What are the other Names for this Condition? (Also known as/Synonyms)

• Post-Polio Muscular Atrophy
• Post-Poliomyelitis Muscular Atrophy
• Post-Poliomyelitis Syndrome

What is Post-Polio Syndrome? (Definition/Background Information)

• Poliomyelitis (Polio) is an acute, infectious disease caused by poliovirus that affects the nervous system. It is highly contagious and causes paralysis, breathing difficulties, even death, if suitable and timely treatment is not administered
• Some individuals are disabled by a set of signs and symptoms that onset many decades (10-40 years) after they have been affected by Polio. This is known as Post-Polio Syndrome (PPS)
• PPS, unlike Polio, is not caused by a virus. On the other hand, it is thought to occur as a result of slow, but progressive degeneration of nerve nodes and the brain, that followed an initial incidence of Polio

Who gets Post-Polio Syndrome? (Age and Sex Distribution)

• Post-Polio Syndrome exclusively affects those individuals, who previously suffered from Polio. Statistically, between 25-40% are said to suffer from some forms of PPS (mild to severe)
• The age at PPS incidence is usually between 30-60 years, and females are more at risk than males

What are the Risk Factors for Post-Polio Syndrome? (Predisposing Factors)

Only individuals who survived an earlier Polio attack are at risk. Those, who were afflicted by mild Polio may suffer milder forms of Post-Polio Syndrome, or may not be affected at all.

• Individuals in whom the Polio attack was severe are more vulnerable to PPS, and may suffer a greater magnitude of the illness
• Individuals who exercise regularly, and those who are highly physically-active over many years, are also at risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Post-Polio Syndrome? (Etiology)

• The exact cause of Post-Polio Syndrome, and why it develops after so many years or decades, is unknown
• It is researched that during Polio, the nervous system and brain undergoes some amount of irreversible injury, by the poliovirus
• As the body tries to cope with the (mildly or severely) damaged nervous system, it places additional stress on certain nerve cells (neurons). It is thought that a prolonged overburdening of the neurons, causes them to gradually deteriorate and lead to PPS manifestation

What are the Signs and Symptoms of Post-Polio Syndrome?

According to the United States National Institute of Neurological Disorders and Stroke (NINDS), there must be around a 15-year period of normal functioning of the muscular and nervous system, and the Post-Polio Syndrome signs and symptoms must persist for minimum period of one year, to confirm diagnosis. The indications of PPS include:

• Early exhaustion and fatigue after normal, simple physical activities
• Muscular weakness, joint pain, atrophy; a progressive worsening is observed
• Difficulty swallowing and breathing (even while sleeping)
• Intolerance to cold conditions
• The symptoms may appear suddenly, or may follow a period of inactivity, or follow an event, like a surgery/trauma. There may not be any suitable explanation for the random occurrences

How is Post-Polio Syndrome Diagnosed?

In order to diagnose Post-Polio Syndrome, the individual must be a Poliomyelitis survivor, and there must be a large interval period after recovery from the disease. The diagnostic tools include:

• Physical exam with evaluation of medical history
• The earlier history of Polio paralytic illness is evaluated to assess current neuromuscular status. Weakness, atrophy of muscles, and fatigue, maybe noted
• Decline of neuromuscular functions are determined using MRI scans, biopsy of muscle sample, neuroimaging studies

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Post-Polio Syndrome?

• Even though a rare occurrence, the decline of muscle strength may cause severe respiratory failure or impairment, and may lead to life-threatening situations with Post-Polio Syndrome
• Weakened muscles and an advancing age, may limit physical function. As a consequence, individuals are prone to falls, resulting in broken bones
• Other complications include: Pneumonia, osteoporosis, malnutrition and dehydration (due to swallowing difficulties)

How is Post-Polio Syndrome Treated?

There is no cure for Post-Polio Syndrome. Supportive care and treatment is provided to control the symptoms, prevent complications, soothe the patient’s condition, and help carry out one’s daily (physical) activities, as independently as possible.

• Individuals with PPS (and their relatives, who would help or care for them) are trained on techniques for safe movement, proper positioning, energy conservation, and on how to be careful, while performing regular physical activities. Frequent periods of rest between activities, to reduce fatigue is suggested
• Home and work environment can be suitably modified to make it a lot more safer and convenient for performing regular activities; this includes safety features normally designed for the physically challenged or the elderly, furniture rearrangement, and use of ramps
• Wheelchairs, splints, crutches, walkers, braces, are used to provide physical support and promote mobility
• Avoid obesity, control diet to reduce weight, and stop smoking to protect your lungs
• Physiotherapy, low impact exercising (like swimming, using light weights) to strengthen muscles and improve movement, have proven to be beneficial. These may be coordinated and planned by a therapist
• Other treatment measures include symptomatic management of conditions, such as swallowing difficulties (a speech therapist can assist), disturbed sleeping due to breathing problems (sleep on the sides, change sleep time or pattern, use breathing devices)
• Use of pain relievers (aspirin, tylenol, ibuprofen), for muscular aches and joint pain

How can Post-Polio Syndrome be Prevented?

• There is a 25-40% chance that an individual with Poliomyelitis might be afflicted by Post-Polio Syndrome. Currently, there are no known preventive measures for PPS
• Those who have suffered from Polio should be made aware of PPS and asked to follow certain basic guidelines in their life to keep their risks low, such as eating healthy, being physically active (in a controlled manner), having regular medical checkups with complete medical history evaluation, and maintaining a healthy lifestyle

What is the Prognosis of Post-Polio Syndrome? (Outcomes/Resolutions)

• This depends primarily on the initial type of Poliomyelitis condition (paralytic, non-paralytic) and the body part affected. Individuals with mild form of Polio suffer from mild PPS, those with severe forms are prone to have it to a greater intensity
• With treatment, therapy, and modifications to work and lifestyle, the condition can be managed to a great extent
• Fatalities are rare, and occur only if respiratory problems are acute

Additional and Relevant Useful Information for Post-Polio Syndrome:

• The poliovirus has no role to play in Post-Polio Syndrome, it is understood to be a purely neuromuscular phenomenon
• The late effect of Polio is called Post-Polio Sequelae, and is different from a Post-Polio Syndrome