224:
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.
176:. 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
335:(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
81:
316:, 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.
393:
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.
53:
319:
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
380:
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
195:
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.
392:
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
223:
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
255:
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
144:, 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,
296:
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
372:
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
367:
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
248:. 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.
1362:
1347:
227:
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
216:. 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.
1321:
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.)
183:
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.
666:
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".
730:
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".
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1469:
244:
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
2479:
1298:
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.
2060:
1726:
1557:
972:
Silbergleit AK, Waring WP, Sullivan MJ, Maynard FM (March 1991). "Evaluation, treatment, and follow-up results of post polio patients with dysphagia".
339:(a life-threatening infection of the lower respiratory tract, especially so if not caught early on). Severe cases may require permanent ventilation or
1597:
236:
attacks normal cells as if they were foreign substances. Again, compared to neural fatigue, the evidence supporting this theory is quite limited.
160:
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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488:
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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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1747:
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1981:
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109:(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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1651:
1637:
765:
929:
Ehde DM, Jensen MP, Engel JM, Turner JA, Hoffman AJ, Cardenas DD (2003). "Chronic pain secondary to disability: a review".
374:
257:
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1850:
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1755:
1645:
1308:
Nollet F. "Perceived health and physical functioning in postpoliomyelitis syndrome". Vrije
Universiteit Amsterdam, 2002.
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1985:
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Ramlow, J; Alexander, M; Laporte, R; Kaufmann, C; Kuller, L (1992). "Epidemiology of the Post-Polio
Syndrome".
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252:
141:
1781:
407:
1975:
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Koopman, Fieke Sophia; Beelen, Anita; Gilhus, Nils Erik; de Visser, Marianne; Nollet, Frans (18 May 2015).
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2028:
2024:
2020:
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In general, PPS is a diagnosis of exclusion whereby other possible causes of the symptoms are eliminated.
292:) and rest (via use of mechanisms to make life easier, such as a powered wheelchair) and is generally of
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determined in specific muscle groups using various muscle scales that quantify] strength, such as the
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2256:
1891:
1720:
1054:
1563:
1366:
229:
80:
1040:
Lambert, David A; Giannouli, Eleni; Schmidt, Brian J (2005). "Postpolio
Syndrome and Anesthesia".
384:
Prognosis can be abruptly changed for the worse by the use of anesthesia, such as during surgery.
1945:
1701:
1075:
997:
954:
489:"Post-Polio Syndrome Fact Sheet: National Institute of Neurological Disorders and Stroke (NINDS)"
134:
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The neural fatigue theory proposes that the enlargement of the motor neuron fibers places added
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802:
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377:(ALS), which progressively weakens muscles. PPS patients do not have an elevated risk of ALS.
348:
269:
187:
A possible early occurring and long-lasting sign is a slight jitter exhibited in handwriting.
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126:
69:
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532:
402:
161:
61:
1152:
Jubelt, B; Cashman, N. R (1987). "Neurological manifestations of the post-polio syndrome".
2308:
2236:
2231:
2213:
2133:
2122:
1993:
1957:
1877:
1663:
1524:
1314:
1110:"Prevalence of post-polio syndrome based on a cross-sectional survey in Kitakyushu, Japan"
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of the spinal cord, generally resulting in the death of a substantial fraction of the
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1534:
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as decreasing mechanical stress with braces and adaptive equipment, is recommended.
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1933:
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1305:
Warm
Springs, GA: March of Dimes International Conference on Post-Polio Syndrome
680:
352:
177:
64:
developed post-polio syndrome in 1988 after initially contracting polio in 1962.
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743:
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The precise mechanism that causes PPS is unknown. It shares many features with
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324:
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201:
180:, and decreased tolerance for cold temperatures are other notable symptoms.
149:
145:
118:
110:
1296:
Handbook on the Late
Effects of Poliomyelitis for Physicians and Survivors.
1258:
1224:
Epidemiology and
Prevention of Vaccine-Preventable Diseases (The Pink Book)
1135:
1071:
950:
915:
864:
751:
637:
596:
544:
536:
1205:
1165:
993:
880:"Update on current and emerging treatment options for post-polio syndrome"
688:
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may also occur. Other management strategies that show improvement include
2433:
2080:
1822:
1678:
273:
165:
2186:
896:
332:
1339:
137:. The same may also occur years after a nonparalytic polio infection.
52:
1795:
1351:
122:
1319:
Post-Polio
Syndrome: A Guide for Polio Survivors and Their Families.
1015:
Lindsay, Kenneth W; Ian Bone; Robin
Callander; J. van Gijn (1991).
2446:
2205:
1837:
1443:
National Institute of Neurological Disorders and Stroke-Post-polio
298:
169:
130:
1451:
1237:
Bruno, Richard L (2000). "Paralytic vs. "Nonparalytic" Polio".
1226:(12th ed.). Washington DC: Public Health Foundation. 2012.
1672:
429:"Arthur C. Clarke, Premier Science Fiction Writer, Dies at 90"
1311:
Nollet, F. "Post-polio syndrome". Orphanet Ecyclopaedia, 2003
1097:. Philadelphia: Lippincott Williams and Wilkins. p. 381.
1095:
Poliomyelitis and the Post-Polio Syndrome in Motor Disorders
117:
and typically occur 15 to 30 years after an initial acute
1239:
American Journal of Physical Medicine & Rehabilitation
1019:. United States: Churchill Livingstone. pp. 489–90.
323:
Because PPS can fatigue facial muscles, as well as cause
1108:
Takemura, J; Saeki, S; Hachisuka, K; Aritome, K (2004).
521:"Characteristics and management of postpolio syndrome"
1329:
280:
may also be useful in establishing a PPS diagnosis.
2423:
2399:
2307:
2230:
2185:
2174:
2003:
1965:
1944:
1912:
1867:
1821:
1700:
1689:
1662:
1489:
1403:
1333:
1303:
Identifying Best Practices in Diagnosis & Care.
288:PPS treatment concerns comfort (relieving pain via
68:
42:
37:
1294:Maynard, F.M., & Headley, J.H. (Eds.) (1999).
794:
1301:March of Dimes Birth Defects Foundation. (1999).
46:Post-poliomyelitis syndrome, Post-polio sequelae
351:, treatment of other respiratory diseases, and
1179:
1177:
1175:
1147:
1145:
725:
723:
453:
451:
1463:
788:
786:
8:
831:The Cochrane Database of Systematic Reviews
2182:
1962:
1727:Progressive multifocal leukoencephalopathy
1697:
1470:
1456:
1448:
1330:
766:"Post-polio syndrome: Tests and diagnosis"
563:"Poliomyelitis and the postpolio syndrome"
79:
34:
1598:Extranodal NK/T-cell lymphoma, nasal type
1125:
1053:
905:
895:
854:
586:
556:
554:
514:
512:
510:
619:"Rehabilitation for postpolio sequelae"
483:
481:
479:
419:
355:against respiratory infections such as
2480:Syndromes affecting the nervous system
1017:Neurology and Neurosurgery Illustrated
612:
610:
608:
606:
820:
818:
801:. Philadelphia: Hanley & Belfus.
7:
121:attack. Symptoms include decreasing
1748:Subacute sclerosing panencephalitis
669:The New England Journal of Medicine
1114:Journal of Rehabilitation Medicine
827:"Treatment for postpolio syndrome"
25:
2067:Severe acute respiratory syndrome
1593:Follicular dendritic cell sarcoma
308:Medications for fatigue, such as
2053:Middle East respiratory syndrome
1251:10.1097/00002060-200001000-00003
1186:American Journal of Epidemiology
1154:Critical Reviews in Neurobiology
1064:10.1097/00000542-200509000-00029
943:10.1097/00002508-200301000-00002
200:attacks specific neurons in the
51:
519:Jubelt B, Agre JC (July 2000).
459:"Post-polio syndrome: Symptoms"
427:Jonas, Gerald (18 March 2008).
1652:Adult T-cell leukemia/lymphoma
1638:Splenic marginal zone lymphoma
839:10.1002/14651858.CD007818.pub3
1:
1093:Jubelt, B; J Drucket (1999).
703:"Post-polio syndrome: Causes"
375:amyotrophic lateral sclerosis
1857:Tropical spastic paraparesis
1762:Lymphocytic choriomeningitis
793:Silver JK, Gawne AC (2003).
2220:Cytomegalovirus esophagitis
2140:Human parainfluenza viruses
1813:Ramsay Hunt syndrome type 2
681:10.1056/NEJM198604103141505
2496:
1280:. New York: Warner Books.
1276:Bruno, Richard L. (2002).
986:10.1177/019459989110400308
974:Otolaryngol Head Neck Surg
744:10.1016/j.apmr.2004.12.022
301:. Some require lower-limb
262:magnetic resonance imaging
1884:Cytomegalovirus retinitis
1127:10.1080/16501970310017423
579:10.1136/bmj.330.7503.1314
331:(difficulty speaking) or
327:(difficulty swallowing),
59:
50:
1986:Infectious mononucleosis
1803:Chandipura vesiculovirus
1633:Hepatocellular carcinoma
1578:Nasopharyngeal carcinoma
1511:Hepatocellular carcinoma
305:to reduce energy usage.
258:Medical Research Council
253:Neurological examination
142:chronic fatigue syndrome
1782:Encephalitis lethargica
1483:viral systemic diseases
561:Howard RS (June 2005).
408:List of polio survivors
60:Science fiction writer
2154:Human orthopneumovirus
1808:Herpesviral meningitis
1769:Arbovirus encephalitis
617:Khan F (August 2004).
537:10.1001/jama.284.4.412
232:, in which the body's
99:poliomyelitis sequelae
2475:Motor neuron diseases
1612:Merkel-cell carcinoma
1198:10.1093/aje/136.7.769
732:Arch Phys Med Rehabil
278:spinal fluid analysis
2257:Adenovirus infection
1721:Human polyomavirus 2
1550:Oropharyngeal cancer
884:Ther Clin Risk Manag
270:electrophysiological
1843:Post-polio syndrome
1479:Infectious diseases
1429:Post-polio syndrome
1220:"11. Poliomyelitis"
230:autoimmune reaction
206:anterior horn cells
148:(pain relief), and
91:Post-polio syndrome
75:Infectious diseases
38:Post-polio syndrome
18:Post polio syndrome
1976:Epstein–Barr virus
1946:Respiratory system
1583:Burkitt's lymphoma
1404:External resources
897:10.2147/TCRM.S4440
797:Postpolio Syndrome
647:on 7 November 2014
626:Aust Fam Physician
156:Signs and symptoms
125:function or acute
2457:
2456:
2419:
2418:
2170:
2169:
2101:Influenza virus A
2018:Human coronavirus
1908:
1907:
1898:Herpes of the eye
1438:
1437:
1287:978-0-446-52907-5
1278:The Polio Paradox
1026:978-0-443-04345-1
808:978-1-56053-606-2
573:(7503): 1314–18.
349:smoking cessation
88:
87:
32:Medical condition
16:(Redirected from
2487:
2183:
2178:digestive system
2095:Orthomyxoviridae
2061:SARS coronavirus
2047:MERS coronavirus
1963:
1775:Orthomyxoviridae
1698:
1664:Immune disorders
1588:Hodgkin lymphoma
1564:Kaposi's sarcoma
1472:
1465:
1458:
1449:
1331:
1315:Silver, Julie K.
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878:Farbu E (2010).
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640:. Archived from
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491:. Archived from
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403:History of polio
272:studies, muscle
214:skeletal muscles
162:muscular atrophy
101:) is a group of
84:
83:
62:Arthur C. Clarke
55:
35:
21:
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2277:Gastroenteritis
2235:
2232:Gastroenteritis
2226:
2214:Cytomegalovirus
2177:
2166:
2134:Paramyxoviridae
2123:Avian influenza
1999:
1994:Cytomegalovirus
1958:viral pneumonia
1956:
1953:nasopharyngitis
1952:
1949:
1940:
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1878:Cytomegalovirus
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1817:
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1525:Cervical cancer
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1270:Further reading
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833:(5): CD007818.
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738:(8): 1693–701.
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495:on 29 July 2011
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1886:
1873:
1871:
1865:
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1862:
1861:
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1859:
1847:
1846:
1845:
1840:
1827:
1825:
1819:
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1810:
1805:
1800:
1799:
1798:
1786:
1785:
1784:
1771:
1766:
1765:
1764:
1752:
1751:
1750:
1738:
1732:
1731:
1730:
1729:
1717:
1711:
1709:
1695:
1693:nervous system
1687:
1686:
1684:
1683:
1682:
1681:
1668:
1666:
1660:
1659:
1657:
1656:
1655:
1654:
1642:
1641:
1640:
1635:
1623:
1617:
1616:
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1614:
1602:
1601:
1600:
1595:
1590:
1585:
1580:
1568:
1567:
1566:
1554:
1553:
1552:
1547:
1545:Vaginal cancer
1542:
1537:
1532:
1527:
1515:
1514:
1513:
1501:
1495:
1493:
1487:
1486:
1477:
1475:
1474:
1467:
1460:
1452:
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1445:
1436:
1435:
1432:
1431:
1420:
1408:
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1405:
1401:
1400:
1397:
1396:
1385:
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1359:
1343:
1338:
1337:
1335:
1334:Classification
1327:
1326:External links
1324:
1323:
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1312:
1309:
1306:
1299:
1292:
1286:
1271:
1268:
1265:
1264:
1229:
1211:
1171:
1160:(3): 199–220.
1141:
1100:
1085:
1042:Anesthesiology
1032:
1025:
1007:
964:
921:
870:
814:
807:
782:
770:MayoClinic.com
757:
719:
707:MayoClinic.com
694:
675:(15): 959–63.
658:
602:
550:
506:
475:
463:MayoClinic.com
447:
434:New York Times
418:
417:
415:
412:
411:
410:
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398:
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389:
386:
364:
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314:pyridostigmine
285:
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115:nervous system
86:
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72:
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57:
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48:
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31:
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2163:
2162:
2158:
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2147:
2146:Parainfluenza
2144:
2143:
2142:
2141:
2136:
2135:
2130:
2129:
2124:
2120:
2117:
2116:
2115:
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2110:
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2030:
2026:
2022:
2019:
2014:
2011:
2010:
2008:
2006:
2002:
1996:
1995:
1991:
1987:
1983:
1982:EBV infection
1980:
1979:
1978:
1977:
1973:
1972:
1970:
1968:
1964:
1961:
1959:
1954:
1947:
1943:
1935:
1932:
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1927:
1926:
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1919:
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1911:
1899:
1896:
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1893:
1889:
1885:
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1880:
1879:
1875:
1874:
1872:
1870:
1866:
1858:
1855:
1854:
1853:
1852:
1848:
1844:
1841:
1839:
1838:Poliomyelitis
1836:
1835:
1834:
1833:
1829:
1828:
1826:
1824:
1820:
1814:
1811:
1809:
1806:
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1797:
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1569:
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1562:
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1560:
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1555:
1551:
1548:
1546:
1543:
1541:
1540:Vulvar cancer
1538:
1536:
1535:Penile cancer
1533:
1531:
1528:
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1523:
1522:
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1520:
1516:
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1509:
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1497:
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1244:
1240:
1233:
1230:
1225:
1221:
1215:
1212:
1207:
1203:
1199:
1195:
1192:(7): 769–86.
1191:
1187:
1180:
1178:
1176:
1172:
1167:
1163:
1159:
1155:
1148:
1146:
1142:
1137:
1133:
1128:
1123:
1119:
1115:
1111:
1104:
1101:
1096:
1089:
1086:
1081:
1077:
1073:
1069:
1065:
1061:
1056:
1051:
1048:(3): 638–44.
1047:
1043:
1036:
1033:
1028:
1022:
1018:
1011:
1008:
1003:
999:
995:
991:
987:
983:
980:(3): 333–38.
979:
975:
968:
965:
960:
956:
952:
948:
944:
940:
936:
932:
925:
922:
917:
913:
908:
903:
898:
893:
889:
885:
881:
874:
871:
866:
862:
857:
852:
848:
844:
840:
836:
832:
828:
821:
819:
815:
810:
804:
799:
798:
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787:
783:
771:
767:
761:
758:
753:
749:
745:
741:
737:
733:
726:
724:
720:
708:
704:
698:
695:
690:
686:
682:
678:
674:
670:
662:
659:
643:
639:
635:
632:(8): 621–24.
631:
627:
620:
613:
611:
609:
607:
603:
598:
594:
589:
584:
580:
576:
572:
568:
564:
557:
555:
551:
546:
542:
538:
534:
531:(4): 412–14.
530:
526:
522:
515:
513:
511:
507:
494:
490:
484:
482:
480:
476:
464:
460:
454:
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448:
436:
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430:
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321:
317:
315:
311:
306:
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295:
291:
283:
281:
279:
275:
271:
267:
263:
260:(MRC) scale.
259:
254:
249:
247:
239:
237:
235:
234:immune system
231:
225:
222:
217:
215:
211:
210:motor neurons
207:
203:
199:
190:
188:
185:
181:
179:
175:
171:
167:
163:
155:
153:
151:
147:
143:
138:
136:
132:
128:
124:
120:
116:
112:
108:
107:poliomyelitis
104:
100:
96:
92:
82:
76:
73:
71:
67:
63:
58:
54:
49:
45:
41:
36:
30:
27:Human disease
19:
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2432:
2408:
2401:Pancreatitis
2383:
2371:
2359:
2347:
2340:
2321:
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2132:
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2093:
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2045:
2016:
1992:
1974:
1929:Pericarditis
1921:
1890:
1876:
1849:
1842:
1830:
1788:
1773:
1754:
1740:
1719:
1702:Encephalitis
1671:
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1625:
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769:
760:
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649:. Retrieved
642:the original
629:
625:
570:
566:
528:
524:
497:. Retrieved
493:the original
466:. Retrieved
462:
438:. Retrieved
432:
422:
391:
388:Epidemiology
383:
379:
366:
345:Sleep apnoea
341:tracheostomy
322:
318:
307:
287:
266:neuroimaging
250:
243:
226:
218:
212:controlling
194:
186:
182:
159:
139:
105:symptoms of
98:
94:
90:
89:
29:
2298:Coronavirus
2039:Common cold
1951:acute viral
1934:Myocarditis
1778:(probable)
1530:Anal cancer
1245:(1): 4–12.
937:(1): 3–17.
931:Clin J Pain
775:23 February
712:23 February
651:24 December
499:30 December
468:23 February
353:vaccination
178:sleep apnea
172:, and limb
43:Other names
2464:Categories
2425:Urogenital
2291:Astrovirus
2251:Adenovirus
2075:SARS-CoV-2
1832:Poliovirus
1707:meningitis
1424:Patient UK
1389:DiseasesDB
1120:(1): 1–3.
890:: 307–13.
414:References
370:antibodies
329:dysarthria
310:amantadine
294:palliative
290:analgesics
284:Management
198:Poliovirus
150:sleep aids
2336:RNA virus
2317:DNA virus
2309:Hepatitis
2284:Norovirus
2272:Rotavirus
2266:RNA virus
2245:DNA virus
2191:Esophagus
2119:Influenza
2005:RNA virus
1967:DNA virus
1736:RNA virus
1715:DNA virus
1621:RNA virus
1499:DNA virus
1491:Oncovirus
1413:eMedicine
1050:CiteSeerX
847:1469-493X
363:Prognosis
357:influenza
337:pneumonia
325:dysphagia
303:orthotics
240:Diagnosis
221:metabolic
202:brainstem
191:Mechanism
146:analgesia
119:paralytic
111:infection
70:Specialty
2434:BK virus
2237:diarrhea
2081:COVID-19
1823:Myelitis
1317:(2001).
1259:10678596
1136:15074431
1072:16129991
1002:33885580
959:23276693
951:12514452
916:20668713
865:25984923
856:11236427
752:16084828
638:15373379
597:15933355
545:10904484
440:19 March
397:See also
274:biopsies
204:and the
166:weakness
127:weakness
123:muscular
2187:Pharynx
1691:Central
1418:pmr/110
1383:D016262
1206:1442743
1166:3315237
1080:3056696
994:1902934
907:2909497
689:3007983
333:aphonia
299:obesity
174:fatigue
135:fatigue
113:on the
1851:HTLV-I
1796:Rabies
1646:HTLV-I
1284:
1257:
1204:
1164:
1134:
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588:558211
585:
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268:, and
103:latent
77:
2470:Polio
2447:Mumps
2206:Mumps
2176:Human
1606:MCPyV
1394:34441
1076:S2CID
998:S2CID
955:S2CID
645:(PDF)
622:(PDF)
276:, or
246:aging
129:with
2161:hMPV
2033:OC43
2029:HKU1
2025:NL63
2021:229E
1679:AIDS
1558:KSHV
1378:MeSH
1367:9-CM
1282:ISBN
1255:PMID
1202:PMID
1162:PMID
1132:PMID
1068:PMID
1021:ISBN
990:PMID
947:PMID
912:PMID
861:PMID
843:ISSN
803:ISBN
777:2009
748:PMID
714:2009
685:PMID
653:2008
634:PMID
593:PMID
541:PMID
525:JAMA
501:2008
470:2009
442:2008
312:and
170:pain
133:and
131:pain
2441:MuV
2410:CBV
2385:HEV
2373:HDV
2361:HCV
2349:HAV
2342:CBV
2323:HBV
2200:MuV
2131:V,
1923:CBV
1892:HSV
1869:Eye
1756:LCV
1742:MeV
1673:HIV
1627:HCV
1572:EBV
1519:HPV
1505:HBV
1372:138
1363:ICD
1357:G14
1348:ICD
1247:doi
1194:doi
1190:136
1122:doi
1060:doi
1046:103
982:doi
978:104
939:doi
902:PMC
892:doi
851:PMC
835:doi
740:doi
677:doi
673:314
583:PMC
575:doi
571:330
567:BMJ
533:doi
529:284
95:PPS
2466::
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1790:RV
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Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
