Post-polio syndrome

Description

Post-polio syndrome is a group of potentially disabling signs and symptoms that appear decades after the initial disease of polio. These signs and symptoms usually appear between 30 to 40 years after polio.

Infection by the virus of polio, once caused paralysis and death. However, the introduction of the inactivated polio vaccine in the 1950s significantly reduced the spread of polio.

Today, very few people in developed countries are paralyzed from polio virus, usually related to a reaction from a form of the vaccine. However, there are many people who had polio at a young age now, later in life, may develop post-polio syndrome.

Symptoms

Post-polio syndrome only affects people who had polio. Common signs and symptoms of post-polio syndrome include:

  • Muscle and joint weakness and pain that gets worse with time
  • Feeling easily fatigued and exhausted
  • Losing muscle tissue (atrophy)
  • Breathing or swallowing problems
  • Sleep-related breathing disorders, such as sleep apnea
  • Decreased tolerance of cold temperatures

Post-polio syndrome progresses slowly in most people. They can experience new signs and symptoms, followed by periods of stability.

When to see a doctor

Consult your doctor if you have increased weakness, or fatigue. It is important to rule out other causes of your signs and symptoms and determine whether you have post-polio syndrome.

Causes

There are several theories as to what caused the post-polio syndrome, but no one knows with certainty.

When poliovirus infects the body, which affects the nerve cells called motor neurons that carry messages (electrical impulses) between your brain and your muscles. Polio Virus particularly affects the motor neurons in the spinal cord.

Each neuron consists of three basic components:

  • A body of the cell
  • One of the main branching of fibers (axons)
  • Numerous small branching of the fibers (dendrites)

A polio infection often damages or destroys many of these motor neurons. Because there are fewer motor neurons, the neurons that are sprouting new fibers and grow bigger.

This promotes the recovery of the use of its muscles, but also the stress of the nerve cells in the body to nourish the additional fibers. Over the years, this stress can be too much. This can cause the gradual breakdown of the sprouted fibers and, finally, the neuron itself.

Risk factors

Factors that may increase your risk of developing post-polio syndrome include:

  • The severity of the initial polio infection. The more severe the initial infection, the more likely it is that you are going to have signs and symptoms of post-polio syndrome.
  • Age at onset of initial illness. If you've developed the polio as an adolescent or adult, rather than as a child, your chances of developing post-polio syndrome increase.
  • Recovery. The largest of its recovery after the acute polio, the more likely it seems that the post-polio syndrome will develop. This may be due to a greater recovery of the places more stress on the motor neurons.
  • An excess of physical activity. If you often exercise to the point of exhaustion or fatigue, you may be the excess of work that has already stressed in the motor neurons and increase the risk of post-polio syndrome.

Complications

Post-polio syndrome is rarely life-threatening, but the severe muscle weakness can lead to complications:

  • Falls. Weakness in the muscles of the legs makes it easier for you to lose your balance and fall. You can then break a bone, such as the hip, leading to other complications.
  • Fatigue. Fatigue is very common in people with post-polio syndrome. Fatigue can be disabling, even after very little activity. It can also lead to problems with concentration and memory.
  • Pain. Musculoskeletal abnormalities and muscle weakness can lead to chronic pain.
  • Malnutrition, dehydration and pneumonia.People who have had polio, bulbar, which affects the nerves that lead to muscles involved in chewing and swallowing, tend to have difficulty with these activities and have other signs of post-polio syndrome. Chewing and swallowing problems can lead to poor nutrition and dehydration, as well as aspiration pneumonia, which is caused by the inhalation of particles of food into the lungs (aspiration).
  • Chronic respiratory insufficiency.Weakness in the diaphragm and the muscles of the chest makes it harder to take deep breaths and cough, which can cause fluid and the accumulation of mucus in the lungs. Obesity, smoking, curvature of the spine, anesthesia, prolonged immobility, and certain medications can further lower your breathing capacity, possibly leading to a sharp drop in the levels of oxygen in the blood (acute respiratory failure). You may need a treatment to help breathing (ventilation therapy).
  • Osteoporosis. In case of prolonged inactivity and immobility are often accompanied by the loss of bone density and osteoporosis in men and women. If you have post-polio syndrome, talk with your doctor about bone density test.
  • Sleep disorders. Sleep apnea and restless leg syndrome are common in people with post-polio syndrome. These sleep disorders may worsen the insomnia and fatigue if not treated.

Malnutrition, dehydration and pneumonia. People who have had polio, bulbar, which affects the nerves that lead to muscles involved in chewing and swallowing, tend to have difficulty with these activities and have other signs of post-polio syndrome.

Chewing and swallowing problems can lead to poor nutrition and dehydration, as well as aspiration pneumonia, which is caused by the inhalation of particles of food into the lungs (aspiration).

Chronic respiratory insufficiency. Weakness in the diaphragm and the muscles of the chest makes it harder to take deep breaths and cough, which can cause fluid and the accumulation of mucus in the lungs.

Obesity, smoking, curvature of the spine, anesthesia, prolonged immobility, and certain medications can further lower your breathing capacity, possibly leading to a sharp drop in the levels of oxygen in the blood (acute respiratory failure). You may need a treatment to help breathing (ventilation therapy).

Post-polio syndrome

Diagnosis

There is No specific test to diagnose the post-polio syndrome. The diagnosis is based on clinical history and physical examination, and exclusion of other conditions that could cause the signs and symptoms.

Indicators of post-polio syndrome

For a diagnosis of post-polio syndrome, doctors look for three indicators:

  • A prior diagnosis of the disease of polio. This may require the search of old medical records or information of a part of older family members.
  • Long interval after recovery. People who recover from the initial attack of polio often live for years without signs or symptoms. The occurrence of late effects vary widely, but typically starts at less than 15 years after the initial diagnosis.
  • Gradual Onset. The subsequent onset of the weakness typically occurs in the muscles that are affected at the time of the onset of the disease of polio. Weakness is often not noticed until that interferes with daily activities. You could wake up fresh but feels exhausted by the evening, tired after the activities that were once easy.

In addition, because the signs and symptoms of post-polio syndrome are similar to those of other disorders, your doctor will attempt to exclude other possible causes, such as arthritis, fibromyalgia, chronic fatigue syndrome, and scoliosis.

Tests to rule out other conditions

Because there are no tests that confirm a post-polio syndrome diagnosis, your doctor may use certain lab tests to rule out other conditions, including:

  • Electromyography (EMG) and nerve conduction studies.Electromyography measures the tiny electrical discharges produced in muscles. A thin needle electrode is inserted into the muscle to be studied. An instrument that records the electrical activity in the muscle at rest and as you contract the muscle. In a variation of the electromyography (EMG) of the so-called nerve conduction studies, two electrodes are taped to your skin over a nerve to be studied. A small shock is passed through the nerve to measure the speed of the nerve signals. These tests help to identify and exclude conditions such as an abnormal condition of the nerves (neuropathy) and in muscle tissue disorder (myopathy).
  • The projection image. Your doctor may recommend a Magnetic resonance imaging (MRI) or computerized tomography (CT scan) to see the images of your brain and spinal cord. These tests can help exclude disorders of the spine, such as degenerative spine condition spondylosis or narrowing of the spinal column that puts pressure on the nerves (spinal stenosis).
  • The muscle biopsy. A muscle biopsy might be done to help your doctor look for evidence of another disease that could be the cause of the weakness.
  • Blood tests. People with post-polio syndrome usually have normal blood test results. Of abnormal blood test results could indicate another underlying problem that is causing your symptoms.

Electromyography (EMG) and nerve conduction studies. Electromyography measures the tiny electrical discharges produced in muscles. A thin needle electrode is inserted into the muscle to be studied. An instrument that records the electrical activity in the muscle at rest and as you contract the muscle.

In a variation of the electromyography (EMG) of the so-called nerve conduction studies, two electrodes are taped to your skin over a nerve to be studied. A small shock is passed through the nerve to measure the speed of the nerve signals. These tests help to identify and exclude conditions such as an abnormal condition of the nerves (neuropathy) and in muscle tissue disorder (myopathy).

A non-invasive test that shows promise for the assessment of the severity of the post-polio syndrome and the monitoring of its progression is the muscle of ultrasound, which uses sound waves to create images of the muscles. More studies are needed.

Treatment

There is a treatment for the various signs and symptoms of post-polio syndrome. The goal of treatment is to control symptoms and help you feel comfortable and independent as possible. Here are some treatment options that can help you manage your post-polio syndrome symptoms:

  • Conservation of energy. This involves the stimulation of physical activity and rest frequently to reduce fatigue. Assistive devices, such as a cane, walker, wheelchair or motor scooter — can help you save energy. Have a shower support bar, or raised toilet seat installed may also help. A therapist can show you ways of breathing that helps to save energy.
  • Therapy física.Su doctor or therapist may prescribe exercises to strengthen their muscles without bothering them. These usually include less strenuous activities, such as swimming or water aerobics, which are performed each day at a relaxed pace. Exercising to maintain a good physical condition is important, but avoid overuse of the muscles and joints and exercise to the point of pain or fatigue.
  • Speech therapy. A speech therapist can show you ways to compensate for difficulties in swallowing. Voice strengthening exercises might also be helpful.
  • Sleep disorder treatment. You may need a change in your sleep patterns, such as avoid sleeping on your back, or the use of a device that helps open up the airways when you sleep. If you have restless legs syndrome, the treatment for this disorder can help to improve sleep quality and reduce fatigue.
  • Drugs. Pain medications — such as aspirin, acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others) — may relieve muscle and joint pain.

The physical therapy. Your doctor or therapist may prescribe exercises to strengthen their muscles without bothering them. These usually include less strenuous activities, such as swimming or water aerobics, which are performed each day at a relaxed pace.

Exercising to maintain a good physical condition is important, but avoid overuse of the muscles and joints and exercise to the point of pain or fatigue.

Other possible treatment options may include the anticonvulsant drug gabapentin (Neurontin, Gralise), which is often used to treat nerve pain. Chronic opioid pain medications in general should not be used due to their long-term risks. You and your doctor should discuss the right treatment plan for you to manage your pain and symptoms.

Self-care

Having to deal again with a disease that I thought was in the past can be daunting or even overwhelming at times. The recovery of the initial illness requires drive and determination, but now the late effects of polio require you to rest and conserve your energy.

Here are some suggestions:

  • Limit activities that cause pain or fatigue. Moderation is the key. The exaggeration of her on a good day can lead to a number of the following bad days.
  • Stay warm. The cold increased muscle fatigue. Keep your home at a comfortable temperature and to dress in layers, especially when you go out.
  • Avoid falls. Get rid of the carpet and let go of the clutter on the floor, use a good pair of shoes, and prevent slippery or icy surfaces.
  • To maintain a healthy lifestyle. Eat a balanced diet, quit smoking and reduce the consumption of caffeine to stay in shape, you breathe better and sleep better.
  • Protect your lungs. If your breathing is deficient, to see signs of a development of the respiratory infection and treat it immediately. Do not smoke, and keep up to date with the flu and pneumonia vaccines.

Coping and support

To deal with the fatigue and the weakness of the post-polio syndrome can be difficult physically and psychologically. You might need to rely on their friends and family. Do not hesitate to tell them what kind of help you need.

Consider joining a support group for people with post-polio syndrome. Sometimes talking about things with people who have similar problems can help you cope. Ask your doctor about support groups in your area.

Preparing for your appointment

It is likely to start by seeing your family doctor. However, it is likely to be referred to a doctor who specializes in disorders of the nervous system (neurologist).

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began
  • Key personal information, including major stresses or recent life changes, medical history, and family medical history
  • All the medications, vitamins, or other supplements you are taking, including dose
  • Questions to ask your doctor

For the post-polio syndrome, basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • There are other possible causes?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What treatments are available? Which would I recommend?
  • I have other health conditions. How can I best manage them together?
  • There are activity restrictions I need to follow?
  • I become incapacitated?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your doctor may ask you questions, including:

  • Have you ever had polio? If so, when?
  • How serious was his polio infection?
  • In what areas of your body were affected by polio?
  • After the polio infection, they were left with the persistent weakness?
  • The symptoms been continuous or occasional?
  • What, if anything, seems to improve your symptoms?
  • Is there something that seems to make your symptoms worse?
Symptoms and treatment of Post-polio syndrome