Post-polio syndrome

Tarakad S Ramachandran MD (Dr. Ramachandran of SUNY Upstate Medical University has no relevant financial relationships to disclose.)
Arun Ramachandran MD (Dr. Ramachandran of the State University of New York at Syracuse has no relevant financial relationships to disclose.)
John E Greenlee MD, editor. (Dr. Greenlee of the University of Utah School of Medicine received an honorarium from Merck for authorship.)
Originally released September 9, 2003; last updated May 1, 2016; expires May 1, 2019

This article includes discussion of post-polio syndrome, postpolio syndrome, late effects of poliomyelitis, and PPS. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

In post-polio syndrome, symptoms occur several decades after recovery, after a long latent period. Use of pharmacological agents in post-polio syndrome has, thus far, been disappointing. It is hoped that support from the polio clinic may result in self-selected lifestyle changes, which may positively influence the development of symptoms and functional capacity. Patient education, health promotion, and energy conservation strategies that include walking with a properly fitting assistive device reduce perceived fatigue and improve posture and function in an individual with post-polio syndrome. Future randomized trials should also address the long-term effects of muscular training in post-polio syndrome, in addition to treatment of pain in these patients. Randomized control studies have shown that intravenous immunoglobulin is effective in reducing pain in complex regional pain syndrome (low-dose intravenous immunoglobulin) and post-polio syndrome (high-dose intravenous immunoglobulin). Open trials have also shown efficacy in additional pain conditions. However, questions still linger around the optimal treatment doses, duration of treatment, and its effect on function and quality of life.

Key points

 

• 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.

 

• Intravenous immunoglobulin (IVIG) therapy holds some promise in improving the quality life as well as in decreasing bodily pain. IVIG has further been shown to dampen the inflammatory markers up to 1 year in post-polio syndrome (PPS).

Historical note and terminology

Poliomyelitis epidemics in the United States 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 (Paul 1971; Centers for Disease Control 1981). Even though poliomyelitis has basically been eliminated, many patients from those epidemics were left with severe sequelae and disabilities. These patients became over-achievers by working hard both physically and emotionally to overcome their disabilities (Wiechers 1985). 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 1980s (Alter et al 1982; Halstead and Wiechers 1985). In 1875 late weakness occurring years after poliomyelitis was noted by Charcot and other clinicians (Carriere 1875; Cornil and Lepine 1875; Raymond 1875). Between 1875 and 1975 only about 200 cases of post-polio syndrome were described in publications (Jubelt and Cashman 1987). However, since 1975 thousands of cases have been reported (Halstead et al 1985; Jubelt and Cashman 1987; Wekre et al 1998; Jubelt and Drucker 1999; Kumakura et al 2002).

Energized by hope and optimism, the mid 1980s and early 1990s saw a surge of support groups (maximum of 298 in 1990) and clinics (96 in 1990), followed by a steady decline in 2010 (131 support groups and 32 clinics) as the limits of research as well as clinical and self-help initiatives became obvious. Also, 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 (Halstead 2011).

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