213:
function may occur in some fibers a second time, but eventually, nerve terminals malfunction and permanent weakness occurs. When these neurons no longer carry on sprouting, fatigue occurs due to the increasing metabolic demand of the nervous system. The normal aging process also may play a role. Denervation and reinnervation are going on, but the reinnervation process has an upper limit where the reinnervation cannot compensate for the ongoing denervation, and loss of motor units takes place. What disturbs the denervation-reinnervation equilibrium and causes peripheral denervation, though, is still unclear. With age, most people experience a decrease in the number of spinal motor neurons. Because polio survivors have already lost a considerable number of motor neurons, further age-related loss of neurons may contribute substantially to new muscle weakness. The overuse and underuse of muscles also may contribute to muscle weakness.
70:
165:. PPS is a very slowly progressing condition marked by periods of stability followed by new declines in the ability to carry out usual daily activities. Most patients become aware of their decreased capacity to carry out daily routines due to significant changes in mobility and decreasing upper limb function and lung capability. Fatigue is often the most disabling symptom; even slight exertion often produces disabling fatigue and can also intensify other symptoms. Problems breathing or swallowing, sleep-related breathing disorders, such as
324:(inability to produce speech), persons may become malnourished from difficulty eating. Compensatory routines can help relieve these symptoms, such as eating smaller portions at a time and sitting down whilst eating. PPS with respiratory involvement requires exceptional therapy management, such as breathing exercises and chest percussion to expel secretions (clearing of the lungs) on a periodic basis (monitored via stethoscope). Failure to properly assess PPS with respiratory involvement can increase the risk of overlooking an aspiration
305:, are ineffective in the management of PPS. Muscle strength and endurance training are more important in managing the symptoms of PPS than the ability to perform enduring aerobic activity. Management should focus on treatments such as hydrotherapy and developing other routines that encourage strength, but do not affect fatigue levels. A recent trend toward use of intravenous immunoglobulin, which had yielded promising albeit modest results, but as of 2010 proves insufficient to recommend as a treatment.
382:
recorded. The disease occurs sooner in persons with more severe initial infections. Other factors that increase the risk of PPS include increasing length of time since acute poliovirus infection, presence of permanent residual impairment after recovery from the acute illness, and being female. PPS is documented to occur in cases of nonparalytic polio (NPP). One review states late-onset weakness and fatigue occur in 14–42% of NPP patients.
42:
308:
PPS increasingly stresses the musculoskeletal system from progressive muscular atrophy. In a review of 539 PPS patients, 80% reported pain in muscles and joints and 87% had fatigue. Joint instability can cause appreciable pain and should be adequately treated with painkillers. Directed activity, such
369:
No sufficient longitudinal studies have been conducted on the prognosis of PPS, but speculations have been made by several physicians based on experience. Fatigue and mobility usually return to normal over a long period of time. The prognosis also differs depending upon different causes and factors
184:
Numerous theories have been proposed to explain post-polio syndrome. Despite this, no absolutely defined causes of PPS are known. The most widely accepted theory of the mechanism behind the disorder is "neural fatigue". A motor unit is a nerve cell (or neuron) and the muscle fibers it activates.
381:
Old data show PPS occurs in roughly 25 to 50% of people who survive a polio infection. Newer data from countries that asked their polio survivors show 85% of respondents have symptoms of post-polio syndrome. Typically, it occurs 30–35 years afterward, but delays between 8 and 71 years have been
212:
stress on the nerve cell body to nourish the additional fibers. After years of use, this stress may be more than the neuron can handle, leading to the gradual deterioration of the sprouted fibers, and eventually, the neuron itself. This causes muscle weakness and paralysis. Restoration of nerve
244:
aided by other laboratory studies can help to determine what component of a neuromuscular deficit occurred with polio and what components are new and to exclude all other possible diagnoses. Objective assessment of muscle strength in PPS patients may not be easy. Changes in muscle strength are
133:, but unlike that disorder it tends to be progressive and can cause loss of muscle strength. Treatment is primarily limited to adequate rest, conservation of available energy, and supportive measures, such as leg braces and energy-saving devices such as powered wheelchairs,
285:
care. No reversive therapies are known. Fatigue is usually the most disabling symptom. Energy conservation can significantly reduce fatigue episodes. Such can be achieved by lifestyle changes, such as additional (daytime) sleep, reducing workload, and weight loss for
361:
against the poliovirus, and because no poliovirus is excreted in the feces, it is not considered a recurrence of the original polio. Further, no evidence has shown that the poliovirus can cause a persistent infection in humans. PPS has been confused with
356:
In general, PPS is not life-threatening. The major exception is patients left with severe residual respiratory difficulties, who may experience new severe respiratory impairment. Compared to control populations, PPS patients lack any elevation of
237:. No laboratory test for post-polio syndrome is known, nor are any other specific diagnostic criteria. Three important criteria are recognized, including previous diagnosis of polio, long interval after recovery, and gradual onset of weakness.
216:
Another theory is that people who have recovered from polio lose remaining healthy neurons at a faster rate than normal. Little evidence exists to support this idea. Finally, the initial polio infection is thought to cause an
205:. In an effort to compensate for the loss of these neurons, surviving motor neurons sprout new nerve terminals to the orphaned muscle fibers. The result is some recovery of movement and the development of enlarged motor units.
1351:
1336:
1310:
New Haven: Yale
University Press. (Dr. Silver is medical director, Spaulding-Framingham Outpatient Center; Assistant Professor, Department of Physical Medicine and Rehabilitation, Harvard Medical School.)
172:
Increased activity during healthy years between the original infection and onset of PPS can amplify the symptoms. Thus, contracting polio at a young age can result in particularly disabling PPS symptoms.
655:
Dalakas, MC; Elder, G; Hallett, M; Ravits, J; Baker, M; Papadopoulos, N; Albrecht, P; Sever, J (10 April 1986). "A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms".
719:
Stolwijk-SwĂĽste JM, Beelen A, Lankhorst GJ, Nollet F (August 2005). "The course of functional status and muscle strength in patients with late-onset sequelae of poliomyelitis: a systematic review".
233:
Diagnosis of PPS can be difficult, since the symptoms are hard to separate from complications due to the original polio infection, and from the normal infirmities of
2035:
1287:
Saint Louis, MO: GINI (now Post-Polio Health
International). Information on 90 post-polio topics; a compilation of the research and experience of over 40 experts.
961:
Silbergleit AK, Waring WP, Sullivan MJ, Maynard FM (March 1991). "Evaluation, treatment, and follow-up results of post polio patients with dysphagia".
328:(a life-threatening infection of the lower respiratory tract, especially so if not caught early on). Severe cases may require permanent ventilation or
1458:
225:
attacks normal cells as if they were foreign substances. Again, compared to neural fatigue, the evidence supporting this theory is quite limited.
149:
After a period of prolonged stability, some people who recover from polio infections begin to experience new signs and symptoms, characterised by
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477:
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affecting the patient. An overall mortality rate of 25% exists due to possible respiratory paralysis; otherwise, it is usually not lethal.
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1715:
1546:
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63:
98:(polio), occurring at about a 25–40% rate (latest data greater than 80%). They are caused by the damaging effects of the viral
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1274:
1013:
795:
754:
1679:
918:
Ehde DM, Jensen MP, Engel JM, Turner JA, Hoffman AJ, Cardenas DD (2003). "Chronic pain secondary to disability: a review".
1736:
1297:
Nollet F. "Perceived health and physical functioning in postpoliomyelitis syndrome". Vrije
Universiteit Amsterdam, 2002.
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1581:
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1970:
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447:
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1640:
1626:
1173:
Ramlow, J; Alexander, M; Laporte, R; Kaufmann, C; Kuller, L (1992). "Epidemiology of the Post-Polio
Syndrome".
691:
2001:
363:
246:
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1634:
814:
Koopman, Fieke Sophia; Beelen, Anita; Gilhus, Nils Erik; de Visser, Marianne; Nollet, Frans (18 May 2015).
240:
In general, PPS is a diagnosis of exclusion whereby other possible causes of the symptoms are eliminated.
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2134:
2128:
1801:
281:) and rest (via use of mechanisms to make life easier, such as a powered wheelchair) and is generally of
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481:
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determined in specific muscle groups using various muscle scales that quantify] strength, such as the
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1872:
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1974:
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1499:
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241:
130:
69:
1029:
Lambert, David A; Giannouli, Eleni; Schmidt, Brian J (2005). "Postpolio
Syndrome and Anesthesia".
373:
Prognosis can be abruptly changed for the worse by the use of anesthesia, such as during surgery.
1770:
478:"Post-Polio Syndrome Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS)"
396:
1436:
208:
The neural fatigue theory proposes that the enlargement of the motor neuron fibers places added
2164:
2142:
2021:
2017:
2013:
2009:
1964:
1902:
1796:
1757:
1560:
1038:
366:(ALS), which progressively weakens muscles. PPS patients do not have an elevated risk of ALS.
176:
A possible early occurring and long-lasting sign is a slight jitter exhibited in handwriting.
2149:
1730:
1600:
1571:
1208:
417:
2413:
2245:
1880:
1709:
1141:
Jubelt, B; Cashman, N. R (1987). "Neurological manifestations of the post-polio syndrome".
1099:"Prevalence of post-polio syndrome based on a cross-sectional survey in Kitakyushu, Japan"
8:
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of the spinal cord, generally resulting in the death of a substantial fraction of the
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115:
58:
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as decreasing mechanical stress with braces and adaptive equipment, is recommended.
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150:
50:
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2122:
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1982:
1946:
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1652:
1513:
1371:
1303:
266:
202:
1294:
Warm
Springs, GA: March of Dimes International Conference on Post-Polio Syndrome
669:
53:
developed post-polio syndrome in 1988 after initially contracting polio in 1962.
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1533:
1382:
974:
732:
422:
302:
129:
The precise mechanism that causes PPS is unknown. It shares many features with
103:
91:
1115:
1098:
567:
2452:
1528:
1523:
1471:
835:
222:
95:
1345:
1186:
169:, and decreased tolerance for cold temperatures are other notable symptoms.
2389:
2239:
1917:
1778:
1285:
Handbook on the Late
Effects of Poliomyelitis for Physicians and Survivors.
1247:
1213:
Epidemiology and
Prevention of Vaccine-Preventable Diseases (The Pink Book)
1124:
1060:
939:
904:
853:
740:
626:
585:
533:
525:
333:
329:
254:
198:
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982:
869:"Update on current and emerging treatment options for post-polio syndrome"
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may also occur. Other management strategies that show improvement include
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234:
209:
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126:. The same may also occur years after a nonparalytic polio infection.
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1993:
1955:
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138:
134:
107:
99:
1308:
Post-Polio
Syndrome: A Guide for Polio Survivors and Their Families.
718:
2422:
2069:
1811:
1667:
1004:
Lindsay, Kenneth W; Ian Bone; Robin
Callander; J. van Gijn (1991).
262:
154:
1432:
National Institute of Neurological Disorders and Stroke-Post-polio
654:
2175:
1466:
321:
960:
1784:
1340:
1226:
Bruno, Richard L (2000). "Paralytic vs. "Nonparalytic" Polio".
1215:(12th ed.). Washington DC: Public Health Foundation. 2012.
111:
1172:
418:"Arthur C. Clarke, Premier Science Fiction Writer, Dies at 90"
2435:
2194:
1826:
1300:
Nollet, F. "Post-polio syndrome". Orphanet Ecyclopaedia, 2003
1096:
1086:. Philadelphia: Lippincott Williams and Wilkins. p. 381.
287:
1084:
Poliomyelitis and the Post-Polio Syndrome in Motor Disorders
813:
41:
158:
119:
106:
and typically occur 15 to 30 years after an initial acute
1228:
American Journal of Physical Medicine & Rehabilitation
1661:
1008:. United States: Churchill Livingstone. pp. 489–90.
312:
Because PPS can fatigue facial muscles, as well as cause
1097:
Takemura, J; Saeki, S; Hachisuka, K; Aritome, K (2004).
1028:
510:"Characteristics and management of postpolio syndrome"
917:
1318:
269:
may also be useful in establishing a PPS diagnosis.
1292:
Identifying Best Practices in Diagnosis & Care.
277:PPS treatment concerns comfort (relieving pain via
1283:Maynard, F.M., & Headley, J.H. (Eds.) (1999).
783:
1290:March of Dimes Birth Defects Foundation. (1999).
2450:
35:Post-poliomyelitis syndrome, Post-polio sequelae
1081:
340:, treatment of other respiratory diseases, and
1168:
1166:
1164:
1136:
1134:
1022:
714:
712:
442:
440:
1452:
1140:
777:
775:
747:
1219:
1161:
1131:
954:
820:The Cochrane Database of Systematic Reviews
781:
709:
437:
1716:Progressive multifocal leukoencephalopathy
1459:
1445:
772:
755:"Post-polio syndrome: Tests and diagnosis"
552:"Poliomyelitis and the postpolio syndrome"
507:
68:
1587:Extranodal NK/T-cell lymphoma, nasal type
1114:
1042:
894:
884:
843:
684:
575:
549:
1201:
997:
545:
543:
503:
501:
499:
866:
608:"Rehabilitation for postpolio sequelae"
472:
470:
468:
344:against respiratory infections such as
2469:Syndromes affecting the nervous system
2451:
1006:Neurology and Neurosurgery Illustrated
605:
601:
599:
597:
595:
409:
1440:
1264:
1225:
809:
807:
790:. Philadelphia: Hanley & Belfus.
540:
496:
415:
144:
911:
465:
110:attack. Symptoms include decreasing
1737:Subacute sclerosing panencephalitis
658:The New England Journal of Medicine
592:
13:
1258:
1103:Journal of Rehabilitation Medicine
816:"Treatment for postpolio syndrome"
804:
14:
2480:
2056:Severe acute respiratory syndrome
1582:Follicular dendritic cell sarcoma
1314:
297:Medications for fatigue, such as
2042:Middle East respiratory syndrome
1240:10.1097/00002060-200001000-00003
1175:American Journal of Epidemiology
1143:Critical Reviews in Neurobiology
1053:10.1097/00000542-200509000-00029
932:10.1097/00002508-200301000-00002
189:attacks specific neurons in the
40:
1090:
1075:
860:
508:Jubelt B, Agre JC (July 2000).
448:"Post-polio syndrome: Symptoms"
416:Jonas, Gerald (18 March 2008).
376:
1641:Adult T-cell leukemia/lymphoma
1627:Splenic marginal zone lymphoma
828:10.1002/14651858.CD007818.pub3
648:
1:
1082:Jubelt, B; J Drucket (1999).
692:"Post-polio syndrome: Causes"
402:
364:amyotrophic lateral sclerosis
272:
1846:Tropical spastic paraparesis
1751:Lymphocytic choriomeningitis
782:Silver JK, Gawne AC (2003).
351:
228:
179:
7:
2209:Cytomegalovirus esophagitis
2129:Human parainfluenza viruses
1802:Ramsay Hunt syndrome type 2
670:10.1056/NEJM198604103141505
385:
10:
2485:
1269:. New York: Warner Books.
1265:Bruno, Richard L. (2002).
975:10.1177/019459989110400308
963:Otolaryngol Head Neck Surg
733:10.1016/j.apmr.2004.12.022
290:. Some require lower-limb
251:magnetic resonance imaging
2412:
2388:
2296:
2219:
2174:
2163:
1992:
1954:
1933:
1901:
1873:Cytomegalovirus retinitis
1856:
1810:
1689:
1678:
1651:
1478:
1392:
1322:
1116:10.1080/16501970310017423
568:10.1136/bmj.330.7503.1314
320:(difficulty speaking) or
316:(difficulty swallowing),
57:
48:
39:
31:
26:
1975:Infectious mononucleosis
1792:Chandipura vesiculovirus
1622:Hepatocellular carcinoma
1567:Nasopharyngeal carcinoma
1500:Hepatocellular carcinoma
294:to reduce energy usage.
247:Medical Research Council
242:Neurological examination
131:chronic fatigue syndrome
1771:Encephalitis lethargica
1472:viral systemic diseases
550:Howard RS (June 2005).
397:List of polio survivors
49:Science fiction writer
2143:Human orthopneumovirus
1797:Herpesviral meningitis
1758:Arbovirus encephalitis
606:Khan F (August 2004).
526:10.1001/jama.284.4.412
221:, in which the body's
88:poliomyelitis sequelae
2464:Motor neuron diseases
1601:Merkel-cell carcinoma
1187:10.1093/aje/136.7.769
721:Arch Phys Med Rehabil
267:spinal fluid analysis
2246:Adenovirus infection
1710:Human polyomavirus 2
1539:Oropharyngeal cancer
873:Ther Clin Risk Manag
259:electrophysiological
1832:Post-polio syndrome
1468:Infectious diseases
1418:Post-polio syndrome
1209:"11. Poliomyelitis"
219:autoimmune reaction
195:anterior horn cells
137:(pain relief), and
80:Post-polio syndrome
64:Infectious diseases
27:Post-polio syndrome
1965:Epstein–Barr virus
1935:Respiratory system
1572:Burkitt's lymphoma
1393:External resources
886:10.2147/TCRM.S4440
786:Postpolio Syndrome
636:on 7 November 2014
615:Aust Fam Physician
145:Signs and symptoms
114:function or acute
2446:
2445:
2408:
2407:
2159:
2158:
2090:Influenza virus A
2007:Human coronavirus
1897:
1896:
1887:Herpes of the eye
1427:
1426:
1276:978-0-446-52907-5
1267:The Polio Paradox
1015:978-0-443-04345-1
797:978-1-56053-606-2
562:(7503): 1314–18.
338:smoking cessation
77:
76:
21:Medical condition
2476:
2172:
2171:
2167:digestive system
2084:Orthomyxoviridae
2050:SARS coronavirus
2036:MERS coronavirus
1952:
1951:
1764:Orthomyxoviridae
1687:
1686:
1653:Immune disorders
1577:Hodgkin lymphoma
1553:Kaposi's sarcoma
1461:
1454:
1447:
1438:
1437:
1320:
1319:
1304:Silver, Julie K.
1280:
1252:
1251:
1223:
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888:
867:Farbu E (2010).
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629:. Archived from
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494:
493:
491:
489:
480:. Archived from
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444:
435:
434:
432:
430:
413:
392:History of polio
261:studies, muscle
203:skeletal muscles
151:muscular atrophy
90:) is a group of
73:
72:
51:Arthur C. Clarke
44:
24:
23:
2484:
2483:
2479:
2478:
2477:
2475:
2474:
2473:
2449:
2448:
2447:
2442:
2404:
2384:
2292:
2266:Gastroenteritis
2224:
2221:Gastroenteritis
2215:
2203:Cytomegalovirus
2166:
2155:
2123:Paramyxoviridae
2112:Avian influenza
1988:
1983:Cytomegalovirus
1947:viral pneumonia
1945:
1942:nasopharyngitis
1941:
1938:
1929:
1893:
1867:Cytomegalovirus
1852:
1806:
1694:
1681:
1674:
1647:
1514:Cervical cancer
1474:
1465:
1428:
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1317:
1277:
1261:
1259:Further reading
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1044:10.1.1.694.6334
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1016:
1002:
998:
959:
955:
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912:
865:
861:
822:(5): CD007818.
812:
805:
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780:
773:
763:
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753:
752:
748:
727:(8): 1693–701.
717:
710:
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653:
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548:
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484:on 29 July 2011
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1977:
1960:
1958:
1949:
1931:
1930:
1928:
1927:
1926:
1925:
1920:
1907:
1905:
1903:Cardiovascular
1899:
1898:
1895:
1894:
1892:
1891:
1890:
1889:
1877:
1876:
1875:
1862:
1860:
1854:
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1836:
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1829:
1816:
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1799:
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1789:
1788:
1787:
1775:
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1773:
1760:
1755:
1754:
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1741:
1740:
1739:
1727:
1721:
1720:
1719:
1718:
1706:
1700:
1698:
1684:
1682:nervous system
1676:
1675:
1673:
1672:
1671:
1670:
1657:
1655:
1649:
1648:
1646:
1645:
1644:
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1631:
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1624:
1612:
1606:
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1591:
1590:
1589:
1584:
1579:
1574:
1569:
1557:
1556:
1555:
1543:
1542:
1541:
1536:
1534:Vaginal cancer
1531:
1526:
1521:
1516:
1504:
1503:
1502:
1490:
1484:
1482:
1476:
1475:
1464:
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1456:
1449:
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1435:
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1425:
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1421:
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1409:
1397:
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1323:Classification
1316:
1315:External links
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1298:
1295:
1288:
1281:
1275:
1260:
1257:
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1218:
1200:
1160:
1149:(3): 199–220.
1130:
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1031:Anesthesiology
1021:
1014:
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910:
859:
803:
796:
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759:MayoClinic.com
746:
708:
696:MayoClinic.com
683:
664:(15): 959–63.
647:
591:
539:
495:
464:
452:MayoClinic.com
436:
423:New York Times
407:
406:
404:
401:
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303:pyridostigmine
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104:nervous system
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2135:Parainfluenza
2133:
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2119:
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2109:
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2019:
2015:
2011:
2008:
2003:
2000:
1999:
1997:
1995:
1991:
1985:
1984:
1980:
1976:
1972:
1971:EBV infection
1969:
1968:
1967:
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1962:
1961:
1959:
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1948:
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1932:
1924:
1921:
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1864:
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1859:
1855:
1847:
1844:
1843:
1842:
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1837:
1833:
1830:
1828:
1827:Poliomyelitis
1825:
1824:
1823:
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1818:
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1809:
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1537:
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1532:
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1529:Vulvar cancer
1527:
1525:
1524:Penile cancer
1522:
1520:
1517:
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1512:
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1509:
1505:
1501:
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1237:
1233:
1229:
1222:
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1210:
1204:
1196:
1192:
1188:
1184:
1181:(7): 769–86.
1180:
1176:
1169:
1167:
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1156:
1152:
1148:
1144:
1137:
1135:
1126:
1122:
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1100:
1093:
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1078:
1070:
1066:
1062:
1058:
1054:
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1045:
1040:
1037:(3): 638–44.
1036:
1032:
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1017:
1011:
1007:
1000:
992:
988:
984:
980:
976:
972:
969:(3): 333–38.
968:
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957:
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937:
933:
929:
925:
921:
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906:
902:
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693:
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675:
671:
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620:
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600:
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561:
557:
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523:
520:(4): 412–14.
519:
515:
511:
504:
502:
500:
483:
479:
473:
471:
469:
453:
449:
443:
441:
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268:
264:
260:
256:
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249:(MRC) scale.
248:
243:
238:
236:
226:
224:
223:immune system
220:
214:
211:
206:
204:
200:
199:motor neurons
196:
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142:
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136:
132:
127:
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121:
117:
113:
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96:poliomyelitis
93:
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62:
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47:
43:
38:
34:
30:
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16:Human disease
2428:
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2390:Pancreatitis
2372:
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2329:
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2187:
2148:
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2062:
2048:
2034:
2005:
1981:
1963:
1918:Pericarditis
1910:
1879:
1865:
1838:
1831:
1819:
1777:
1762:
1743:
1729:
1708:
1691:Encephalitis
1660:
1633:
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762:. Retrieved
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631:the original
618:
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559:
555:
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486:. Retrieved
482:the original
455:. Retrieved
451:
427:. Retrieved
421:
411:
380:
377:Epidemiology
372:
368:
355:
334:Sleep apnoea
330:tracheostomy
311:
307:
296:
276:
255:neuroimaging
239:
232:
215:
207:
201:controlling
183:
175:
171:
148:
128:
94:symptoms of
87:
83:
79:
78:
18:
2287:Coronavirus
2028:Common cold
1940:acute viral
1923:Myocarditis
1767:(probable)
1519:Anal cancer
1234:(1): 4–12.
926:(1): 3–17.
920:Clin J Pain
764:23 February
701:23 February
640:24 December
488:30 December
457:23 February
342:vaccination
167:sleep apnea
161:, and limb
32:Other names
2453:Categories
2414:Urogenital
2280:Astrovirus
2240:Adenovirus
2064:SARS-CoV-2
1821:Poliovirus
1696:meningitis
1413:Patient UK
1378:DiseasesDB
1109:(1): 1–3.
879:: 307–13.
403:References
359:antibodies
318:dysarthria
299:amantadine
283:palliative
279:analgesics
273:Management
187:Poliovirus
139:sleep aids
2325:RNA virus
2306:DNA virus
2298:Hepatitis
2273:Norovirus
2261:Rotavirus
2255:RNA virus
2234:DNA virus
2180:Esophagus
2108:Influenza
1994:RNA virus
1956:DNA virus
1725:RNA virus
1704:DNA virus
1610:RNA virus
1488:DNA virus
1480:Oncovirus
1402:eMedicine
1039:CiteSeerX
836:1469-493X
352:Prognosis
346:influenza
326:pneumonia
314:dysphagia
292:orthotics
229:Diagnosis
210:metabolic
191:brainstem
180:Mechanism
135:analgesia
108:paralytic
100:infection
59:Specialty
2423:BK virus
2226:diarrhea
2070:COVID-19
1812:Myelitis
1306:(2001).
1248:10678596
1125:15074431
1061:16129991
991:33885580
948:23276693
940:12514452
905:20668713
854:25984923
845:11236427
741:16084828
627:15373379
586:15933355
534:10904484
429:19 March
386:See also
263:biopsies
193:and the
155:weakness
116:weakness
112:muscular
2176:Pharynx
1680:Central
1407:pmr/110
1372:D016262
1195:1442743
1155:3315237
1069:3056696
983:1902934
896:2909497
678:3007983
322:aphonia
288:obesity
163:fatigue
124:fatigue
102:on the
1840:HTLV-I
1785:Rabies
1635:HTLV-I
1273:
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577:558211
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257:, and
92:latent
66:
2459:Polio
2436:Mumps
2195:Mumps
2165:Human
1595:MCPyV
1383:34441
1065:S2CID
987:S2CID
944:S2CID
634:(PDF)
611:(PDF)
265:, or
235:aging
118:with
2150:hMPV
2022:OC43
2018:HKU1
2014:NL63
2010:229E
1668:AIDS
1547:KSHV
1367:MeSH
1356:9-CM
1271:ISBN
1244:PMID
1191:PMID
1151:PMID
1121:PMID
1057:PMID
1010:ISBN
979:PMID
936:PMID
901:PMID
850:PMID
832:ISSN
792:ISBN
766:2009
737:PMID
703:2009
674:PMID
642:2008
623:PMID
582:PMID
530:PMID
514:JAMA
490:2008
459:2009
431:2008
301:and
159:pain
122:and
120:pain
2430:MuV
2399:CBV
2374:HEV
2362:HDV
2350:HCV
2338:HAV
2331:CBV
2312:HBV
2189:MuV
2120:V,
1912:CBV
1881:HSV
1858:Eye
1745:LCV
1731:MeV
1662:HIV
1616:HCV
1561:EBV
1508:HPV
1494:HBV
1361:138
1352:ICD
1346:G14
1337:ICD
1236:doi
1183:doi
1179:136
1111:doi
1049:doi
1035:103
971:doi
967:104
928:doi
891:PMC
881:doi
840:PMC
824:doi
729:doi
666:doi
662:314
572:PMC
564:doi
560:330
556:BMJ
522:doi
518:284
84:PPS
2455::
2126::
2087::
2081:,
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2002:IV
1779:RV
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2079:V
2020:/
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Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
