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  • Post-polio Syndrome

    Definition

    Post-polio syndrome (PPS) is a condition that affects polio survivors. About 20% to 40% of people who recover from polio will later develop PPS. The onset may occur 10 to 40 years after the initial polio attack.

    Causes

    The exact cause is unknown. It is not due to renewed progression of the original polio infection. However, long-term damage to nerve and muscle cells caused by the polio may contribute to the development of PPS.

    Risk Factors

    These factors increase your chance of developing PPS. Tell your doctor if you have any of these risk factors:
    • Previous polio attack—the only absolute risk factor
    • Severity of original polio attack
    • Age at onset (worse for those who get polio later in life)

    Symptoms

    Symptoms may include:
    • Fatigue
    • Slowly progressive muscle weakness
    • Muscular atrophy
    • Muscle spasms
    • Joint pain
    • Muscle pain
    • Difficulty swallowing, breathing, or sleeping
    • Intolerance to heat or cold
    • Speech problems
    • Skeletal deformities (eg, scoliosis )
    Scoliosis
    Scoliosis
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    If the symptoms during the first attack of polio were severe, the symptoms of PPS may also be severe.

    Diagnosis

    The doctor will ask about your symptoms and medical history. She will also do a neuromuscular exam. PPS may be hard to diagnose because symptoms come and go. The symptoms also overlap with other diseases.
    Testing often involves electromyography. This measures electrical activity in affected muscles. Other, less common tests may include:
    • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body
    • Muscle biopsy —removal of a sample of muscle tissue for testing
    • Spinal tap —insertion of a needle between the vertebrae in the lower back to remove cerebrospinal fluid for testing

    Treatment

    Treatment focuses on managing symptoms. The goals are to:
    • Prevent overuse of weak muscles
    • Prevent disuse atrophy and weakness
    • Protect joints left vulnerable from weak muscles
    • Maximize function
    • Minimize discomfort
    Treatment may include:
    • Physical therapy
    • Occupational therapy
    • Speech therapy
    • Assistive devices
    • Weight loss, if overweight
    • Medicine to relieve muscle spasms and pain
    • Occasionally, surgery to correct deformities that interfere with function
    • Immunoglobulin—currently being studied to treat PPS

    Prevention

    There are no guidelines for preventing PPS. But, polio survivors who keep physically fit are probably at reduced risk.

    RESOURCES

    March of Dimes http://www.modimes.org/

    Post-polio Health http://www.post-polio.org/

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Dalakas M. IVIg in other autoimmune neurological disorders: current status and future prospects. Journal of Neurology. 2008;255(Suppl 3):12-16.

    Howard R. Poliomyelitis and the postpolio syndrome. BMJ . 2005;330:1314-1318.

    The Post-polio program. National Rehabilitation Hospital website. Available at: http://www.nrhrehab.org/Patient+Care/Programs+and+Service+Offerings/Outpatient+Services/Service%5FPage.aspx?id=39 .

    Post-polio syndrome. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/post-polio-syndrome/DS00494/DSECTION=symptoms . Updated March 2, 2008. Accessed February 9, 2009.

    Rowland LP, ed. Merritt's Neurology . 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.

    Revision Information

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