Accept the existence the Post Polio Syndrome opens opportunities for those who have PPS : Liliana Marasco

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Dis - capacidad.com 
By: Karent Mendoza Mendoza Arizmendi Arizmendi

 Mexico City - On July 28 will be held the 2nd National Symposium on Post Polio Syndrome (CAP) Approval of the existence of Post Polio Syndrome in Mexico, which aims to educate the medical, paramedical and therapists. The signs and symptoms of this disease establish an early diagnosis to enable patients to have better quality of life .
The Symposium is organized by the Post Polio Association Litaff and the Ministry of Health.Dis - capacidad.com spoke with Liliana Marasco Garrido, president and founder of the Post Polio Association Litaff who told us that the main objective is to recognize the existence of PPS in Mexico.  She said, "doctors, and people with polio, may prevent actions that may reduce our quality of life because they were not clearly recognized as SSP. "
She explained that on 28th July in Auditorium 1 of the Congress Unit of the Medical Center Siglo XXI , doctors will be trained to carry out an appropriate differential diagnosis in all health sector clinics. "This opens a range of opportunities for those who have polio and PPS. The generations of doctors who treated the polio epidemics in the 50s, 60s and early 70s , are mostly retired or have died, and the younger physicians are not familiar with the disease.  Hence the importance this Symposium and current medical updates."
Although, due to the complexity and medical terminology the symposium is addressed to practitioners.  Between 300 and 500 doctors of different specialties are expected to attend.  Liliana extends the invitation to people with polio and PPS worldwide to attend this event, as well as their families and friends.
For Liliana, the symposium represents the completion of nine years of work and a constant struggle for recognition of the syndrome and says, "It is my ultimate dream come true, I am proud to be able to meet people with polio and PSS.  I promised that one day, if God lends me life and gave me health, PSS would be classified and  certified in the world medical codes, which we have achieved with the help and interest of Health Secretary Mauricio Hernández Avila. I am finally satisfied we know that the Health Department accepts the existence and evidence of the syndrome."
    This satisfaction is even greater because this year, the World Health Organization (WHO) finally included this syndrome in Clasificación Internacional de Enfermedades within the G14 code corresponding to the central nervous system diseases . WHO states that PPS is, "an evolution of an irreversible and incurable clinical situation in relation to the progressive dysfunction of the motor units, which can not be classified as sequelae of polio."
She said, "Add to that the existence of evidence and acceptance, we already have the complete package.  Now everyone with SSP can be properly treated and their needs covered, receiving care and rehabilitation, including therapies, orthotics and prosthetic devices to enable people to lead a better quality of life."  The main themes of the Symposium are: Epidemiology and diagnosis, rehabilitation and treatment, classification in the CIF and family involvement .
And while Liliana is so excited to have fulfilled one of her dreams, nervous tension has her in bed with a strong bronchopneumonia. But that is unimportant, she says, "I am very happy because this symposium opens the possibility to its attendees to hear the latest treatments for the care of this and other mobility impairments."
Liliana Marasco thanks all those who directly and indirectly supported the realization of this great project. "I thank the physicians from the United States, partly because I know they do it for the great love they have for LITAFF, for me this was a beautiful detail that they helped me close this circle."
The main expectation of this symposium, Marasco said, "is not to lose sight of the G14 classification.  Although the Secretary of Health who conducted the symposium, he must be very attentive to the application of the G14 and can not be beyond the month of October.
The president of LITAFF has faith that the end of the symposium the medical authorities will be more interested in the care of patients with SSP.  "They need more clinics because there are not enough with only the National Rehabilitation Institute; many people from other states can not come to be treated at the DF so it is important to build clinics in other states.  They do not need to be large; doctors only need to be prepared.  Perhaps there is no polio in Mexico at this time, but SSP and those who have it, need attention."
Liliana said, "This event is the result of a great effort and I can only thank God, my family, my loved ones and all the institutions that worked with me."
The symposium is sponsored by the Ministry of Health and the National Council for Persons with Disabilities (CONADIS). The Symposium is at: Av Cuahutemoc No. 300 , Col. Doctores, July 28 from 8:00                 http://www.dis-capacidad.com/page/details.php?id=1006 
AGENDA : http://conadis.salud.gob.mx/descargas/pdf/100705-Programa-Simposio-Postpolio-v2.pdf
Asociación Post Polio Litaff, A.C_APPLAC
Liliana Marasco Garrido Founder President
 Post Polio Survivor
Correo litaffac@prodigy.net.mx
Web  www.postpoliolitaf.org  


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Erradicación de La poliomielitis

Polio Tricisilla Adaptada

March Of Dimes Polio History

Dr. Bruno




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


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



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.


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


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


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



  • tumours

  • amyloidosis

  • cysticercosis

    Link here