6/10/2016





Post-polio syndrome: The sequel

The Story












Decades after the last Canadian polio outbreak in 1959, a new medical condition revisits polio survivors. Some of these symptoms include extreme fatigue, muscle weakness, muscle and joint pain, and muscular atrophy. Post-polio syndrome (PPS) is a condition that strikes polio survivors anywhere from 10 to 40 years after recovery from the initial attack. Doctors believe PPS is caused by further weakening of the muscles previously damaged by polio. It also seems to occur as a result of healthy muscles deteriorating after years of over-compensating for the damaged muscles. PPS is particularly devastating for those who believed they had polio beat. In severe cases former survivors must once again use an artificial lung, reminiscent of the dreaded iron lung. Like polio itself, there is no known cure for PPS.

  • Did You Know?


  • Post polio syndrome strikes almost one quarter of the 20,000 - 30,000 Canadians who survived their initial bout with polio.
  • There has been much debate over the role of exercise in combating PPS. Some doctors say too much exercise can make the condition worse while others say this is unfounded and has not been scientifically documented. Both sides agree more study is needed.
  • In 1940 Australian nurse sister Elizabeth Kenny came up with her rigorous and unorthodox treatments for polio. The Kenny treatments used towels dipped in boiling hot water. These were laid on the muscles along with intense, often painful stretches to prevent muscular atrophy.
  • Ironically some doctors believe the degree of intensity of the Kenny treatment has a direct correlation to the severity of PPS.

More 
  • Post polio syndrome strikes almost one quarter of the 20,000 - 30,000 Canadians who survived their initial bout with polio.
  • There has been much debate over the role of exercise in combating PPS. Some doctors say too much exercise can make the condition worse while others say this is unfounded and has not been scientifically documented. Both sides agree more study is needed.
  • In 1940 Australian nurse sister Elizabeth Kenny came up with her rigorous and unorthodox treatments for polio. The Kenny treatments used towels dipped in boiling hot water. These were laid on the muscles along with intense, often painful stretches to prevent muscular atrophy.
  • Ironically some doctors believe the degree of intensity of the Kenny treatment has a direct correlation to the severity of PPS.













































Post Polio Litaff, Association A.C _APPLAC Mexico

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