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To the Editor: Parkinson disease (PD), which is due to loss of dopaminergic neurons in the zona compacta of the substantia nigra,¹ may involve both genetic and environmental risk factors.² Poliovirus is believed to cause neuronal damage in the substantia nigra,³ and thus a history of poliovirus infection may be associated with an increased risk of PD.⁴

Methods

We assessed the risk of PD in a large cohort of patients hospitalized for poliomyelitis in Copenhagen, Denmark, between 1919 and 1954.⁵ This cohort represented more than 80% of all the cases of poliomyelitis registered by the National Board of Health in the population of Copenhagen during the same period.⁵ A total of 5421 of these patients were alive on January 1, 1977, when the National Hospital Discharge Register (NHDR) was established in Denmark. The NHDR is a population-based register containing information on all somatic hospitalizations and, since January 1, 1995, all outpatient . . . [Full Text of this Article]

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Bilateral substantia nigra involvement in vaccine-associated poliomyelitis
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