Post-polio syndrome

• Late effects of polio
• Post-polio sequelae

• 138 Late effects of acute poliomyelitis
• 344 Other paralytic syndromes
• 357.4 Polyneuropathy in other diseases classified elsewhere

• G14 Postpolio syndrome
• G63 Polyneuropathy in diseases classified elsewhere

• 4A: Primary Prevention/Risk Reduction for Skeletal Demineralization
• 5H: Impaired motor function, peripheral nerve integrity, and sensory integrity associated with nonprogressive disorders of the spinal cord
• 5G: Impaired Motor Function and Sensory Integrity Associated With Acute or Chronic Polyneuropathies
• 6B Impaired Aerobic Capacity/Endurance Associated With Deconditioning
• 6E: Impaired Ventilation and Respiration/Gas Exchange Associated With Ventilatory Pump Dysfunction or Failure
• 7A: Primary Prevention/Risk Reduction for Integumentary Disorders
• 7B: Impaired Integumentary Integrity Associated With Superficial Skin Involvement
• 7C: Impaired Integumentary Integrity Associated With Partial-Thickness Skin Involvement and Scar Formation

Description

• Onset of polio symptoms in people who suffered the effects of the poliovirus in the past

Essentials of Diagnosis

• The poliovirus was eradicated in the US by 1994 due to the introduction of nationally required polio vaccines in 1955 and 1960.
• Two types of acute poliovirus infection
  • Paralytic
  • Nonparalytic
• The poliovirus attacks the motor neurons by destroying anterior horn cells. In the recovery process, anterior horn cells that survived the virus attempted to reinnervate muscle cells by extensive sprouting of any undamaged motor neurons
• In PPS, the motor neurons with the extensive sprouting appear to be degenerating and the associated muscle cells are losing innervation
• Several hypotheses are discussed for the onset of PPS
  • The degree of loss of anterior horn cells with the initial virus is the primary factor
  • Age-related changes on the already limited motor neuron pool causes the “late-effect” symptoms
  • Overuse and fatigue of the already weakened muscles are a factor in the development of new muscle weakness
  • Neurons that recovered from the initial attack were not physiologically normal, thus susceptible to premature aging and failure
  • The dormant poliovirus was reactivated by an unknown mechanism

General Considerations

• Predictive factors for the onset of PPS are
  • Time since initial polio
  • Degree of weakness during the acute polio
  • Muscle pain during exercise
  • Joint pain
  • Recent weight gain
• For most of the people who suffered from polio in the past, the diagnosis of PPS can be devastating
• Often patients will not identify deficits for several years after onset
• Symptoms appear after a long period of neurological and functional stability after recovery from the acute poliovirus infection
• Symptoms will appear in muscles that were not noticeably impacted from the initial poliovirus attack

Demographics

• Estimates of the number of people with the original poliovirus are uncertain so the number of people with PPS is also uncertain
• The time from polio to PPS onset is on average 35 years, but reportedly ranges from 10 to 80 years

Signs and Symptoms

• General fatigue
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