Post-Polio Syndrome or Sequelae (PPS) is a condition that can strike polio survivors anywhere from 10 to 40 years after recovery from an initial attack of polio. PPS is characterized by a further weakening of the muscles that were previously injured by polio. PPS is usually a very slow progressing condition and often occurs after a physical or emotional trauma, illness or accident.
Polio, also known as poliomyelitis or infantile paralysis, is caused by three viruses that enter the mouth, grow in the intestines and pass along the nerves into the brain and then the spinal column causing the nerves to stop working normally. The loss of mobility caused by the damaged nerve(s) is called paralysis and can affect the muscles in the arms, legs, chest, diaphragm and throat.
Polio was eradicated in the 1950s with the introduction of the polio vaccine developed by Jonas Salk. Mandatory immunization for polio is recommended at 2 months of age, 4 months of age, 6 to 18 months age, and 4 to 6 years of age.
It is estimated that between 40 and 80 percent of polio survivors will get PPS after 20 to 40 years of initial onset of polio.
To date, doctors are not certain what causes PPS but researchers hypothesize that it may be one of the three possibilities.
The first possibility is that the polio virus becomes active again after decades of lying dormant in the victim's cells. What activates it is still uncertain and is under investigation. British scientists have found polio-type antibodies in the spinal fluid of recently diagnosed PPS sufferers.
The second possibility is the evidence of impairment in the production of various hormones and neurotransmitters in brain.
Lastly, and the most promising theory of PPS, is the nerve cells (neurons) that were undamaged or partly damaged took over the functions of the dead cells. These nerve cells not only had to do their job, but the job of the damaged cells. Over time, these overworked cells began to show "wear and tear," thus the re-emergence of polio-like symptoms.
The symptoms of PPS mimic those of the original disease, polio, and can occur in previously affected muscles and/or in what were previously thought to be muscles that were not affected at onset. The symptoms may include:
- Muscle weakness
- Muscle atrophy (stiffening)
- Painful joints and muscles
- Low back pain
- Sensitivity to cold and heat
- Sleep disorders
- Difficult breathing and/or swallowing
- Muscle twitching
The extent to which polio survivors will suffer from PPS depends on how seriously they were affected by the first polio attack. Patients who had mild symptoms of polio will have mild symptoms of PPS. However, post-polio survivors who had hospital care, or were older than 10, or had paralysis in all four limbs, or needed mechanical assistance to breathe will have a more severe case of PPS.
Diagnosis of PPS is made after observing the patient, asking about the symptoms and reviewing their medical records for previous polio infection. If needed, an electromyographic study (EMG) will be done to determine which extremities have evidence of old polio. EMG is a test in which electrical activity in muscle in analyzed.
To relieve the pain of PPS, doctors may recommend nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin IB or Nuprin), and heat applications on the affected areas. Otherwise, the treatment therapy for PPS is to "take it easy." Things to do that may help the PPS sufferer cope with this condition are as follows:
- Take time to nap
- If the person is experiencing increasing muscle weakness, exercise may be needed. Please consult your doctor.
- Eat a well-balanced diet
- Be alert to the changes in the body
- Take note of any new symptoms or any clear or gradual changes
- Pace yourself
- Use medical equipment such as canes or crutches or other adaptive medical equipment to ensure that you do not fall
- Avoid weight gain
- Minimize alcohol use
- Take common colds very seriously
- Get regular checkups with emphasis on the major areas affected by the polio: neuromuscular, circulatory and respiratory, as well as, muscle strength evaluations
- Discontinue any exercise that causes pain, weakness or muscle fatigue
- Know your own strengths and limits
- Get involved or continue with physical therapy
- Consider possible adaptations to your lifestyle
Is the pain, fatigue, and muscle weakness due to the original polio?
Should the muscles be rested or exercised?
What exercises are recommended to strengthen the muscles?
What changes in lifestyle are called for?
Can muscle be added surgically?
What assistive devices can be used?
Will the problem get worse?