POST POLIO SYNDROME AWARENESS

POST POLIO SYNDROME AWARENESS

 

After a period of prolonged stability individuals who had been infected and recovered from polio begin to experience new signs and symptoms.

POST POLIO SYNDROME is a condition that affects approximately 25–50% of people who have previously contracted poliomyelitis—a viral infection of the nervous system—after the initial infection. The symptoms appear 15–30 years after recovery from the original paralytic attack, at an age of 35 to 60. Thus, contracting poliomyelitis at a young age can result in particularly disabling PPS symptoms.^[5]

 

 

SYMPTOMS

MUSCULAR ATHROPHY (decreased muscle mass).

WEAKNESS, pain and fatigue in limbs that were originally affected or in limbs that didn’t seem to have been affected at the time of the initial polio illness.^[2] The same symptoms may also occur years after no paralytic polio (NPP) infection.

The neural fatigue theory proposes that the enlargement of the motor neuron fibers places added metabolic stress on the nerve cell body to nourish the additional fibers. After years of use, this stress may be more than the neuron can handle, leading to the gradual deterioration of the sprouted fibers and, eventually, the neuron itself. This causes muscle weakness and paralysis. Restoration of nerve function may occur in some fibers a second time, but eventually nerve terminals malfunction and permanent weakness occurs.^[3] When these neurons no longer carry on sprouting, fatigue occurs due to the increasing metabolic demand of the nervous system.^[6] The normal aging process also may play a role. With age, most people experience a decrease in the number of spinal motor neurons. Because polio survivors have already has lost a considerable number of motor neurons, further age-related loss of neurons may contribute substantially to new muscle weakness. The overuse and underuse of muscles also may contribute to muscle weakness.^[7]

Another theory is that people who’ve recovered from polio lose remaining healthy neurons at a faster rate than normal. However, little evidence exists to support this idea.^[8] Finally, it has been proposed that the initial polio infection causes an autoimmune reaction, in which the body’s immune system attacks normal cells as if they were foreign substances. Again, compared to neural fatigue, the evidence supporting this theory is quite limited.^[8]

 

PPS is a very slowly progressing condition marked by periods of stability followed by new declines in the ability to carry out usual daily activities.^[3] Most patients become aware of their decreased capacity to carry out daily routines due to significant changes in mobility, decreasing upper limb function and lung capability. Fatigue is often the most disabling symptom; even slight exertion often produces disabling fatigue and can also intensify other symptoms.^[4] Problems breathing or swallowing, sleep-related breathing disorders, such as sleep apnea and decreased tolerance for cold temperatures are other notable symptoms.^[2]

Increased activity during intervening healthy years between the original infection and onset of PPS can amplify the symptoms. Thus, contracting poliomyelitis at a young age can result in particularly disabling PPS symptoms.^[5]

 

SUMMARY:

• The post-polio population is aging and decreasing in size. Still, there are thousands of post-polio patients who require skilled nursing care with their advancing age and declining function.

• Fatigued post-polio patients can be considered a distinct subgroup across the fatigue continuum.

• Diaphragmatic paralysis in post-polio syndrome can be unilateral or bilateral. When unilateral, the prognosis is good, but bilateral diaphragmatic paralysis often has a worse prognosis.

• Supportive care, self-selected life style changes, and energy conservation strategies still remain the main axiom of therapy.

 

HISTORY:

Poliomyelitis epidemics in the United States and all over the world came to a dynamic end with the introduction of the inactivated poliomyelitis vaccine (Salk vaccine) in 1955 and the live attenuated oral polio vaccine (Sabin vaccine) in 1961. Even though poliomyelitis has basically been eliminated, many patients from those epidemics were left with severe disabilities. These patients became over-achievers by working hard both physically and emotionally to overcome their disabilities. Now, some 30 plus years after contracting acute poliomyelitis, these survivors are developing new symptoms, collectively referred to as “late effects of poliomyelitis” or the “post-polio syndrome.” Not only are there new physical disabilities with which to cope, but also psychological effects of a second disability from a disease presumably resolved.

The syndrome of late weakness occurring many years after acute poliomyelitis has been recognized for over 100 years. However, it did not receive general public recognition until the large number of cases began to be seen in the 1980’s. In 1875 late weakness occurring years after poliomyelitis was noted by Charcot and other clinicians. Between 1875 and 1975 only about 200 cases of post-polio syndrome were described in publications. The post-polio population is aging and decreasing in size. Still, there are thousands of post-polio patients who require skilled nursing care with their advancing age and declining function.

 

MANIFESTATIONS:

 

(1) A prior episode of paralytic poliomyelitis with residual motor neuron loss (which can be confirmed through a typical patient history, a neurologic examination, and, if needed, an electro diagnostic exam); (2) A period of neurologic recovery followed by an interval (usually 15 years or more) of neurologic and functional stability; (3) A gradual or abrupt onset of new weakness or abnormal muscle fatigue, decreased endurance, muscle atrophy, or generalized fatigue; and (4) Exclusion of medical, orthopedic, and neurologic conditions that may be causing the symptoms mentioned in number 3.

 

Neurologic manifestations: New slowly progressive muscle weakness is the most important neurologic, occurring in most post-polio syndrome patients. It appears to be related to a disintegration of the lower motor neuron unit (motor unit) and can occur in muscles previously affected and partially or fully recovered or in muscles previously unaffected. Electromyography (EMG) indicate that some clinically unaffected muscles were involved sub clinically during the acute poliomyelitis. However, previously affected muscles are more likely than unaffected muscles to later become weak. The distribution of the new weakness, appears to correlate with the severity of paralysis at the time of the acute poliomyelitis and, thus, with the number of surviving motor neurons.

 

Hyperreflexia, Babinski signs, and occasionally, muscle pain (myalgias) appears to be due to overuse of weak muscles. Fasciculation and cramps without weakness, muscle pseudo hypertrophy, and tingling paresthesias are other neuromuscular problems that occur infrequently in post-polio patients, with or without new

Weakness

 

TREATMENT: The treatment for post-polio syndrome is generally palliative and consists of rest, conservation of available energy, and supportive measures, such as leg braces and energy-saving utilization of mechanisms to make life easier such as powered wheelchairs, also analgesia (pain relief) and sleep aids.,. There are no riverside therapies. Fatigue is usually the most disabling symptom; energy conservation can significantly reduce fatigue episodes. Such conservation can be achieved with lifestyle changes, reducing workload and daytime sleeping. Weight loss is also recommended if patients are obese. In some cases, the use of lower limb orthotics can reduce energy usage. Medications for fatigue, such as amantadine and pyridostigmine, have not been found to be effective in the management of PPS.^[6] Muscle strength and endurance training are more important in managing the symptoms of PPS than the ability to perform long aerobic activity. Management should focus on treatments such as hydrotherapy and developing other routines that encourage strength but do not affect fatigue levels.^[6]

 

MY STORY:

 

At only six months of age I was diagnosed with polio and managed to live a productive life but having such a hard time going on with my full time job due to severe fatigue and muscular exhaustion, I’m trying now to go on with a productive life even though I have a Post-Polio Syndrome condition. So I decided to fulfill this task of making a Post-Polio Awareness a public issue making people aware of its difficulties in the everyday lives of the ones that suffer of this syndrome.

 

 

 

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