New concepts of the reinnervated motor unit revealed by vaccine-associated poliomyelitis

A late onset of slowly progressive muscle weakness 30-40 years after acute polio is well known. Previous studies by the author and others have demonstrated transmission abnormalities within the reinnervated motor unit. These transmission abnormalities shown by motor unit action potential (MUAP) instability in size and shape with repetitive discharges occurs in postpolio patients who are and who are not complaining of progressive muscle weakness. Although some reinnervated MUAPs do seem to stabilize their neuromuscular transmission with time in mildly affected muscles, the question arises as to whether or not some MUAPs ever stabilize after polio. Two cases of acute polio personally followed by the author, one over a 9 1/2 year period, are presented. In both cases, in muscles where there are more deinnervated muscle fibers than could possibly be reinnervated, the MUAPs have remained unstable. New concepts of function in the reinnervated motor unit following polio are presented.