Postpolio syndrome and the late effects of poliomyelitis. Part 1. pathogenesis, biomechanical considerations, diagnosis, and investigations.

Postpolio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. Many theories exist regarding the pathogenesis of PPS, which remains incompletely understood. In contrast, the late effects of poliomyelitis are often a consequence of biomechanical alterations that occur as a result of polio-related surgeries, musculoskeletal deformities, or weakness. Osteoporosis and fractures of the polio-involved limbs are common. A comprehensive clinical evaluation with appropriate investigations is essential to fulfilling the established PPS diagnostic criteria. PPS is a diagnosis of exclusion in which a key clinical feature required for the diagnosis is new muscle weakness and/or muscle fatigability that is persistent for at least 1 year. Electromyographic and muscle biopsy findings including evidence of ongoing denervation cannot reliably distinguish between patients with or without PPS. Muscle Nerve 58:751-759, 2018.

Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis.

Post-polio syndrome (PPS) is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. An individualized approach to rehabilitation management is critical. Interventions may include rehabilitation management strategies, adaptive equipment, orthotic equipment, gait/mobility aids, and a variety of therapeutic exercises. The progression of muscle weakness in PPS is typically slow and gradual; however, there is also variability in both the natural history of weakness and functional prognosis. Further research is required to determine the effectiveness of selected medical treatment. Muscle Nerve 58:760-769, 2018.

[Post-polio syndrome - a case report]. / Zespól post-polio - opis przypadku.

Post-polio syndrome occurs 30-40 years after polio virus infection. The main symptoms of PPS are slowly progressive muscle limbs paresis with muscle atrophy, joints pain, paresthesia. In 90% of patients the main symptom is fatigue that leads to physical and mental activity deterioration. The cause of disease remains unknown. Probably it is an effect of motoneurons damage during acute virus polio infection, their overloading and degeneration of remaining ones. In this study we described a case of man who developed PPS 36 years after Heine-Medin disease. The main symptom was intensification of right limb paresis and muscle atrophy. In electromyography there were damage features of muscle clinically affected and unaffected. Changes in lifestyle made possible to continue occupational activity.

[Polio paralytic. New problems: postpolio syndrome]. / Poliomielitis paralítica. Nuevos problemas: el síndrome postpolio.

In 1875 M. Raymond described a progressive muscle wasting and weakness in 3 individuals survivors of childhood acute poliomyelitis. Jean-Martin Charcot suggested that the initial injury should let these guys neurons more sensitive to develop posterior spinal diseases and new weakness was the result of overuse of the affected muscles. In 1979, after the publication of the description given by a 57 year old patient on motor difficulties that developed after suffering of polio in childhood, there was a very significant increase of comments of other individuals with similar symptoms, reaching wedged in the 80s the term of post-polio syndrome. The term is reserved for describing the development of new neurological symptoms, especially for the development of muscle weakness, muscle atrophy and new muscle fatigue not explained by other medical causes, and appear after more than 15 years of infection acute. Is estimated to affect 20 to 85% of individuals with a history of polio in childhood. In 2000 first described the diagnostic criteria. This syndrome determines a change in the functional abilities. Its pathogenesis is unknown, may be associated with aging. It could also be due to an inflammatory persistent or be influenced by genetic factors. There is no effective drug treatment, so I can only recommend symptomatic and moderate muscle training.

Post-poliomyelitis syndrome: clinical features and management.

Post-poliomyelitis syndrome affects mostly women who have had paralytic polio. Most patients do very well when they are given non-fatiguing exercises in a warm environment. Patients must be correctly diagnosed with this syndrome and offered appropriate management and rehabilitation.

Síndrome pospolio: revisión de sus características clínicas y tratamiento / Post-polio syndrome: a review of its clinical characteristics and treatment

Introducción. El síndrome pospolio (SPP) se reconocecomo un síndrome clínico causante del deterioro funcional tardío yprogresivo que sufren los supervivientes de un episodio de poliomielitisaguda. La importancia del SPP se reconoce por sectores cadavez más amplios de la población y las esferas sanitarias; sin embargo,tanto su epidemiología como sus características clínicas y sutratamiento están escasamente documentados. Objetivo. Revisar laevidencia científica actualmente disponible sobre las manifestacionesclínicas, factores de riesgo, prevalencia, diagnóstico y recomendacionesde tratamiento del SPP. Desarrollo. Revisión de la literaturamédica en la base de datos MEDLINE. La búsqueda se ha restringidoa estudios en humanos publicados de forma completa en inglésy/o castellano hasta diciembre de 2004. Conclusiones. El SPP se reconocecomo un síndrome neurológico específico que aparece variasdécadas después del episodio agudo de polio, agrava las secuelasmotoras ya presentes en dichos pacientes y reduce su capacidadfuncional hasta afectar las actividades de la vida diaria. Su etiologíaaún no ha sido claramente identificada y constituye un procesode difícil diagnóstico y manejo para el cual aún no existe un tratamientoespecífico. Sin embargo, el impacto psicológico y funcionalque supone en los afectados y la posibilidad de una notable mejoríasintomática exigen un esfuerzo de identificación por parte de losprofesionales de manera que se reconozcan las necesidades clínicasque dicho síndrome impone y se reduzcan las barreras asistencialesexistentes en la actualidad

Introduction. Post-polio syndrome (PPS) is recognised as a clinical syndrome that causes the late, progressivefunctional impairment suffered by survivors of an acute episode of poliomyelitis. The importance of PPS is acknowledged byincreasingly wider sectors of the population and health care sectors; nevertheless, few reports have been published about itsepidemiology or its clinical characteristics and treatment. Aim. To review the current scientific evidence available on theclinical manifestations, risk factors, prevalence, diagnosis and recommendations for treatment of PPS. Development. Weconducted a review of the medical literature in the MEDLINE database. The search was restricted to studies conducted inhumans that had been published as complete works in English and/or Spanish up to December 2004. Conclusions. PPS isrecognised as being a specific neurological syndrome that appears several decades after the acute episode of polio; itexacerbates the motor sequelae already present in these patients and reduces their functional capacity to a point where it affectstheir activities of daily living. Its causation has still not been clearly identified and it constitutes a process that is difficult todiagnose and manage. In addition, no specific treatment has been developed for this condition to date. Nevertheless, thepsychological and functional impact it has on its victims and the possibility of bringing about a significant improvement in thesymptoms call for a greater effort by professionals to identify the clinical needs imposed by the syndrome and to break downsome of the health care barriers that currently exist

Postpolio syndrome and anesthesia.

The development of polio vaccines 50 yr ago essentially halted childhood polio epidemics in the industrialized world. During the past quarter century, a constellation of delayed neuromuscular symptoms, called postpolio syndrome, became recognized among the aging polio survivors. The prevalence of postpolio syndrome in the U.S. population is estimated to be in the hundreds of thousands. The most common symptoms are fatigue, pain, and new onset weakness thought to be related to delayed deterioration of motor neuron function. When a patient with postpolio syndrome presents for surgery, special precautions are warranted, because these patients may have respiratory impairment, sleep apnea, swallowing difficulties, and cold intolerance. This article first reviews clinical features and some pathoetiologic theories of postpolio syndrome and then focuses on anesthetic considerations including the use of common anesthetics, neuromuscular blockade, regional anesthesia, and general anesthetic management strategies.

Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors.

OBJECTIVE: To investigate frequency and associated factors of post polio syndrome (PPS) in an Italian cohort of people with prior poliomyelitis. METHODS: We screened subjects admitted for poliomyelitis at the paediatric hospital of the University of Palermo during the time frame 1945-1960. Patients who developed PPS were identified through a structured questionnaire and a neurologic examination. PPS diagnosis was made according to specified diagnostic criteria. Frequency of PPS was calculated in the selected cohort of polio survivors. The association with the investigated risk factors (sex, age at onset of polio, extension and severity of polio, education, associated diseases, cigarette smoking, trauma, polio vaccination) was analysed by the calculation of the odds ratio. RESULTS: Forty-eight participants met the adopted diagnostic criteria for PPS, giving a prevalence of 31.0%. The prevalence rate was significantly higher in women than in men (p=0.02). Logistic regression analyses revealed a significant inverse association with onset of poliomyelitis at over 12 months of age (OR 0.33; CI 0.14-0.79) a higher degree of education (OR 0.20; CI 0.07-0.79), and a significant association with the presence of other diseases (OR 9.86; CI 3.69-26.34). CONCLUSIONS: In our survey one-third of patients with prior poliomyelitis had PPS. Higher age at onset of poliomyelitis is inversely associated with PPS. The association with other diseases may indicate that a chronic physical stress, particularly in already weak motor units, can contribute to the development of signs and symptoms of PPS. Our results also suggest the impact of socio-economic conditions on the risk of PPS.

Postpolio syndrome: a challenge to the health-care system.

The practical eradication of poliomyelitis in industrialized countries marks one of the most important achievements of world health policy. Yet, disability induced by polio not only continues to exist among survivors with paralytic sequelae, but may also be further accentuated in a considerable number of affected subjects by the development of postpolio syndrome (PPS). PPS aggravates the motor sequelae already present in such subjects and reduces their functional capacity to the point where it affects their activities of daily living and worsens their quality of life. Inasmuch as development of PPS questions the concept of poliomyelitis as a static disease it poses a challenge not only to health professionals but also to policy-makers tasked with providing the necessary health-care measures and appropriate resources. This study sought to review research on this syndrome and to draw up some recommendations that might prove useful to the health authorities for decision-making purposes.

Long term outcome after poliomyelitis in different health and social conditions.

OBJECTIVE: To examine and compare the long term outcome after polio in an east European and a west European country with different access to rehabilitation and with different medical and social conditions. DESIGN AND SETTING: The patients who were acutely hospitalised for polio 1950-54 in the University Hospital in Bergen, Norway and 1958 in the University Hospital in Tartu, Estonia received the mailed questionnaire in the period between January 1998 and December 1998. PATIENTS: Patient files concerning 334 patients hospitalised in Tartu and 243 patients hospitalised in Bergen were obtained; of these 128 Estonian and 148 Norwegian patients were re-examined. MAIN RESULTS: Despite more pronounced disability in the acute stage, significantly more Norwegian patients were working full time and part time in 1998 (p<0.0001) and also through the period 1958-1998. In both countries, 30% of patients had manual work and 18% changed profession during their career. Low income (below 50% of national average) was reported by 73% of Estonian and 35% of Norwegian patients (p<0.0001). Except for the odds ratio for muscular pain of 1.89 (95%CI =1.14 to 3.14) for Norwegian patients, new symptoms indicating late progression did not differ. Norwegian patients were more independent with significantly less need for assistance in housekeeping (p=0.02), whereas the use of orthopaedic devices did not differ. CONCLUSIONS: The long term outcome after polio is different in eastern and western Europe. Access to continuous rehabilitation seems to maintain physical independence in polio patients, improves their ability to earn their own income, and lessens the need for disability pensions.