pradalier F, Galtier F, Jentzer A, Lozano C, Vincent T, Morales RJ. Post-polio syndrome is not a dysimmune condition. Eur J Phys Rehabil Med 2024; 60:270-279. [PMID: 38252127 PMCID: PMC11112507 DOI: 10.23736/s1973-9087.23.08158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/21/2023] [Accepted: 12/06/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Poliomyelitis is a global disabling disease affecting 12-20 million of people. Post poliomyelitis syndrome (PPS) may affect up to 80% of polio survivors: increased muscle weakness, pain, fatigue, functional decline. It relies on aging of an impaired neuro-muscular system with ongoing denervation processes. A late involvement of humoral or cellular pro-inflammatory phenomena is also suspected. AIM To assess the dysimmune hypothesis of PPS by comparing lymphocyte subpopulations and humoral immune factors between PPS patients and controls. DESIGN Cross-sectional study. SETTING Montpellier University Hospital. POPULATION Forty-seven PPS and 27 healthy controls. METHODS PPS patients and controls were compared on their lymphocyte subpopulations and humoral immune factors (IL-1β, IL-6, IL-8, IL-17, IL-21, IL-22, IL-23, IFN-γ, TNF-α, GM-CSF, RANTES, MCP1, MIP-3a, IL-10, TGF-β, IL4, IL13). Patients were further compared according to their dominant clinical symptoms. Sample size guaranteed a power >90% for all comparisons. RESULTS PPS patients and controls were comparable in gender, age and corpulence. Most patients had lower limb motor sequelae (N.=45, 95.7%), a minority had upper limb motor impairment (N.=16, 34.0%). Forty-five were able to walk (94%), 35/45 with technical aids. The median of the two-minute walking test was 110 meters (interquartile range 55; 132). Eighteen (38%) required help in their daily life. Their quality of life was low (SF36). All described an increased muscular weakness, 40 (85%) a general fatigue, and 39 (83%) muscular or joint pain. Blood count, serum electrolytes, T and B lymphocyte subpopulations and cytokines were comparable between patients and controls, except for creatine phospho kinase that was significantly higher in PPS patients. None of these variables differed between the 20/47 patients whose late main symptoms were pain or fatigue, and other patients. CONCLUSIONS Our results suggest that PPS is not a dysimmune disease. CLINICAL REHABILITATION IMPACT Our results do not sustain immunotherapy for PPS. Our work suggest that PPS may be mostly linked to physiological age-related phenomena in a disabled neuromuscular condition. Thus, our results emphasize the role of prevention and elimination of aggravating factors to avoid late functional worsening, and the importance of rehabilitation programs that should be adapted to patients' specific conditions.
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Affiliation(s)
- Isabelle Laffont
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France -
- Euromov-Digital Health in Motion, Montpellier University, Montpellier, France -
| | - Claire Duflos
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Christophe Hirtz
- Institute for Regenerative Medicine and Biotherapy, INSERM 1183, Montpellier University, Montpellier, France
| | - Karima Bakhti
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
- Euromov-Digital Health in Motion, Montpellier University, Montpellier, France
| | - Anthony Gelis
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
- Department of Physical and Rehabilitation Medicine, Propara, Montpellier, France
| | - Claire Palayer
- Department of Physical and Rehabilitation Medicine, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Valérie Macioce
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Marion Soler
- Clinical Research and Epidemiology Unit, Department of Public Health, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Fanny Pradalier
- Department of Physical and Rehabilitation Medicine, Nimes University Hospital, Montpellier University, Nimes, France
| | - Florence Galtier
- Inserm CIC 1411, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Alexandre Jentzer
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Claire Lozano
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Thierry Vincent
- Department of Immunology, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Raul J Morales
- Department of Neurology, Montpellier University Hospital, Montpellier University, Montpellier, France
- Department of Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
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Ghelman R, Akiyama IY, de Souza VT, Falcão J, Orgolini V, Hosomi JK, Quadros AAJ, Oliveira ASB. A twelve-week, four-arm, randomized, double-blind, placebo-controlled, phase 2 prospective clinical trial to evaluate the efficacy and safety of an anthroposophic multimodal treatment on chronic pain in outpatients with postpolio syndrome. Brain Behav 2020; 10:e01590. [PMID: 32162497 PMCID: PMC7177555 DOI: 10.1002/brb3.1590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 12/01/2019] [Accepted: 01/04/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Chronic pain and fatigue are the main symptoms of postpoliomyelitis syndrome (PPS). This study aimed to evaluate the efficacy and safety of an anthroposophic multimodal treatment for chronic pain in PPS outpatients. METHODS A twelve-week, four-arm, randomized, double-blind, placebo-controlled, phase 2 prospective clinical trial was designed to compare four groups (n = 48): groups A and B received daily active experimental transdermal gel (ETG) or placebo gel (PTG), respectively; groups C and D received weekly external therapies, art therapies, and neurofunctional reorganization, plus either daily ETG or PTG, respectively. The pain symptoms were evaluated through a visual analogue scale (VAS), the McGill questionnaire, and thermography. Quality of life and resilience were evaluated by the WHOQOL-BREF and Antonovsky sense of coherence questionnaires applied at baseline and after the interventions. RESULTS No related adverse events occurred, and 10% of the patients reports dysphagia improvement. In the groups C and D, pain reduction was statistically significant in both the placebo group (p = .02, d = 1.315) and in the ETG (p = .005, d = 2.035). However, following the week-to-week evolution of pain with the concomitant use of the ETG, this significant pain reduction occurred earlier from the 4th week and continued to decrease (p = .016, d = 1.369). In the group that received the complete multimodal treatment, the greatest significant benefit in increasing quality of life occurred in the physical domain and elevation in resilience with an emphasis on meaning and comprehension domains. CONCLUSIONS The anthroposophic multimodal treatment group presented both safety and efficacy as an analgesic in the groups that received the nonpharmacological therapies, much earlier when associated with the ETG. The multimodal approach corresponded to the pattern of better efficacy for both pain reduction and improvement in quality of life and resilience.
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Affiliation(s)
- Ricardo Ghelman
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil.,Department of Pediatrics, Universidade de São Paulo, São Paulo, Brazil
| | - Ivete Y Akiyama
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Valeria T de Souza
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Jussara Falcão
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Vera Orgolini
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Jorge K Hosomi
- Department of Obstetrics, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Abrahão A J Quadros
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Acary S B Oliveira
- Department of Neurology, Universidade Federal de Sao Paulo, São Paulo, Brazil
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Fiorini M, Iselle G, Perra D, Bongianni M, Capaldi S, Sacchetto L, Ferrari S, Mombello A, Vascellari S, Testi S, Monaco S, Zanusso G. High Diagnostic Accuracy of RT-QuIC Assay in a Prospective Study of Patients with Suspected sCJD. Int J Mol Sci 2020; 21:ijms21030880. [PMID: 32019068 PMCID: PMC7038328 DOI: 10.3390/ijms21030880] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 12/13/2022] Open
Abstract
The early and accurate in vivo diagnosis of sporadic Creutzfeldt–Jakob disease (sCJD) is essential in order to differentiate CJD from treatable rapidly progressive dementias. Diagnostic investigations supportive of clinical CJD diagnosis include magnetic resonance imaging (MRI), electroencephalogram (EEG), 14-3-3 protein detection, and/or real-time quaking-induced conversion (RT-QuIC) assay positivity in the cerebrospinal fluid (CSF) or in other tissues. The total CSF tau protein concentration has also been used in a clinical setting for improving the CJD diagnostic sensitivity and specificity. We analyzed 182 CSF samples and 42 olfactory mucosa (OM) brushings from patients suspected of having sCJD with rapidly progressive dementia (RPD), in order to determine the diagnostic accuracy of 14-3-3, the total tau protein, and the RT-QuIC assay. A probable and definite sCJD diagnosis was assessed in 102 patients. The RT-QuIC assay on the CSF samples showed a 100% specificity and a 96% sensitivity, significantly higher compared with 14-3-3 (84% sensitivity and 46% specificity) and tau (85% sensitivity and 70% specificity); however, the combination of RT-QuIC testing of the CSF and OM samples resulted in 100% sensitivity and specificity, proving a significantly higher accuracy of RT-QuIC compared with the surrogate biomarkers in the diagnostic setting of patients with RPD. Moreover, we showed that CSF blood contamination or high protein levels might interfere with RT-QuIC seeding. In conclusion, we provided further evidence that the inclusion of an RT-QuIC assay of the CSF and OM in the diagnostic criteria for sCJD has radically changed the clinical approach towards the diagnosis.
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Affiliation(s)
- Michele Fiorini
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
- Correspondence:
| | - Giorgia Iselle
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Daniela Perra
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Matilde Bongianni
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Stefano Capaldi
- Department of Biotechnology, University of Verona, Cà Vignal 1, Strada Le Grazie 15, 37134 Verona, Italy;
| | - Luca Sacchetto
- Surgery, Dentistry, Maternity and Infant Department, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Aldo Mombello
- Diagnostics and Public Health Department, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy;
| | - Sarah Vascellari
- Department of Biomedical Sciences, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Cagliari, Italy;
| | - Silvia Testi
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Salvatore Monaco
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
| | - Gianluigi Zanusso
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, Italy; (G.I.); (D.P.); (M.B.); (S.F.); (S.T.); (S.M.); (G.Z.)
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Baj A, Colombo M, Headley JL, McFarlane JR, Liethof MA, Toniolo A. Post-poliomyelitis syndrome as a possible viral disease. Int J Infect Dis 2015; 35:107-16. [PMID: 25939306 DOI: 10.1016/j.ijid.2015.04.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 12/27/2022] Open
Abstract
This review summarizes current concepts on post-polio syndrome (PPS), a condition that may arise in polio survivors after partial or complete functional recovery followed by a prolonged interval of stable neurological function. PPS affects 15-20 million people worldwide. Epidemiological data are reported, together with the pathogenic pathways that possibly lead to the progressive degeneration and loss of neuromuscular motor units. As a consequence of PPS, polio survivors experience new weakness, generalized fatigue, atrophy of previously unaffected muscles, and a physical decline that may culminate in the loss of independent life. Emphasis is given to the possible pathogenic role of persistent poliovirus infection and chronic inflammation. These factors could contribute to the neurological and physical decline in polio survivors. A perspective is then given on novel anti-poliovirus compounds and monoclonal antibodies that have been developed to contribute to the final phases of polio eradication. These agents could also be useful for the treatment or prevention of PPS. Some of these compounds/antibodies are in early clinical development. Finally, current clinical trials for PPS are reported. In this area, the intravenous infusion of normal human immunoglobulins appears both feasible and promising.
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Affiliation(s)
- Andreina Baj
- Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy
| | - Martina Colombo
- Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy
| | - Joan L Headley
- Post-Polio Health International, Saint Louis, Missouri, USA
| | | | - Mary-Ann Liethof
- Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy; Polio Australia Incorporated, Kew, Victoria, Australia
| | - Antonio Toniolo
- Laboratory of Clinical Microbiology, University of Insubria Medical School, Viale Borri 57, 21100 Varese, Italy.
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Risk factors for post-polio syndrome among an Italian population: a case-control study. Neurol Sci 2012; 33:1271-5. [PMID: 22246456 DOI: 10.1007/s10072-012-0931-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 01/03/2012] [Indexed: 10/14/2022]
Abstract
Post-polio syndrome (PPS) is a clinical syndrome of new weakness, fatigue and musculoskeletal pain occurring in a variable proportion of polio survivors decades after acute disease. To date, several risk factors for PPS development have been reported, although the etiology of this disorder remains elusive. Using a case-control design, we aimed to assess risk indicators for PPS in a group of Italian polio survivors. Subjects with prior poliomyelitis attending the rehabilitation hospital of Malcesine, Italy, were the target population. Patients with PPS, diagnosed according to the European Federation of Neurological Societies criteria, served as cases, while patients not meeting diagnostic criteria for PPS were used as controls. All subjects were assessed through a structured questionnaire made of 82 questions and neurological examination. The association with investigated risk factors (sex, age at polio onset, age at onset of symptoms, extension and severity of polio, employment) was analyzed by the calculation of the odds ratio. A total of 161 out of 391 eligible patients met the adopted diagnostic criteria for PPS, giving a frequency of 41.2%. Symptoms most frequently complained by PPS patients were loss of muscle strength, loss of resistance, loss of muscle volume and generalized fatigue. Female gender, the presence of respiratory disturbance during the acute phase of polio and the use of orthoses and aids during the recovery and stabilization represented independent risk factors for PPS in the studied population.
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