6/10/2010

Expert delivers answers for those inflicted with polio

   Rebuilding Lives, Empowering People and Preventing Injuries

An internationally known Post Polio Syndrome expert from the US will give a much-needed insight into the illness during Post Polio Awareness Week (3-9 August).
Dr William DeMayo, Medical Director of the comprehensive Post Polio Clinic at the John P Murtha Neuroscience and Pain Institute in Philadelphia, will share his vast knowledge about Post Polio Syndrome, including its symptoms, side effects and pain management techniques, via a video conference at the Spinal Injuries Association’s Woolloongabba office next Wednesday (5 August).
His talk will centre on the theme, Comprehensive Post Polio Assessment Clinics – do we really need them?
“As Post Polio Syndrome becomes more recognised in both medical circles and in the general community, an increasing amount of people worldwide are being diagnosed with the condition,” Dr DeMayo said.
“I’m looking forward to sharing what I know about the syndrome with a Queensland audience, as I’m aware there are six Post Polio Support Groups operating in regions throughout the state.
“By providing the audience with practical information about the condition, I hope to make a difference in their lives that will assist in easing the disability and pain of Post Polio Syndrome.”
Like most five-year-olds, Varsity Lakes resident Lyn Glover was full of energy, but when she was struck with polio in 1958, she spent a month of solitude while quarantined in hospital recovering from the insidious illness.
Polio did not really feature in Lyn’s life again for many years, until she broke her foot in 2006 and began experiencing the late effects of polio.
To highlight Post Polio Awareness Week (3-9 August), Lyn explains that polio is a viral disease that attacks the spinal cord and causes permanent or temporary paralysis.
“The nerves that were killed or damaged at the time of the initial virus attack when I was young were replaced by the development of compensatory nerves, which resulted in partial recovery,” she said.
“What is now believed to be happening is that those compensatory nerves are dying as the result of over use of muscles and joints and a return for many elderly people with polio to the wheelchairs, calipers and walking canes that many had long discarded.
“Many post polio sufferers are now experiencing considerable pain as the result of this reversal. The condition is called Post Polio Syndrome or known as experiencing the late effects of polio.”
Symptoms are varied but include muscle weakness, extreme fatigue, sleep and breathing difficulties.
The Gold Coast Post Polio Support Group formed in 2007 and Lyn is convenor of the group, which meets monthly to discuss issues ranging from healthcare advice to accessibility issues in the community.
Spinal Injuries Association CEO Mark Henley said it was a real coup for the organization to host the live video conference with Dr DeMayo.
“Because Post Polio Syndrome and the late effects of polio are still relatively unknown, there are many people in the community with misconceptions, or who may not realise they have one of these conditions,” Mr Henley said.
“Dr DeMayo’s insight into Post Polio Syndrome will answer a lot of questions for many people.”
For more information on Post Polio Syndrome or your local Member Networks group, please visit www.spinal.com.au.
Issued 28 July.

Polio gone, but its impact on Albany Creek resident continues.

 Creek’s Dr Margaret Peel will later this month attend an international conference on polio survivors in Warm Springs, Georgia – the place where former US President Franklin D Roosevelt, who famously had polio throughout his presidential term, spent a lot of time rehabilitating and passed away in 1945.

The Post Polio Health 10th International Conference: Living with polio in the 21st century, will draw approximately 400 people from around the world.

Delegates will include those such as Dr Peel who has Post Polio Syndrome (PPS), people experiencing the late effects of polio and medical practitioners from a range of health fields.

Diagnosed with polio as a child when the epidemic struck in 1951, Dr Peel spent many years working as a microbiologist and travelling extensively with manageable side effects from her childhood affliction until 10 years ago, when she was diagnosed with PPS.“The side effects are different for everyone but can include progressive loss of muscle strength, joint and muscle pain, unaccustomed fatigue, cramping and in some instances, trouble swallowing and breathing,” Dr Peel said.

Increased sensitivity to cold temperatures, difficulty sleeping and a decline in the ability to perform basic daily activities are other symptoms of PPS.

Dr Peel said she would be travelling with several other Australians to the conference and hoped to hear about the latest research being carried out and useful advice on relieving PPS symptoms.

As the secretary of the Brisbane Post Polio Support Group, Dr Peel will then share her conference findings with other members of the group.

While PPS is still quite unknown in the general community, well-known people who had polio as children include Kim Beazley, John Laws, Janet Powell and the late Kerry Packer and Joh Bjelke-Petersen.

In 1921, Franklin D Roosevelt was diagnosed with polio at the age of 39 but that did not prevent him from going on to become President of the United States.

He worked tirelessly to fundraise for a polio vaccine and raised more than $25 million for the cause during his time in office.Spinal Injuries Association CEO Mark Henley said the not-for-profit organisation had six Post Polio Support Groups (PPSG) located throughout Queensland.

“Members share their experiences and provide support to each other as they deal with the late effects of polio,” Mr Henley said.“Because the condition is still quite new as the people who had polio in the 1950s begin to age, it can be a daunting time for our members.“Having other people to talk to who are experiencing the same symptoms is reassuring and decreases feelings of isolation and helplessness.

“It’s important to remember that polio may be gone from Australia, but its impact on lives continues.”

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