5/16/2010

“Post Polio Syndrome – Management and Treatment in Primary Care”


Post Polio Syndrome – Management and Treatment in Primary Care



The Post Polio Support Group in Ireland has published a book entitled “Post Polio Syndrome – Management and Treatment in Primary Care”. Written by medical professionals, including a doctor, physiotherapist, occupational therapist and speech therapist it allows polio Survivors to discover more about their condition, diagnosis and treatment. Although only published in English it is free to download and reproduce with due acknowledgement being given. To discover more go to http://www.ppsg.ie/publications_postpolio.html

P O L I O – STRIKING A SECOND TIME IN LIFE ?

The article (Polio - Striking a Second Time in Life?), reproduced by kind permission of Dr. Peter Brauer, is given in EnglishFrench (Français), Dutch & German (Deutsch)

By Dr. Peter Brauer
When the World Health Organisation (WHO) declared Europe as free of polio on the 21st June 2002, this was, no doubt, the most welcome result of a successful world-wide vaccination campaign to eradicate a disease that had been nearly forgotten. Except for the victims and a handful of medical doctors hardly anybody remembers anything about it. Therefore it comes as a huge surprise when tens of years later patients with a polio history suddenly face new problems very similar or / and different to those experienced in the acute stage of the polio infection , these new symptoms leading inevitably to a progressive deterioration of their already more or less affected state of health. In spite of intensive medical efforts the cause of this cannot be found. Attempts at treatments fail most of the time or even speed up the deterioration. A really truly horror scenario starts for the affected people in trying to find medical help .

For more than twenty years, very gradually, one has come to recognise that polio in its convalescence stage represents an inherent invisible “trap”. The affected and reduced nerve/muscle system is “repaired” to a degree where sufficient training enables it to function and move relatively normally with fewer nerves and muscles. Due to this reduced number they must, even under normal circumstances, work up to 10 times as hard, functioning for years and tens of years at their very limit. Then, eventually, regeneration and recovery abilities fail – pain, exhaustion, fatigue are warning signals, dying of nerves and muscles being the final stage. Important regulatory functions of the brain are affected , such as e.g. breathing.

In this way polio comes back a second time in the form of its own pattern of disease which with its many symptoms can be summarised as “ post-polio syndrome”, abbreviated PPS. The beginning of PPS goes unnoticed until a more serious level of problems occurs , which varies from case to case. As long as this is not recognised nor considered by either the patient or the doctor there is no way of providing any help. If after a number of physical examinations and laboratory tests no other disease can be found many doctors diagnose the patient as having a psychosomatic or imaginary disease and fail to provide the urgently needed treatment. PPS can be treated to a certain point but cannot be healed. If the effects of the old polio infection is not taken into account as being the cause of the problems and therefore the new symptoms misjudged it is inevitable that the wrong treatment leads to disastrous results. Unfortunately a lot of people do not know that they lived through a polio infection because it passed asymptomatic, e.g. flu-like symptoms. Even these people can get PPS, a fact which a lot of medical professionals are quite unaware of.

Doctors need to know about PPS in order to be able to help. But not only does this apply to doctors specialising in different areas of medicine, but also to physiotherapists, rehabilitation centres, to the medical and orthopaedic technology, to people providing health certificates, and last not least to the national health system, insurance companies, pension, health and social security systems.

At present the estimated figure of people suffering from the postpolio syndrome is estimated at 1 Mio people in Europe – the unknown figure is supposed to be much higher. Unfortunately there rarely is a conscious cooperation or networking between all the above areas of health care down to the non-medical staff, and they are therefore not to blame for ignorance. Here the patient is called upon to provide information. In his own interest he should inform himself about his own symptoms and to pass on medical information to his doctor etc. The European Polio Union and their national organisations as well as all their associated self-help and support groups (addresses and links can be found on www.europeanpolio.eu)  will help the patient to the best of their abilities.

ATTENTION: Do not forget immunisation !! Global travelling and migration will necessitate protection by vaccination more than ever, POLIO STILL EXISTS !!!
Author of this article :
Dr. med. Peter Brauer is the scientific adviser to the Polio Group of the Schleswig-Holstein Self-Help Group e.V. and member of the Medical Scientific Advisory Board to the Bundesverband Poliomyelitis e.V. Germany www.polio.sh
We thanks Dr. Peter Brawer for letting us publish and for his support to our organization Post Polio Litaff, Association A.C _APPLAC
          CODIGO G "14" 

El pasado mes de febrero de 2009 y como resultado de la reunión anual del Comité de Revisión y Actualización de la Organización Mundial de la Salud, (OMS)  que tuvo lugar en Delhi, durante el mes de octubre de 2008, la Clasificación Internacional de Enfermedades, en su versión 10 (ICD-10) ha adjudicado un lugar específico al Síndrome Post-Polio (SPP) clasificándolo bajo el código "G14" y excluyéndolo del código B91  (Secuelas de poliomielitis), en el que antes ese organismo lo consideraba abarcado. Más informes www.postpoliolitaff.org

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno

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A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

Figure 1

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1
What is that nature of the acute illness in infancy?
2
What is the nature of the subsequent deterioration?
3
What investigations should be performed?
4
What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Figure 2

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

Causes of calf muscle hypertrophy

Chronic partial denervation

  • radiculopathy

  • peripheral neuropathy

  • hereditary motor and sensory neuropathy

  • spinal muscular atrophy

  • following paralytic poliomyelitis

    Neuromyotonia and myokymia

  • Isaac's syndrome

  • generalised myokymia

  • neurotonia

  • continuous muscle fibre activity due to: chronic inflammatory demyelinating polyradiculopathy, Guillain Barre syndrome, myasthenia gravis, thymoma, thyrotoxicosis, thyroiditis

    Muscular dystrophies

    Myositis

    Infiltration

  • tumours

  • amyloidosis

  • cysticercosis

    Link here