8/15/2014

What are the late effects of polio?

A Few Words about Definitions  (Source: Post-Polio Health International) 

Diagrams courtesy of
Post-Polio Health International
Technically, post-polio syndrome is NOT the same condition as post-polio sequelae / the late effects of polio. Post-polio syndrome is usually considered a specific NEW condition. A diagnosis of exclusion is used to determine if a patient has post-polio syndrome. This means if a survivor of polio is found to have osteoarthritis, for example, that is what the diagnosis will be – osteoarthritis, not post-polio syndrome. Because of this, the number will be lower for post-polio syndrome than when the number is referring to post-polio sequelae or the late effects of polio.
Twenty-five to forty percent of polio survivors experience post-polio syndrome (depending on the study).
As many as seventy percent of polio survivors are said to have post-polio sequelae or the late effects of polio.
The Late Effects of Polio – The Paralytic versus Non-Paralytic Polio Debate . . .
“It should be absolutely understood that patients who were told that they had ‘non-paralytic’ polio did, in reality, have polio, which affected their anterior horn cells. Now, 30 to 40 years later, these patients are potentially subject to all of the vagaries and insults to the body that affect other persons with postpolio syndrome.”
A Clarification of “Nonparalytic” Polio
Johnson, Ernest W MD
American Journal of Physical Medicine, Vol. 79(1), Jan/Feb 2000
“Asserting that a history of paralytic polio is required for a history of PPS effectively, and incorrectly, says that no neurologic damage was done during acute nonparalytic polio.”
Late Functional Loss in Nonparalytic Polio
Falconer, Marcia PhD; Bollenbach, Edward MA
American Journal of Physical Medicine, Vol. 79(1), Jan/Feb 2000
“PPS must be considered in the differential diagnosis of individuals with unexplained fatigue and weakness … regardless of whether they report a prior history of paralytic polio”
Late Functional Loss in Nonparalytic Polio
Halstead, Lauro S MD; Silver, Julie K
American Journal of Physical Medicine, Vol. 79(1), Jan/Feb 2000
Managing the late effects of polio
Polio-experienced health professionals recommend a management plan that is designed specifically for the individual polio survivor. The plan may include a variety of recommendations including:
  • bracing to support weak muscles and/or over-used and stretched joints
  • use of walking sticks and crutches to relieve weight on weak limbs and to prevent falls
  • customized shoes to address unequal leg lengths, which can be the cause of back pain and requires extra energy to walk
  • use of wheelchairs or motorized scooters for long-distance
  • recommendation of weight loss
  • recommendation of specific select exercises to avoid disuse weakness and overuse weakness
  • use of a breathing machine at night to treat underventilation
Polio survivors can also help them themselves by ‘listening’ to their bodies and ‘pacing’ their activities. With time, survivors can learn when to stop before they become over fatigued. Many survivors report feeling better after adapting assistive devices and interspersing activities with brief rest periods. Read more in PPS Guidelines for people who have had polio. http://www.polioaustralia.org.au/what-are-the-late-effects/

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