Post-polio syndrome

Introduction
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By Tarakad S Ramachandran MD and Arun Ramachandran

In post-polio syndrome, symptoms occur several decades after recovery, after a long latent period. Use of pharmacological agents in post-polio syndrome thus far has been disappointing. It is hoped that support from the polio clinic may result in self-selected lifestyle changes, which may positively influence the development of symptoms and functional capacity. Patient education, health promotion, and energy conservation strategies that include walking with a properly fitting assistive device reduce perceived fatigue and improve posture and function in an individual with post-polio syndrome. Future randomized trials should also address the long-term effects of muscular training in post-polio syndrome, in addition to treatment of pain in these patients. Randomized control studies had shown that intravenous immunoglobulin is effective to reduce pain in complex regional pain syndrome (low-dose intravenous immunoglobulin) and post-polio syndrome (high-dose intravenous immunoglobulin). Open trials have also shown efficacy in additional pain conditions. But questions still linger around the optimal treatment doses, duration of treatment, and its effect on function and quality of life.

Key points

  • The post-polio population is aging and decreasing in size. Still, there are thousands of post-polio patients who require skilled nursing care with their advancing age and declining function.
  • Fatigued post-polio patients can be considered a distinct subgroup across the fatigue continuum.
  • Diaphragmatic paralysis in post-polio syndrome can be unilateral or bilateral. When unilateral, the prognosis is good, but bilateral diaphragmatic paralysis often has a worse prognosis.
  • Supportive care, self-selected life style changes, and energy conservation strategies still remain the main axiom of therapy.
  • Intravenous immunoglobulin (IVIG) therapy holds some promise in improving the quality life as well as in decreasing bodily pain. IVIG has further been shown to dampen the inflammatory markers up to 1 year in post-polio syndrome (PPS).

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Anesthesia
References cited
Contributors