Post-Polio Syndrome: Causes, Treatment and Complications

Post-polio syndrome is a collection of potentially incapacitating signs and symptoms that develop decades after the first polio sickness. These indications and symptoms typically show up 30 to 40 years after polio.

Polio used to be able to kill you or leave you paralyzed. Conversely, the introduction of the inactivated vaccine throughout the 1950s significantly curtailed the transmission of polio.

Very few people in developed nations are paralyzed by the polio virus these days; when it does, it's typically the result of a vaccine-related adverse response. On the other hand, a considerable percentage of individuals who contracted polio as children may go on to experience post-polio syndrome in their later years.

Causes Of Post-Polio Syndrome

Though there are several theories, the precise cause of post-polio syndrome is unknown. Poliovirus infection affects motor neurons, which are nerve cells that carry electrical impulses from your brain to your muscles. The motor neurons in the spinal cord are particularly susceptible to poliovirus infection.

Each motor neuron is made up of three basic components:

• A cell body
• Several small branching fibers (dendrites) 
• A main branching fiber (axon)

Polio frequently results in the destruction or injury of several of these motor neurons. The remaining motor neurons grow larger and generate new fibers as a result of the motor neurons dying off.

This promotes muscle recovery from previous strain, but it may also strain the nerve cell body supporting the newly formed fibers. Over time, this stress could become intolerable. This might cause the sprouting fibers to gradually degrade and eventually the neuron itself.

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Symptoms Of Post-Polio Syndrome

Only those who have had polio are susceptible to post-polio syndrome. The following are common signs and symptoms of post-polio syndrome:

• Atrophy, or loss of muscle mass, is accompanied by weakening, soreness, and weariness in the muscles and joints. It also causes difficulties in breathing and swallowing. respiratory issues during sleep, including sleep apnea.
• Decreased capacity to tolerate cold
• For most people, the post-polio condition advances gradually. There may occasionally be intervals of stability followed by the emergence of new symptoms and signs.

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Risk Factors Of Post-Polio Syndrome

Some factors that can increase your risk of developing post-polio syndrome include the following:

• The severity of the initial polio infection: If your original disease was severe, you are more likely to experience the symptoms and signs of post-polio syndrome.
• Age at which the initial signs manifest: If you have polio as an adult or adolescent rather than as a child, your chance of developing post-polio syndrome increases.
• Recovery: The more fully an individual recovers from acute polio, the higher the chance of developing post-polio syndrome. This might be the consequence of motor neurons being overstressed by greater recuperation.
• Excessive body motion: Regularly exerting yourself to the maximum during exercise may exacerbate already-stressed motor neurons and increase the likelihood of developing post-polio syndrome.

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Diagnosis Of Post-Polio Syndrome

There is no specific test that can identify post-polio syndrome. The diagnosis is made using the patient's medical history, physical examination, and the exclusion of any other conditions that may be the cause of the symptoms and indicators.

To make a diagnosis of post-polio syndrome, doctors look for three symptoms:

• A previous diagnosis of polio: It can be required for this to look up old medical records or to get information from older family members.
• Extended period after recovery: Patients often recover from their first episode of polio for years without developing any subsequent symptoms. The late effects often begin to show up at least 15 years after the initial diagnosis, however this varies widely.
• Gradual onset: The muscles that suffer the later onset weakness are typically the ones that were affected during the initial polio episode. Weakness frequently goes unrecognized until it gets in the way of daily activities. You may feel energized when you wake up, but by early afternoon, you may feel exhausted from simple tasks.
  • Your doctor will also attempt to rule out other likely causes, as the signs and symptoms of post-polio syndrome can be confused with those of other disorders such as scoliosis, fibromyalgia, arthritis, and chronic fatigue syndrome.

The diagnosis of post-polio syndrome cannot be confirmed by a test, so your doctor may order some tests to rule out other illnesses. Among these tests are:

• Studies on nerve conduction and electromyography (EMG). Electromyography measures the tiny electrical discharges produced by muscle contractions. A thin-needle electrode has been placed into the muscles that are being studied. Both at rest and during contractions, an apparatus records the electrical activity in your muscles.
• In a kind of electromyography (EMG) called a nerve conduction inquiry, two electrodes are applied to your skin over the nerve under study. A small shock is injected into the nerve to measure the speed of nerve transmissions. These examinations help in the diagnosis and rule out conditions including neuropathy, an aberrant state of the nerves, and myopathy, a malfunction of the muscle tissue.
• Imagining: To get images of your brain and spinal cord, your doctor can recommend a magnetic resonance imaging (MRI) or computed tomography (CT) scan. These tests can help rule out spinal diseases such as spondylosis, a degenerative condition of the spine, and spinal stenosis, a narrowing of the spinal column that presses against the nerves.
• Muscle biopsy: A muscle biopsy may be done to assist your doctor in looking for indications of an alternative illness that could be the cause of the weakness.
• Blood tests: Results from blood tests are frequently normal in post-polio syndrome patients. The results of an abnormal blood test could indicate that your symptoms are being caused by another underlying problem.
• Muscle ultrasonography is a noninvasive diagnostic technique that uses sound waves to create images of the muscles. It has the potential to be used for tracking the development and severity of post-polio disease. Additional investigation is necessary.

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Treatment Of Post-Polio Syndrome

There isn't a single treatment for the various post-polio syndrome signs and symptoms. The two major goals of treatment are to manage your symptoms and to promote your greatest level of comfort and independence. The following treatments may help you manage your post-polio syndrome symptoms:

• Energy conservation: This means planning your physical activities and taking frequent pauses to minimize tiredness. Using assistive technology, such as a wheelchair, cane, walker, or motor scooter, can help you save energy. It might also be beneficial to install a grab bar in the shower or a taller toilet seat. You can learn energy-saving breathing strategies from a therapist.
• Physiotherapy: Exercises that develop muscle without making you tired may be recommended by your doctor or therapist. Water aerobics and swimming are two examples of less strenuous activities that you can perform at a moderate pace every other day.
• Exercise is essential to maintaining your health, but it's better to avoid overusing your joints and muscles and to quit when you begin to feel fatigued or uncomfortable.
• Speech therapy: You can learn compensatory swallowing methods from a speech-language pathologist. Strengthening exercises for the voice could be advantageous as well.

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Complications Of Post-Polio Syndrome

While severe muscle weakness may not always be fatal, post-polio syndrome can:

• Falls: If you have weak leg muscles, it is easy to lose your balance and fall. Subsequently, you may fracture a bone, such as your hip, which could lead to other problems.
• Tired: Exhaustion is a common symptom of post-polio syndrome. The fatigue may be incapacitating even with minimal effort. It may also lead to problems with memory and focus.
• Pain: Muscular weakness and abnormalities of the musculoskeletal system can cause chronic pain.
• Malnourishment, pneumonia, and dehydration: Along with other symptoms of post-polio syndrome, chewing and swallowing difficulties are common in people with bulbar polio, a disorder that affects the nerves that feed the muscles involved in these activities.
• Aspiration pneumonia: which is caused by inhaling food particles into your lungs, as well as inadequate nutrition and dehydration, can be caused by difficulties chewing and swallowing.
• Persistent respiratory failure. Weak diaphragm and chest muscles make it harder to cough and take deep breaths, which can cause a build-up of mucus and fluid in your lungs.
• Chronic immobility, obesity, smoking, spinal curvature, anesthesia, and some medications can all worsen your breathing difficulties. Acute respiratory failure or a sudden drop in blood oxygen levels could follow from this. Ventilation therapy, a treatment for breathing problems, would then be required.
• Osteoporosis: Both genders are equally affected by osteoporosis and bone density loss, which are commonly linked to extended periods of inactivity and immobility. If you have been diagnosed with post-polio syndrome, you should talk to your doctor about bone density screening.
• Problems with sleep: Sleep apnea and restless legs syndrome are common in people with post-polio syndrome. These sleep disorders may worsen fatigue and insomnia if they are not treated.

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