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Tips And Techniques For Treating Chronic Fatigue Syndrome: The Post-Polio Connection

  [ 134 votes ]   [ Discuss This Article ]
By Dr. Richard L. Bruno • • April 24, 2002

My sister had Polio in 1953 and was paralyzed. I was 6 years old and got sick at the same time but had no paralysis, just a fever and a stiff neck, and was never diagnosed with polio. Over the past five years, I have developed severe fatigue. I can't concentrate, have trouble staying awake in the afternoon and have been diagnosed with chronic fatigue syndrome. Could I have had polio, too, and now have Post-Polio Sequelae?

We think the answer is yes. A 1999 epidemiological study by Lenny Jason found that half of the estimated 836,000 Americans with CFS are at least 40 years old. He concluded that baby-boomers may be at greater risk for CFS. That rang a bell for me. We though baby boomers' greater risk might be related to their having had a "mild" or even undiagnosed case of polio before the Salk vaccine was distributed in 1955.

It has been known since 1947 that the poliovirus damaged brain stem neurons that activate the brain – the "activating system" that keeps the brain awake and focuses attention – whether or not it damaged spinal cord neurons that move the muscles. We also know that individuals diagnosed with so called "non-paralytic" polio sometimes had severe damage to the brain activating system and report severe fatigue today, even though they had no paralysis or even weakness back when.

Fifteen years of Post-Polio Institute research has found evidence of brain activating system damage in polio survivors with fatigue, including lesions on MRI of the brain, attention deficits on neuropsychologic testing, reduced levels of brain activating hormones and brain wave slowing. These abnormalities are identical to findings in CFS/ME patients. We hypothesized that the poliovirus damaged the brain activating system and causes the signs and symptoms of chronic fatigue in some baby boomers who had undiagnosed polio years ago and therefore actually have PPS - not CFS or ME -- today.

To test this hypothesis we developed a questionnaire and, with the help of Dr. Elizabeth Dowsett in the UK and Lydia Nelson of Canada's National ME/FM Action Network, conducted the 2001 International Chronic Fatigue Survey. Americans, Britons and Canadians diagnosed with CFS/ME were asked if they'd had a childhood illness -- a fever that left them fatigued for several days, a stiff neck or even muscle weakness -- in the years before the polio vaccine was distributed in 1955.

Two-thirds of the 586 chronic fatigue patients who responded were born before 1955; they were on average 61 years old, just 4 years younger than the average polio survivors in our previous International Surveys of over 3,000 polio survivors. Twenty percent of CFS/ME patients born before 1955 were able to remember an illness with a fever, typically in 1947 when they were seven, the average age of polio patients in 1947. Just over one-third recall having had a stiff neck -- the "red flag" symptom of the poliovirus infecting the brain -- about one-third were hospitalized and 70% remember having had muscle weakness. Remarkably the distribution of childhood illness cases in the survey was virtually identical to the distribution of reported polio cases in the US and UK between 1935 and 1955.

What's more CFS/ME patients who remembered a childhood illness are more affected than CFS/ME patients who did not remember an illness or even polio survivors with PPS: They report more difficulty with concentration, thinking clearly, word finding and joint pain, are more affected by emotional stress, have had more episodes of fainting, and are more likely to have sleep
disturbed by abnormal breathing and muscle twitching.

Our findings suggests that a relatively mild childhood illness occurring before polio vaccination began in 1955 -- possibly the poliovirus damaging the brain activating system -- set the stage for mid-life symptoms that are identical to the brain fatigue reported by polio survivors and patients with CFS/ME. You are likely one of at least 20% of baby boomers diagnosed with CFS who had an undiagnosed case of polio and actually have PPS -- not CFS or ME -- today.

So when baby boomers report symptoms of chronic fatigue, doctors need to ask if they have a history of a childhood illness with fever, stiff neck or muscle weakness that occurred during the polio years. And whether or not chronic fatigue patients recall a childhood illness, the finding that over 50% of all CFS/ME patients surveyed had symptoms of abnormal nighttime breathing, and that 80% had nighttime muscle twitching (see March T'N'T), requires that a sleep history be taken in anyone reporting chronic fatigue and that clinical sleep studies be performed so that disturbed sleep as a cause of chronic fatigue can be ruled out or treated.

There is no question that neither the naturally-occurring poliovirus nor the Sabin oral polio vaccine causes CFS/ME today. But the possibility of a non-paralytic poliovirus infection in childhood causing chronic fatigue in middle-aged baby-boomers is actually a reason for hope. Our research has found that conserving energy, daytime rests breaks, stopping activities
before fatigue starts and a higher-protein diet significantly reduce symptoms of fatigue in polio survivors and CFS/ME patients.

Dr. Richard Bruno is Director of Fatigue Management Programs and The Post-Polio Institute at Englewood (NJ) Hospital and Medical Center. Go to AOL Keyword POLIO PARADOX or and click on The Post-Polio Letter. Much more information on the parallels between polio and CFS/ME and the treatment program for fatigue will be found in THE POLIO PARADOX: UNCOVERING THE HIDDEN HISTORY OF POLIO TO UNDERSTAND TREAT "POST-POLIO SYNDROME" AND CHRONIC FATIGUE, published by Warner Books in
June. E-mail questions to Dr. Bruno at

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