Post polio is a symptom complex following childhood polio (Heine-Medina) disease. It affects most people who have had a history of severe polio, as well as severe paralytic polio. How does post polio syndrome manifest itself and what is the treatment of people suffering from it?

Post polio syndrome(Englishpost-polio syndrome , PPS) affects people who have had polio disease, or Heine -Medina, acute widespread childhood paralysis or spinal palsy.

It is observed in as many as 15-80% of patients with a history of polio, and the probability of developing the disease is the higher the more severe the form of the primary disease. The first symptoms may appear on average 35 (15-70) years after infection with thepoliomyelitisvirus, usually as a result of an apparently harmless accident - e.g. a fall, prolonged bed rest, surgery. According to WHO, the post-polio syndrome affects approximately 20 million people worldwide.

Polio is a viral disease, infection with a viruspoliomyelitis , the history of which dates back to antiquity - already in Egyptian paintings adult people with flaccid limbs and children walking with a cane are depicted. The oldest traces of this disease - deformed leg bones - have been found by archaeologists in the Egyptian pyramids dating back 5700 years.

Acute widespread palsy, as the full name sounds, mainly affects the motor cells of the anterior horns of the spinal cord in the cervical and lumbar regions. It primarily attacks small children. It manifests as asymmetric paresis or flaccid paralysis of skeletal muscles. Polio was first described in detail by the German physician Jakob Heine (1840) and the Swede Karl Oskar Medin (1890).

The last mass epidemic of Heine-Medina disease took place in the 1950s. The slowdown in its spread only resulted in the introduction of vaccinations.

The last case of polio diagnosed in Poland was recorded by doctors in 1984, and in the United States in 1979. In 1994, the WHO recognized America as free from this disease, and in 2001, Europe. In 2015, the elimination of polio was announced worldwide, but compulsory vaccination is still used in many countries just in case.

Symptoms of post polio

Years after developing polio and then stabilizingnew symptoms of peripheral motor neuron damage appear:

  • progressive muscle weakness - not only those previously infected by the virus, but also others
  • worsening of paresis which remained stable for years
  • muscle and joint pain
  • muscle wasting
  • breathing disorders
  • swallowing disorders
  • overwhelming fatigue
  • decline in physical performance
  • reduced tolerance to pain and cold
  • sleep disturbance
  • increased drug sensitivity, abnormal drug response
  • cognitive impairment
  • sometimes depression, dysthymia

Reasons for the development of post polio

Until now, scientists have not been able to say with certainty why post-polio occurs. There are several hypotheses about this, such as reactivation of the viruspoliomyelitis , which has been dormant for years, or the autoimmune theory. But the most likely cause of PPS is decades of overstrain in the neuromuscular system.

In polio, nearly all motor neurons in the brainstem are damaged, and about 50% are completely destroyed.

When the disease is healed, the patient's condition stabilizes, and the remaining neurons grow a bit and take extra work to activate the muscles without their own neurons.

Over time, they are so overloaded that they start to fail, and the person feels fatigue, respiratory problems and others.

Post polio diagnosis

Doctors often fail to correctly recognize post polio, which is due to the fact that there are no specific diagnostic tests to make a clear diagnosis.

Post polio syndrome is diagnosed by excluding other diseases with similar symptoms (mainly respiratory disorders and muscle spasms interfering with sleep), hypothyroidism, anemia.

Physicians should pay special attention to the fact that the symptom of overwhelming, chronic fatigue is characteristic of many different diseases, such as Parkinson's disease, heart disease, kidney disease, depression.

PPS can be confused with Multiple Sclerosis or Amyotrophic Lateral Sclerosis. It seems crucial to conduct a detailed interview in a doctor's office, because the knowledge of childhood polio explains a lot.

Treatment of post polio syndrome

In PPS, unfortunately, there is no cure, in fact, post polio is not a disease at all,only a consequence of a disease that was once a history. Therefore, treatment in this case is only symptomatic, and is mainly based on physical rehabilitation, changing the lifestyle and education of the patient and his relatives.

Patients with PPS should be under the care of a specialized team consisting of doctors of various speci alties, rehabilitators and psychologists. Treatment of a person affected by post polio syndrome should be based on:

  • providing the patient with all orthopedic devices that may facilitate his movement, incl. crutches, canes, orthoses
  • moderate movement to let you relax, e.g. dancing
  • weight reduction to relieve the muscles and joints. People suffering from PPS should take particular care of their diet, and to take care of weakened muscles, eat high-protein breakfasts and often eat high-protein and low-fat snacks during the day.
  • limiting physical activity, avoiding activities that require effort
  • relieving the muscles - frequent rest in a lying position
  • using painkillers carefully, especially when it comes to opioids, and benzodiazepine hypnotics, as they relax the muscles excessively
  • quitting smoking and breathing exercises - this is to allow your lungs to be properly ventilated
  • avoiding alcohol
  • sleeping at least 7 hours a day
  • psychotherapy

PPS is not life threatening. It is worth emphasizing, however, that people suffering from post polio syndrome are very sensitive to anesthetics, both intravenous and inhaled, and to sedatives, so they should be administered lower doses of these agents.

People with PPS may have difficulty waking up from anesthesia, as well as breathing and swallowing, even under local dental anesthesia.NOTE PPS patients often struggle with pain. But because painkillers can cause adverse reactions in them, the question of how to use them should always be discussed with a doctor, preferably a pain clinic.

Category:

Infectious diseases