NOTE: This Message was originally addressed to Tom Mckeever
      from Dempt@eskimo.com and was forwarded to you by Tom Mckeever
                           --------------------
> POST-POLIO FATIGUE
>
> How It Can Change Your Mind
>
> Mavis J. Matheson, M.D.
> Written February, 1995
>
>     
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>
> One of the most frustrating late effects of polio for me was the
> awareness that I could not concentrate and a feeling that I wasn't
> thinking clearly anymore. For many of us who have compensated for our
> physical limitations through intellectual pursuits this is a
> terrifying feeling. Is it not bad enough that our bodies are giving
> out? Must we undergo the indignity of losing our minds as well?
> Studies show that in spite of marked impairments of attention, polio
> survivors are within the high normal or superior range on measures of
> higher-level cognitive processes and IQ.[1] They also show that if we
> allow ourselves to become fatigued we do lose our ability to focus our
> attention and to rapidly process complex information (requiring 23 to
> 67 percent more time to complete tasks requiring sustained attention
> and vigilance than did polio survivors with no fatigue or mild
> fatigue). [2]
>
> Polio survivors experience two kinds of fatigue. One is physical
> tiredness and decreased endurance. The other and often more
> distressing kind is "brain fatigue." Brain fatigue describes problems
> with attention, alertness and thinking. Between 70% and 96% of polio
> survivors reporting fatigue complained of problems with concentration
> (96%), memory (85%), attention (82%), word finding (80%), staying
> awake, and thinking clearly(70%).[3] Tests indicate that an impairment
> of selective attention (related to damage as a result of polio)
> results in feelings of fatigue and cognitive problems.[2]
>
> The poliovirus damages the anterior horn cells of the spinal cord but
> that is not all it damages. It also damages parts of the brain stem.
> Findings indicate that poliovirus consistently and often severely
> damaged the brain areas known as the Reticular Activating
> System.[4],[5] These areas are responsible for activating the part of
> the brain involved in maintaining voluntary attention, memory,
> spontaneous interest, initiative and the capacity for effort and work,
> and for preventing feelings of fatigue. This is the area that keeps us
> awake and allows us to focus our attention.[5]
>
> Polio survivors report that they are most disabled by the visceral
> symptoms of fatigue. These are feelings of exhaustion, passivity and
> an aversion to continued effort that generate an avoidance of both
> mental and physical activity.[5] Dr. R. L. Bruno suggests the
> existence of a Fatigue Generator in the brain.[5] His findings suggest
> that there is a close relationship between impaired attention and
> fatigue. There would be survival value in a brain mechanism that
> promotes rest when attention and information processing ability are
> impaired. An area of the brain (the Basal Ganglia) may generate mental
> and physical fatigue. When the Reticular Activating System is damaged,
> the Fatigue Generator takes over and produces problems with focusing
> attention and with physically moving without significant conscious
> effort. Damage caused by the poliovirus chronically reduces the firing
> of the nerve cells in the Reticular Activating System. Rest or sleep
> would increase the firing of the brain activating system nerves,
> restore activation and once again allow motor behavior.[5]
>
> The damage would explain why polio survivors have difficulty
> concentrating after the original infection but why are we developing
> problems thirty or forty years later. One theory is that the
> age-related loss of nerve cells combined with an already abnormally
> small number of nerve cells as a result of the original poliovirus
> infection may impair the brain's activating system enough to produce
> impaired attention and fatigue as polio survivors reach mid-life.[4]
>
> The first step in treating the disorders of concentration, memory,
> attention, word finding, staying awake, and thinking clearly is to
> deal with the fatigue. Energy conservation, work simplification and
> the proper provision of rest periods throughout the day are the
> treatments of choice in dealing with post-polio fatigue.[6] Stress
> management is also critical in the treatment of post-polio fatigue.[7]
> Dr. Bruno et al are currently studying the use of a medication (a
> post-synaptic dopamine receptor agonist currently used in the
> treatment of Parkinson's Disease) in the treatment of post-polio
> patients who do not respond to conservative treatments.[1] They
> caution that there is a real danger that treatment with medications
> will allow Polio survivors to resume their hyperactive Type A
> lifestyles and further stress poliovirus-damaged, "metabolically
> vulnerable" neurons in the brain stem and anterior horn.[7]
>
> As with any treatment strategy we must try to find the most effective
> treatment that will do the least long term damage while helping us to
> deal with our current problems. Certainly reducing physical and
> emotional stresses in our lives and getting adequate rest make sense
> for everyone, even polio survivors. The good news is if you can get
> rested, you will find your ability to concentrate, pay attention,
> remember words and stay awake will improve. You may even find that you
> can enjoy reading and thinking again!
>
>     
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>
> [1]. Bruno, R. L., Sapolsky R, Zimmerman JR., and Frick, NM. The
> Pathophysiology of Post-Polio Fatigue: A Role for the Basal Ganglia in
> the Generation of Fatigue. Annals of the New York Academy of Science,
> (1994) in press.
>
> [2].Bruno RL, Galski T, DeLuca J. The Neuropsychology of Post-Polio
> Fatigue. Arch Phys Med Rehabil Vol 74, Oct. 1993
>
> [3].Bruno RL Its All in your Brain: The cause and treatment of
> Post-Polio Fatigue Lecture at Healthy Partnerships Conference Oct. 22,
> 1994, Toronto, Ont. Canada
>
> [4]. Bruno RL, Frick NM, Cohen J. Polioencephalitis, Stress, and the
> Etiology of Post-polio Sequelae. Orthopedics. 1991; 14:1269-1276
>
> [5].Bruno RL, Frick NM, Lewis T, & Creange SJ: The Physiology of
> Post-Polio Fatigue: A Model for Post- Viral Fatigue Syndromes and a
> Brain Fatigue Generator. The CFIDS Chronicle Fall 1994
>
> [6].Young GR. Occupational Therapy and the Post polio Syndrome. The
> American Journal of Occupational Therapy. 1989; 43:97-103
>
> [7].Bruno RL, Frick NM. The Psychology of Polio as Prelude to
> Post-Polio Sequelae; Behavior Modification and Psychotherapy.
> Orthopedics. 1991; 14:1185-1193
>
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