Post-polio syndrome (PPS): Symptoms, causes, and treatments
Some people who have polio at a young age may have a certain effect in later years, post-polio syndrome. The exact cause of the post-polio syndrome is unknown.
Post-polio syndrome (PPS) is a condition that some people who were paralyzed at a young age may experience years later.
Polio was once one of the most feared diseases in America, responsible for paralysis and death. Shortly after polio peaked in the early 1950s, inactivated polio vaccines were introduced and significantly reduced the spread of polio. Currently, very few people in developing countries have polio, thanks to the polio vaccine.
But some people who have polio at a young age may have a certain effect in later years, post-polio syndrome. The exact cause of the post-polio syndrome is unknown.
Treatment focuses on managing the signs and symptoms of post-polio syndrome and improving quality of life.
The post-polio syndrome refers to a group of signs and symptoms that appear - on average 30 to 40 years after the illness begins. Common signs and symptoms include:
Progressive muscle and joint pain.
Fatigue and exhaustion with minimal activities.
Difficulty breathing or swallowing.
Breathing-related sleep disorders, such as sleep apnea.
Reduced tolerance to cold temperatures.
In most people, post-polio syndrome tends to progress slowly, with new signs and symptoms followed by a period of stabilization.
If weakness or fatigue seems to be slowly getting worse, see your doctor. It is important to rule out other causes of signs and symptoms that may require treatment other than those currently present with post-polio syndrome.
No one knows exactly what causes the signs and symptoms of post-polio syndrome that appear many years after first contracting polio. Currently, the most accepted theory of the etiology of post-polio syndrome is based on the idea of neuronal degeneration.
When poliovirus infects the body, it affects nerve cells called motor neurons - especially in the spinal cord - that carry messages (electrical impulses) between the brain and muscles.
Neurons consist of three basic components:
Large branch (axon).
Many small branches (dendrites).
Polio often destroys or damages many motor neurons. To compensate for the neuronal deficit, new fibers grow from the remaining neurons, and the surviving units become hypertrophic. This promotes recovery using the muscles, but there is increased stress on the nerve cells to nourish the additional fibers. These stresses can be more than the nerve cells can handle, leading to a gradual deterioration of additional fibers and eventually the neurons themselves.
Another theory is that the original disease may have triggered an autoimmune response, causing the body's immune system to attack normal cells as if they were foreign substances. Some experts believe that the poliovirus can stay in the body and reactivate years later.
Factors that may increase your risk of developing post-polio syndrome include:
The severity of the initial polio infection. The more severe the initial infection is, the more likely there will be signs and symptoms of post-polio syndrome.
Age of onset of the primary disease. If polio was present as an adolescent or an adult, other than a child, the risk of developing post-polio syndrome increases.
Rehabilitate. With poor recovery from acute polio, it seems more likely that post-polio syndrome will develop. This may be due to stress on additional motor neuron repair sites.
Physical activity. If you regularly perform physical activities to the point of exhaustion or fatigue, overwork may activate motor neurons and increase the risk of post-polio syndrome.
In general, post-polio syndrome is rarely life-threatening, but severe muscle weakness can lead to complications:
Fall. Weakness in the leg muscles makes it easier to lose balance and fall. Falls can lead to broken bones, such as hip fractures, leading to other complications.
Malnutrition, dehydration, pneumonia. People who have had bulbar palsy, which affects nerves leading to muscles involved in chewing and swallowing, often have difficulty with these activities as well as other signs of post-polio syndrome. Chewing and swallowing problems can lead to inadequate nutrition and dehydration, as well as pneumonia from the aspiration of food into the lungs.
Acute respiratory failure. Weakness of the diaphragm and chest muscles makes it difficult to breathe deeply and cough, which can eventually lead to a build-up of fluid and mucus in the lungs. Obesity, the curvature of the spine, prolonged immobilization, and certain medications can impair breathing, which can lead to acute respiratory failure. This is characterized by a sharp drop in blood oxygen and may require respiratory support.
Osteoporosis. Prolonged inactivity and movement are often associated with loss of bone density and osteoporosis in both men and women. If you have post-polio syndrome, you may be screened for osteoporosis.
Testing and diagnosis
To arrive at a diagnosis of post-polio syndrome, doctors look for three indicators:
Prior diagnosis of polio. This may require finding old medical records or getting information from a family member, as acute polio mostly occurs during childhood. The terminal effects of the disease usually occur in people who are adults or older in the initial illness and have severe symptoms.
Approximately after a long recovery. People who recover from primary polio often live for years without signs or symptoms. The onset of the effect later in life varies widely, but usually begins at least 15 years after the initial diagnosis.
Start slowly. Weakness is usually not noticeable until it interferes with daily functioning.
Also, because the signs and symptoms of the post-polio syndrome are similar to those of other disorders, your doctor will try to rule out other possible causes, such as arthritis, muscle pain, chronic fatigue, and scoliosis.
Some people who worry about post-polio syndrome may have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease. However, post-polio effects are not a form of ALS.
Your doctor may use several tests to rule out another diagnosis, including:
Electromyography (EMG) and nerve conduction studies. Electromechanical measures measure the electricity produced from within the muscle. The electrode needle is inserted. An instrument that records electrical activity while the muscle is at rest and during activity. A variant of the neuromuscular study, two electrodes are recorded on the skin above the study nerve. Small shocks are passed through the nerve to measure the speed of the nerve signal. These tests help identify and rule out conditions such as neuropathic pain, an abnormal condition of the nerves, and disease of muscle and muscle tissue.
Image. You may undergo testing, such as magnetic resonance imaging (MRI) or computed tomography (CT), to create images of the brain and spinal cord. These tests can help rule out spinal nerve disorders, such as spondylolisthesis or spinal stenosis, a narrowing of the spine that puts pressure on nerves.
Blood tests. People with the post-polio syndrome often have normal blood samples. Abnormal blood test results may indicate an underlying problem causing symptoms.
Treatments and drugs
Because signs and symptoms are often variable, there is no specific treatment for post-polio syndrome. The goal of treatment is to manage symptoms and help make the body as comfortable and independent as possible:
Energy conservation. This involves cadence of physical activity and combining it with regular rest periods to reduce fatigue. Assistive devices, such as wheelchairs, walkers, or motor vehicles, can also help save energy. Even guided breathing therapy can help conserve energy.
Physical therapy. Therapists may prescribe muscle-strengthening exercises or exercises without the need for fatigue. There are usually less stressful activities, like swimming every day at a relaxed pace. Exercise to maintain fitness is important, but exercise caution in regular and daily exercise activities. Avoid overuse of muscles and joints and try to exercise beyond the point of pain or fatigue. If not, take a break to regain strength.
Occupational therapy. Physical therapy or occupational therapy can help change the home environment for safety and convenience. Therapy can also help rearrange furniture or rethink household or task-related chores, reducing the number of steps that must be taken and increasing efficiency.
Language treatment. A speech therapist can show you how to compensate for difficulty speaking and swallowing.
Sleep apnea. Treatment of depression
Lifestyle and remedies
Having to deal with an illness can be frustrating, even overwhelming. Recovery from initial illnesses takes determination, but the end effects of polio require rest and conserving energy. Migration can be a difficult transition. Here are some suggestions that may help:
Limit activities that cause pain or fatigue. Moderation is key. Excessive activity on one day can lead to some bad things for the next.
Smart living. Conserving energy through lifestyle changes and assistive devices does not mean bringing on the disease. It just means found a smarter way to deal with it.
Keep warm. Cold muscles will increase fatigue. Keep your home at a comfortable temperature and dress well, especially when going out.
Avoid falling. Eliminate carpet and floor clutter, wear good shoes and avoid slippery or cold surfaces.
Maintain a healthy lifestyle. Eat a balanced diet, stop smoking and reduce your coffee intake to stay fit, breathe easier and sleep better.
Lung protection. If breathing is impaired, watch for signs of a respiratory infection to develop, which can make breathing problems worse, and get treatment promptly. Also, avoid smoking and get flu and pneumonia vaccines.
Coping and supporting
Coping with post-polio syndrome fatigue can be physically and psychologically difficult. You may need to rely on friends and family for support. In most cases, ways to help can be found and can be helped by telling them how.
Maybe even consider joining a support group for people with post-polio syndrome. Sometimes, just saying the above to people with similar problems allows you to better cope with challenges.