Circadian variation of fatigue in paralytic poliomyelitis and postpolio syndrome: just fatigue or masked restless legs syndrome?

Post-polio Syndrome: More Than Just a Lower Motor Neuron Disease

“…Fatigue is thought to exhibit circadian variations throughout the day (90). Sleep disorders such as restless leg syndrome (RLS) (87, 91–94), sleep related breathing disturbances (95), obstructive sleep apnoea (OSA) (96), excessive daytime somnolence (EDS), and periodic limb movement in sleep (PLMS) (97) are not only often reported in PPS but they are likely to play an important role in the pathogenesis of fatigue in PPS (98, 99). Fatigue is thought to be more severe in PPS with RLS, and correlate to the severity of RLS (87).…”

“…The simultaneous onset of RLS and PPS symptoms (91) and the positive response to pramipexole in an uncontrolled trial by Kumru et al (93) have been interpreted as a pathophysiological link between RLS and PPS (98). The putative link between RLS and neuroimmunological alterations (100, 101) may also suggest shared pathophysiological processes between PPS and RLS (99). Furthermore, a higher incidence of cauda equina syndrome (102) and renal impairment (103) has also been reported in PPS but the association between these syndromes remains to be elucidated.…”

Restless legs syndrome and post polio syndrome: a case−control study

“…Although these authors did not explore clinical RLS in the PPS sample, it is intriguing to note that fatigue could resemble the circadian pattern of RLS symptoms. On the basis of the association presently proved between general fatigue and RLS, and considering that RLS could be difficult to identify because fatigue itself may mask RLS symptoms, one could argue that unrecognized RLS may represent a possible cause of the ‘circadian’ fatigue observed in PSS .…”

Reply

“…However we still did not detect all aspects that permeate the issue of fatigue in PPS. Finally, I think the placement Romigi et al 1 is quite intriguing, interesting and whets our curiosity and interest in this topic making us think developing new research. It was very well placed.…”