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*Responses from PHI's Medical Advisory Committee Members

"The Mayo Clinic researchers are to be congratulated for having carried out a well-designed, rigorous prospective study over the past 15 years. The results represent an important contribution to the literature. It is also interesting, historically, that they provide confirmation for one of the earliest hypothesis regarding late-onset symptoms – namely aging, and it was discussed at the two Warm Springs conferences in 1984 and 1986. I only wish that a similar study could have been accomplished at my clinic and many others around the country.

"The central question it raises for many of us is, 'How representative is this study group of the larger population of polio survivors in this country?' Based on my experience-and that of many others – it probably represents a majority of individuals who visit post-polio clinics. However, it clearly doesn't represent an important minority-perhaps 5-15% – who are experiencing significant functional deterioration, especially in recent years.

"Many of these people are similar to the group of patients described by Mulder et al. in 1972 in the Mayo Clinic Proceedings in the article entitled 'Late progression of poliomyelitis or forme fruste amyotrophic lateral sclerosis.' Although details are lacking, they might also be similar to the control subjects in the 2006 Swedish paper describing the results of IVIG therapy. Thus, it's important to keep in mind that the Mayo Clinic study represents only one part, all be it a large one, of the post-polio spectrum."

Lauro S. Halstead, MD, Director, Post-Polio Program, National Rehabilitation Hospital, Washington, DC


"The Mayo Clinic findings are similar to my own clinical experience: that is, post-polio people with the greatest initial losses and proportionally the greatest recovery are the most vulnerable to later-life functional declines.

"I believe the confusion/controversy about this issue comes from the poor correlation between the severity (percentage) of motor neuron (MN) loss and the severity of clinical weakness or functional disability.

"Thus, some polio survivors had severe losses but made significant functional recovery (by very hard work at rehabilitation) to apparently become normal (not disabled).

"After age-related proportional losses of MU's, as suggested by Sorenson's study, they experience very significant and distressing increased weakness and functional losses (i.e., post-polio syndrome).

"Nevertheless, the study suggests that it is age-related cell losses, not unexplained or immunologic accelerated MU losses that lead to increased weakness, functional declines and pain in many polio survivors.

"Certainly, the study does not invalidate the distressing increased weakness and functional declines experienced by many polio survivors. Rather, it offers data to support a different explanation for these symptoms."

Frederick Maynard, MD, UP Rehabilitation Medicine Associates PC, Marquette, Michigan


"I think this is interesting and positive, but impossible to extrapolate to a worldwide population of 20 million polio survivors."

Julie K. Silver, MD, International Rehabilitation Center for Polio at Spaulding-Framingham, Massachusetts


"The Post-Polio Network (NSW), Inc. has devoted 8 pages of our newsletter to the Mayo matter (pdf). What the news release failed to explain was that: The results of a relatively small loss of muscle strength in a polio survivor can result loss of ability to perform important, even major functions. So a relatively slight loss on some type of measures used in Sorenson, et al's research can have a dramatic impact ... in my case losing the ability to walk and needing a wheelchair."

Mary Westbrook, PhD, Conjoint Associate Professor, Faculty of Medicine,
University of New South Wales, Sydney, Australia

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