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Post-Polio Syndrome

Definition


Disease: Post-Polio Syndrome Post-Polio Syndrome
Category: Neurological diseases
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Disease Definition:

Some people who experience polio when they are young might have post-polio syndrome (PPS) after years.
Polio was once considered to be the most dangerous disease causing paralysis and even death. Soon after polio reached its peak in the early 1950s, the inactivated polio vaccine was introduced and greatly decreased polio’s spread. Nowadays, paralytic polio occurs in few people in developed countries, and it's because of polio vaccine.


It's not certain what causes post-polio syndrome, but some people who had polio when they were younger might have experienced some late effects of post-polio syndrome after several years.


Treatment for post-polio syndrome aims at controlling the signs and symptoms in addition to improving one’s life.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The post polio syndrome that is a cluster of disabling signs and symptoms that appear decades – an average of 30 to 40 years ــ after the initial disease first took place. The followings are typical signs and symptoms of this condition:

 

 

  • Muscle atrophy
  • Reduced tolerance of cold temperatures
  • General fatigue and exhaustion after minimal activity
  • Problems concerning breathing or swallowing
  • Sleep-related breathing disorders, like sleep apnea
  • Progressive muscle and joint weakness and pain

 

Post-polio syndrome in most cases seems to slowly develop with new signs and symptoms followed by periods of stability.
Consulting a doctor might be needed when one has weakness or fatigue that seems to be slowly getting worse. It's important to rule out other causes of the signs and symptoms that may require different therapy from what's currently advised for post-polio syndrome.

Causes:

It's not known exactly what causes the signs and symptoms of post-polio syndrome to appear so many years after the first episode of polio. At present, the most accepted theory related to the reason of post-polio syndrome rests on the idea of degenerating nerve cells.
Nerve cells that are known as motor neurons are the first to be affected when the body is infected by poliovirus, especially those in the spinal cord carrying messages (electrical impulses) between the brain and muscles.
Each neuron consists of three basic components that are:

 

  • A major branching fiber (axon)
  • Several smaller branching fibers (dendrites)
  • A cell body


Usually numerous motor neurons are either damaged or destroyed due to polio. To correct the resulting neuron shortage, the persistent neurons sprout new fibers, and the surviving motor units get extended. This advances recovery of the use of the muscles, but it positions added stress on the nerve cell body nourishing the additional fibers as well. As time passes, this stress might be more than the neuron could deal with, leading to the gradual deterioration of the sprouted fibers and finally the neuron itself.
The initial illness might have produced an autoimmune response, resulting in the body’s immune system attacking normal cells as though they were foreign substances. Some experts believe that the poliovirus may persist in the body and reactivate itself years later.
Factors that may increase the risk of developing post-polio syndrome include:


Severity of initial polio infection: Signs and symptoms of post-polio syndrome appear when the initial infection is more severe.
Age at onset of initial illness: There’s an increased risk of developing post-polio syndrome, when getting infected by polio in either adolescence or adulthood, instead of younger childhood.
Recovery: Post-polio syndrome will more likely to be developed in people who greatly recover after acute polio, since greater recovery areas adds stress on motor neurons.
Physical activity: The risk of post-polio syndrome increase, in the case of frequent physical activity to the extent of exhaustion or fatigue might exploit the motor neurons that are stressed-out.

Complications

Complications:

Post-polio syndrome in general might seldom be life-threatening, even though muscle weakness could contribute to the following complications:


Falls: Losing balance and eventually falling becomes unavoidable when leg muscles are weakened. A fall might cause broken bone, like a hip fracture, leading to other complications.
Malnutrition, dehydration, pneumonia: People who've had bulbar polio, which affects nerves leading to muscles involved in chewing and swallowing, often have difficulty with these activities as well as other signs of post-polio syndrome. Chewing and swallowing problems can lead to inadequate nutrition and to dehydration, as well as aspiration pneumonia, which is caused by inhaling (aspirating) food particles into the lungs.
Acute respiratory failure: Fluid and mucus accumulation in lungs could be the result of the weakness in the diaphragm and chest muscles that makes it more difficult to inhale deep breaths and cough. Obesity, curvature of the spine, anesthesia, prolonged immobility and certain medications can further decrease breathing ability, possibly leading to acute respiratory failure. This is characterized by a sharp drop in blood-oxygen levels and may require to receive treatment to help the patient breathes (ventilation therapy).
Osteoporosis: Prolonged inactivity and immobility are often accompanied by loss of bone density and osteoporosis, in both men and women. If the patient has post-polio syndrome, he/she may wish to be screened for osteoporosis.

Treatments:

Post-polio syndrome doesn’t have specific treatment, since its signs and symptoms usually differ from one person to another. Treatment aims at controlling the symptoms and providing comfort as much as possible:


Energy conservation: In order to get less tired, one might pace their physical activity and combining it with frequent rest periods, in addition to assistive devices that could help maintaining energy, such as motor scooter, wheelchair, cane or walker. To help preserving energy a therapist could teach ways to breathe.


Physical therapy: A doctor or therapist may prescribe exercises that strengthen the muscles without experiencing muscle fatigue. These usually include less strenuous activities, such as swimming or water aerobics, that the patient might perform every other day at a relaxed pace. Exercising to maintain fitness is important, but one should be cautious in the exercise routine and daily activities. Avoid overusing the muscles and joints and attempting to exercise beyond the point of pain or fatigue. Otherwise, the patient may need significant rest to regain his/her strength.


Occupational therapy: A physical or occupational therapist can help the patient to modify his/her home environment to become safe and convenient. This may include installation of grab bars in the shower or a raised toilet seat. In addition to rearranging furniture or rethinking some household or work-related tasks, reducing the number of steps the affected must take and increase their efficiency.


Speech therapy: Correcting swallowing problems could be performed by a speech therapist.


Sleep apnea treatment: One of the common symptoms of post-polio syndrome is sleep apnea; so changing sleeping patterns might help treat this condition as in quitting sleeping on the back or using a device that aids opening up a blocked airway.


Medications: Medications, including aspirin and other nonsteroidal anti-inflammatory drugs, may ease muscle and joint pain. Numerous drugs, such as pyridostigmine, amantadine , modafinil, insulin-like growth factor-I (IGF-I) and alpha-2 recombinant interferon, have been studied as treatments for post-polio syndrome, but no clear benefit has been found for any of them. Early studies of intravenous immunoglobulin suggest that it may reduce pain, boost strength and improve quality of life for people with post-polio syndrome.

Prognosis:

Not Available

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