Post polio syndrome is a set of symptoms experienced by many people who have had polio at an early age. The symptoms include fatigue, muscle weakness and muscle and joint pain. These symptoms can be quite debilitating and may compromise health and independence.

Post polio syndrome generally begins to appear 20 to 45 years after recovering from polio.

Although New Zealand is now polio free, with no cases of polio infection since 1962, post polio syndrome continues to affect many New Zealanders. The syndrome can be difficult to diagnose and can require a management regime to deal with the effects of the symptoms.

Polio

Poliomyelitis, or polio, is a highly contagious viral disease. It was responsible for killing and maiming large numbers of people in the early 20th century. It is transmitted orally and initially infects the small intestine. Most people who contract the disease do so when they are very young, between three and five years old.

The initial symptoms of polio are flu-like. In a small minority of cases, the infection spreads beyond the intestine, into the blood stream and invades the central nervous system. In this case, called paralytic polio, the disease is far more serious and can cause floppy limbs or paralysis, which can be permanent. It is this form of polio that may later lead to post polio syndrome.

A vaccine for polio was developed in 1955 and intensive immunisation campaigns worldwide have successfully eradicated the disease from much of the world. Immunisation in New Zealand began in 1957 and the last reported case due to wild poliovirus was in 1962. There have been nine vaccine-related cases since 1962. However, in 2002, immunisation was switched to the inactivated polio vaccine, which is not associated with vaccine related infections.

Follow this link for more information about polio. Follow this link for data on polio incidences in New Zealand in the 20^th century.

Life after polio

While an attack of polio only lasts a short time, recovery can take about two to eighteen months. During this time, movement in affected limbs gradually returns, unless permanently affected, though the limbs may be weak. Physiotherapy can further help recovery and surgery may be required for serious cases to repair damaged muscles or straighten bones.

Polio survivors have shown a great capacity to recover and to cope with the long term effects of polio. For years after recovery, a normal life can be lived, with perhaps some adjustment for residual paralysis or weak limbs.

Paralytic polio damages the nerves of the body, which may result in too few healthy nerves working the body’s muscles. The body has a great capacity to adapt, so it can cope with this in the short term. However, over time the overworked nerves begin to break down. It is this weakening of the nervous system that is believed to give rise to post polio syndrome. (Follow this link for other theories on the cause of post polio syndrome.)

Onset of post polio syndrome

About 20 to 45 years after the initial attack, the recovered polio victim may begin to deteriorate, showing some of the symptoms listed below. This is the onset of post polio syndrome.

It is important to note that post polio syndrome is not caused by old age, though age may worsen the symptoms. Its onset is related to the length of time since the original polio attack. However, the onset may be triggered by trauma, such as emotional upheaval, an accident or undergoing surgery.

Symptoms of post polio syndrome

The symptoms of post polio syndrome include

• General fatigue, not related to activity
• Muscles weakness or pain and tenderness
• Muscle cramps and spasms
• Joint pain
• Episodes of pain, exhaustion or weakness that vary in duration and occur spontaneously and unpredictably
• Respiratory difficulties
• Depression or anxiety

These symptoms are not specific to post polio syndrome and can also be due to the natural effects of aging, diabetes, heart disease or other enervating diseases. Because of this, post polio syndrome can be difficult to diagnose. If you feel you may be affected by post polio syndrome but are unsure, you should consult a neurologist.

Post polio syndrome may give rise to other consequences:

• Easily fractured bones due to polio-induced osteoporosis, and slow healing of fractures
• Joint problems
• Use of crutches and wheelchairs can cause carpel tunnel syndrome and other repetitive strain injuries, as well as arthritis
• Loss of independence and the disappointment that goes with that loss

Treatment

Currently, there is no reliable treatment that can reverse the effects of post polio syndrome. Treatment therefore concentrates on managing the symptoms, as detailed in the next section below.

Several medications are being researched for the treatment of PPS:

• Pyridostigmine, used for muscle fatigue, has many side effects
• Human growth factor, very expensive
• Magnesium supplements to help with cramp
• Carnitine, used in Australia and Switzerland, but very expensive and not fully proven
• CoEnzyme Q10, may reverse muscle pain, but expensive

Managing post polio syndrome

Managing post polio syndrome involves coping with the weakness and pain that arises, avoiding becoming overly fatigued and remaining positive. On another page we deal with these management approaches in detail, but below we give some general advice for coping with PPS:

• Do not get overtired, learn how to pace yourself
• Exercise only under the supervision of a knowledgeable physician
• Swimming in warm water is best
• Do not let yourself get chilled; make it a habit to carry a sweater with you whenever you go out
• Keep a normal weight
• Have periodic muscle strength evaluations
• Get adequate nutrition, including enough bulk producing fibre
• Maintain a positive attitude towards your health
• Join the Post Polio Support Group in your area

Drugs to avoid

• Sleeping pills, tranquilisers and too much alcohol may lead to falls
• Muscle relaxants such as benzodiazepines and orphenedrine may further weaken muscles
• High-dose steroids can cause muscle weakness and osteoporosis
• Lipid-lowering drugs, especially statins, can cause muscle pain and inflammation