Retrospectoscope: Did FDR Have Polio or Polyneuropathy?

Abstract & Commentary

Soure: Goldman AS, et al. What was the cause of Franklin Delano Roosevelt’s paralytic illness? J Med Biogr. 2003;11: 232-240.

In August 1921, Franklin D. Roosevelt (1882-1945) was stricken with poliomyelitis, then also referred to as "infantile paralysis." Afterward, he made a courageous, lifetime effort to overcome the ravages of the disease. In time, he helped create a foundation to help other polio victims, and he inspired, as well as directed, the March of Dimes program that eventually funded an effective polio vaccine.

The diagnosis of polio in FDR’s case has never been questioned until now. Armond Goldman, a pediatric immunologist, and associates in a new analysis of FDR’s symptoms suggest that he might not have been stricken with polio but by Guillain-Barré syndrome (GBS). Goldman et al compiled all the details they could find of FDR’s case and reviewed the literature to determine how common the symptoms were 80 years ago. They used Bayesian analysis to calculate the likelihood that a 39-year-old man with each of 8 symptoms would have polio or GBS (see Table). The latter emerged as the more likely diagnosis of FDR’s paralytic illness.

Table
Clinical Features of FDR's Case, GBS, and Poliomyelitis Compared

Commentary

In the setting of fever, FDR developed ascending, symmetrical paralysis of all 4 limbs and the facial muscles bilaterally. In addition, FDR complained of numbness and felt intense pain when anyone touched his paralyzed legs. Eventually, his paralysis slowly and partially resolved in a descending fashion. Therefore, FDR’s illness more closely resembled GBS than polio.

Paralysis due to polio rarely is symmetric or ascending. Facial paralysis without involvement of other cranial nerves is rare in bulbar polio. Numbness is very rare in polio, and the pain experienced by polio patients originates in muscles (myalgias) rather than nerves (dysesthesias). Finally, a descending, symmetric recovery from paralysis as FDR experienced is rare in polio.

We will never know the cause of FDR’s paralysis with certainty because the cerebrospinal fluid was not examined, and the laboratory methods now used to diagnose poliomyelitis and GBS had not been developed in 1921. If FDR did indeed have GBS, it is unlikely that his physicians would have diagnosed it since few, if any, causes of flaccid paralysis other than polio would have been considered at the time.

This paper is of both neurological and historical interest because, as noted by a commenter in Science, FDR’s diagnosis or misdiagnosis of polio probably changed the course of history.1 His paralytic affliction gave great impetus to medical research that lead to the development of the polio vaccine, an outcome that might have been delayed had his diagnosis been GBS. — John J. Caronna

Dr. Caronna, Vice-Chairman, Department of Neurology, Cornell University Medical Center; Professor of Clinical Neurology, New York Hospital, is Associate Editor of Neurology Alert.

Reference

1. Random Samples edited by Constance Holden. Science. 2003;302:981.