Post-Polio Syndrome: Causes, Symptoms, Treatment, Prognosis

Post-Polio Syndrome is a collection of severely disabling symptoms that occur in individuals who have had a polio attack in their earlier stages of life. Post-Polio Syndrome usually strikes about 30 to 40 years after the initial attack of polio. These days with the advent of polio vaccinations there are very rare cases of polio but people who have had polio before the introduction of these vaccines are at risk for developing Post-Polio Syndrome.

Post-Polio Syndrome is believed to be caused due to degeneration in the nerve cells which were damaged during the initial attack of polio. The symptoms of this condition may range from progressive muscle weakness to muscle atrophy and generalized fatigue. There is no permanent cure for Post-Polio Syndrome but treatment is mainly aimed at controlling the symptoms and making the patient as comfortable and independent as possible.

There is no clear cut cause for Post-Polio Syndrome but it is believed to occur because of degeneration of nerve cells which may have been damaged during the initial polio attack. As of now, the most accepted cause for Post-Polio Syndrome is this only. This theory is explained as when the polio virus affects the body, it tends to damage the motor neurons of the spinal cord.

These motor neurons are responsible for carrying messages between the brain and various muscles of the body. Due to the polio virus, these neurons get damaged or destroyed. To compensate for the severe shortage of neurons to carry out instructions the neurons that are remaining start to produce new nerve fibers and thus the motor units become enlarged. This may lead to recovery of the muscle functioning but with time as the pressure on these neurons increase there comes a stage where the neurons are not able to handle the sustained pressure or stress put on it by the new nerve fibers which results in degeneration of the neurons resulting in symptoms of muscle fatigue and weakness and that is what we call as Post-Polio Syndrome.

Some of the symptoms of Post-Polio Syndrome are:

• Progressive muscle and joint weakness along with pain
• Generalized fatigue
• Exhaustion with minimal physical activity
• Muscle atrophy
• Breathing difficulties
• Dysphagia
• Sleep apnea
• Intolerance to cooler temperatures.

To confirm a diagnosis of Post-Polio Syndrome, doctor look for three factors which are:

Detailed History of Polio: A detailed history of the patient is required in which it should be clearly mentioned that the patient has a history of a polio attack previously. This will give the doctor a sign that the symptoms experienced by the patient may be a sign of Post-Polio Syndrome.

Time Interval for Recovery after Initial Attack: The second factor for diagnosing Post-Polio Syndrome is the time interval that was required by the patient to recover from the initial attack. Usually, people who recover from an initial attack of polio lead a normal life without further symptoms for many years and if the symptoms start to recur this definitively points towards a Post-Polio Syndrome.

Gradual Onset of Symptoms: The third and the most important factor that the doctor looks for is the onset of symptoms. If the onset of symptoms have been gradual and over a period of time then along with the above factors gives clinching evidence that the patient is suffering from Post-Polio Syndrome.

The doctor will conduct other tests as well to rule out other conditions which may cause similar symptoms like arthritis, fibromyalgia or chronic fatigue syndrome.

Additional studies in the form of MRI, CT, EMG, nerve conduction studies and a muscle biopsy to rule out other conditions causing similar symptoms to that of Post-Polio Syndrome.

As the symptoms of Post-Polio Syndrome are so variable there is no one specific treatment for this condition. The treatment is aimed at controlling the symptoms and the making the patient as comfortable and as independent as possible. Some of the treatment methods used for treating Post-Polio Syndrome are:

Conservation of Energy: Since patients with Post-Polio Syndrome get exhausted very easily, hence it is very imperative that they conserve as much energy as possible. For this, it is very important for them to take frequent breaks when doing a physical activity to get back the strength. The patient also needs to avoid prolonged ambulation and if required may use assistive devices like a cane or a walker or even a wheelchair to conserve as much energy as possible which can be used for other tasks. A visit to a therapist can give the patient different ways to conserve energy in various forms.

Physical Therapy: This is the most important aspect of treating Post-Polio Syndrome. The therapist will recommend exercises which will enable the patient to strengthen the muscles without any muscle fatigue. Some of the exercises that may be prescribed are swimming or water aerobics. It is important for the patient with Post-Polio Syndrome to maintain an adequate level of fitness. The therapist may also recommend certain exercises to keep the patient fit without over exerting and without causing excessive strain on muscles.

Occupational Therapy: This is also an important aspect for treating Post-Polio Syndrome. An occupational therapist may recommend certain changes to be made to the home environment which may make it convenient for the patient to reach for objects without having to exert much. This may include installing grab bars and railings and other objects which may make it easier for the patient to do his or her household chores without any problem.

Speech Therapy: This is important for a patient with Post-Polio Syndrome to control and cope up with dysphagia caused by Post-Polio Syndrome.

Medications: Pain medications may be given to control muscle and joint pains caused by Post-Polio Syndrome.

The prognosis of Post-Polio Syndrome depends on the extent of the symptoms experienced and how much damage has been caused by the original attack of polio to the patient and the level of disability the patient has due to the initial polio attack as well as Post-Polio Syndrome. Patients who have had mild damage from initial polio attack are not much affected by Post-Polio Syndrome. People who are severely affected by the initial polio attack may experience more symptoms of Post-Polio Syndrome.