Post-Polio Syndrome (PPS) is a disease of muscle weakness and atrophy experienced by post-polio victims.   The Mayo Clinic defines the disease as, “a condition that some people who had polio at a young age may experience years later.”  The disease by definition is confirmed with an electromyography (EMG).  Originally, it was thought that the severity of systems of PPS was directly related to the severity of the polio.  Recently, further research shows many who were not severely affected by the poliovirus have more pronounced symptoms with PPS.   Research and patient history is difficult because many had polio at a very young age and accurate memory fades with time.  Because the symptoms of PPS manifest years’ later, diagnosing data facts such as symptoms, and severity are often inaccurate or forgotten.

According to the National Center for Health Statistics, more than 440,000 polio survivors in the United States are at risk for PPS.  Post-Polio Health International estimates there are 10-12 million polio survivors in the world today. Over time, the disease progresses and symptoms continually worsen.  Polio was the single most feared disease of its time.  The peak occurred in the early 1950s, until the polio vaccine became available.

Symptoms of PPS include: fatigue, lack of muscle stamina or feeling exhausted.  This usually occurs 30 to 40 after initial onset of polio.

From the Mayo Clinic website, symptoms include:
•    Progressive muscle and joint weakness and pain
•    General fatigue and exhaustion with minimal activity
•    Muscle atrophy
•    Breathing or swallowing problems
•    Sleep-related breathing disorders, such as sleep apnea
•    Decreased tolerance of cold temperatures

In most people, post-polio syndrome tends to progress slowly, with new signs and symptoms followed by periods of stability.  Weakness in muscles both muscles which were originally affected by the polio.  Other PPS patients experience an onset of symptoms to previously unaffected joints and other muscles.

Causes are unknown.  The most popular theory is that degenerating nerve cells causes motor neurons to be damaged and or destroyed.  Another theory is that the disease is an autoimmune reaction, similar to an allergic reaction that is caused from the polio.

Complications are related to severe muscle weakness and fatal circumstances occur during:
•    Falls–due to weak leg muscles
•    Malnutrition, dehydration and pneumonia– weak stomach especially in bulbar polio, which affects the nerves of swallowing and chewing.
•    Acute respiratory failure–weak diaphragm causes pneumonia.
•    Osteoporosis–movement, strain and exercise causes the replacement of minerals in the skeletal system.  Without the muscles to move the skeletal system around, osteoporosis is common.

Today, there isn’t a cure for PPS.  A few symptoms can be treated with medications such as NSAIDS.  Many physicians will also recommend a healthy lifestyle including proper amount of sleep, a well-balanced diet, avoiding unhealthy practices such as smoking and maintaining a tailored exercise program.

Exercise is safe and effective when administered correctly under the supervision of health care professionals.   Cardiopulmonary endurance training yields better results than strength training.  Intense muscle training, such as weight lifting is counterproductive.

Currently there isn’t a drug found to be helpful in reversing the effects of PPS.  Many studies have been tried and as of the writing proved wrong. Pyridostigmine (Mestinon) was tried hoping that a low dose would reduce fatigue, but it was unsuccessful. Insulin-like growth factor (IGF-1), was used hoping to enhance the body’s ability to grow neurons and it didn’t work out.  Modifinil (Provigil) and also amantadine were found unhelpful in reducing fatigue either.  Prednisone showed some improvement in the condition but it wasn’t significant and the side effects overshadowed the improvement.

References

•    Post-Polio Syndrome: Identifying Best Practices in Diagnosis & Care. March of Dimes, 2001.
•    Polio disease – questions and answers. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vpd-vac/polio/dis-faqs.htm. Accessed Jul. 7, 2009.
•    http://www.medicinenet.com/post-polio_syndrome. Accessed Jul. 7, 2009.
•    Post-polio syndrome fact sheet, National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/post_polio/detail_post_polio.htm. Accessed Jul. 7, 2009.
•    Shefner JM, et al. Post-polio syndrome. http://www.uptodate.com/home/index.html. Accessed Jul. 7, 2009.
•    Howard RS. Poliomyelitis and the post-polio syndrome. British Medical Journal. 2005;330:1314.