Brain volume and fatigue in patients with postpoliomyelitis syndrome.
BACKGROUND
Acute paralytic poliomyelitis is associated with encephalitis. Early brain inflammation may produce permanent neuronal injury with brain atrophy, which may result in symptoms such as fatigue. Brain volume has not been assessed in postpoliomyelitis syndrome (PPS).


OBJECTIVE
To determine whether brain volume is decreased compared with that in normal controls, and whether brain volume is associated with fatigue in patients with PPS.


METHODS
A cross-sectional study.


METHODS
Tertiary university-affiliated hospital postpolio and multiple sclerosis (MS) clinics.


METHODS
Forty-nine ambulatory patients with PPS, 28 normal controls, and 53 ambulatory patients with MS.


METHODS
We studied the brains of all study subjects with magnetic resonance imaging by using a 1.5 T Siemens Sonata machine. The subjects completed the Fatigue Severity Scale. Multivariable linear regression models were computed to evaluate the contribution of PPS and MS compared with controls to explain brain volume.


METHODS
Normalized brain volume (NBV) was assessed with the automated program Structured Image Evaluation, using Normalization, of Atrophy method from the acquired magnetic resonance images. This method may miss brainstem atrophy.


RESULTS
Technically adequate NBV measurements were available for 42 patients with PPS, 27 controls, and 49 patients with MS. The mean (standard deviation) age was 60.9 ± 7.6 years for patients with PPS, 47.0 ± 14.6 years for controls, and 46.2 ± 9.4 years for patients with MS. In a multivariable model adjusted for age and gender, NBV was not significantly different in patients with PPS compared with that in controls (P = .28). As expected, when using a similar model for patients with MS, NBV was significantly decreased compared with that in controls (P = .006). There was no significant association between NBV and fatigue in subjects with PPS (Spearman ρ = 0.23; P = .19).


CONCLUSIONS
No significant whole-brain atrophy was found, and no association of brain volume with fatigue in PPS. Brain atrophy was confirmed in MS. It is possible that brainstem atrophy was not recognized by this study.
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, 3801 University Street, Montreal, Quebec, Canada H3A 2B4(∗). Electronic address: daria.trojan@mcgill.ca.
Daria A
DA
Trojan
Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada(†).
Sridar
S
Narayanan
Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada(‡).
Simon J
SJ
Francis
Magnetic Resonance Spectroscopy Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada(§).
Zografos
Z
Caramanos
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada(‖).
Ann
A
Robinson
Clinical Research Unit, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada(¶).
Mauro
M
Cardoso
Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University Health Centre, Montreal, Quebec, Canada(#).
Douglas L
DL
Arnold
D001921:Brain / Q000473:pathology*; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D018450:Disease Progression; D004576:Electromyography; D005221:Fatigue / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis; D016262:Postpoliomyelitis Syndrome / Q000150:complications / Q000175:diagnosis*; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors