Post-polio syndrome

Historical note and nomenclature
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By Tarakad S Ramachandran MD and Arun Ramachandran

Poliomyelitis epidemics in the United States came to a dynamic end with the introduction of the inactivated poliomyelitis vaccine (Salk Vaccine) in 1955 and the live attenuated oral polio vaccine (Sabin Vaccine) in 1961 (Paul 1971; Centers for Disease Control 1981). Even though poliomyelitis has basically been eliminated, many patients from those epidemics were left with severe sequelae and disabilities. These patients became over-achievers by working hard both physically and emotionally to overcome their disabilities (Wiechers 1985). Now, some 30 plus years after contracting acute poliomyelitis, these survivors are developing new symptoms, collectively referred to as “late effects of poliomyelitis” or the “post-polio syndrome.” Not only are there new physical disabilities with which to cope, but also psychological effects of a second disability from a disease presumably resolved.

The syndrome of late weakness occurring many years after acute poliomyelitis has been recognized for over 100 years. However, it did not receive general public recognition until the large number of cases began to be seen in the 1980s (Alter et al 1982; Halstead and Wiechers 1985). In 1875 late weakness occurring years after poliomyelitis was noted by Charcot and other clinicians (Carriere 1875; Cornil and Lepine 1875; Raymond 1875). Between 1875 and 1975 only about 200 cases of post-polio syndrome were described in publications (Jubelt and Cashman 1987). However, since 1975 thousands of cases have been reported (Halstead et al 1985; Jubelt and Cashman 1987; Wekre et al 1998; Jubelt and Drucker 1999; Kumakura et al 2002).

Energized by hope and optimism, the mid 1980s and early 1990s saw a surge of support groups (maximum of 298 in 1990) and clinics (96 in 1990), followed by a steady decline in 2010 (131 support groups and 32 clinics) as the limits of research as well as clinical and self-help initiatives became obvious. Also, 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 (Halstead 2011).

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