Brain, Vol 120, Issue 8 1415-1421, Copyright © 1997 by Oxford University Press
AJ McComas, C Quartly and RC Griggs
Motor unit number estimation was employed to assess muscle innervation in
76 patients with prior poliomyelitis. Of the 68 patients who were < 70
years of age, new musculoskeletal symptoms had appeared in all but four;
the mean latent interval was 38.0 +/- 10.1 years. As expected, there was a
high incidence of muscles exhibiting denervation in previously affected
limbs (87%). However, the incidence in supposedly unaffected limbs was also
high (65%). Significant differences in the degree of denervation were found
between muscles of the same hands and feet. Judged on the basis of their
potential amplitudes, the surviving motor units in partially denervated
muscles tended to be enlarged. The enlargement was proportional to the
extent of the denervation and was comparable to that found in amyotrophic
lateral sclerosis. In some muscles, possibly those innervated by failing
motor neurons, motor-unit enlargement was not present. Needle examination
confirmed the high incidences of denervation in affected and allegedly
unaffected limbs. Of the 188 muscles with EMG features of chronic
denervation, only nine exhibited fibrillations or positive sharp waves
(4.8%). Ninety-five muscles of 18 patients were studied a second time after
an interval of 2 years. Overall, there was a 13.4% reduction in motor-unit
number and a 18.4% diminution in M-wave amplitude (P < 0.001). The rate
of motor- unit loss was twice that occurring in healthy subjects aged >
60 years. Analysis of individual patients indicated that some were
deteriorating more rapidly than others. These studies confirm that
denervation progresses in patients with prior poliomyelitis in both
clinically affected and unaffected muscles, and indicate that this
progression is more rapid than that occurring in normal ageing.
ARTICLES
Early and late losses of motor units after poliomyelitis
Department of Medicine, McMaster University, Hamilton, Canada.
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