Postpoliomyelitis syndrome (PPS) is characterized by the delayed appearance of new neuromuscular symptoms in patients many years after their acute poliomyelitis paralysis. PPS affects polio survivors years after they recover from their initial polio attack. It is usually 15 years or more but may range up to 30 to 40 years after an acute attack and is observed in approximately 25% to 28% of patients. PPS usually appears as a new weakening of the muscles affected in polio. This weakness progresses in a stepwise fashion, with periods of decline followed by periods of stability.
Content Courtesy: Dr. Satendra Singh and Mitali Thakore
The main clinical features are new weakness, muscular fatigability, general fatigue, and pain. Cold intolerance, difficulty in swallowing and breathing, sleep disorders, and worsening functional abilities are also seen.
Only those who have been affected by polio can get PPS. Those who had more severe polio and who recovered more function are more likely to be strongly affected by PPS.
Although the cause of PPS is debated, the common theory is that it is the result of the slow weakening of nerve cells in the spinal cord that were damaged by the polio virus. Overworking these weakened neurons over time leads to even more damage, eventually giving rise to PPS. Symptoms of PPS can appear anywhere from 10 to 40 years after initial polio attack. The average time of onset is about 30 years after initial polio attack.
PPS is not an infectious disease- it cannot spread from one person to another. People affected by PPS are not experiencing another attack of the virus which causes polio, and they cannot spread polio to others.
PPS is difficult to diagnose since the symptoms of presentation are usually non-specific. Predominantly, it is diagnosed by exclusion. Your doctor will confirm your diagnosis by ruling out other illnesses and checking to see if you have:
Do not diagnose yourself; you may have other issues that are causing your symptoms.
Although there is no specific treatment for PPS, an interdisciplinary management program can be useful in controlling symptoms. The effectiveness of pharmacological treatment and rehabilitation management in PPS is not yet established. Results indicate that IVIG, lamotrigine, muscle strengthening exercises and static magnetic ﬁelds may be beneﬁcial but need further investigation. The focus should be on a multidisciplinary approach with provision of appropriate exercise regimens and suitable medical or orthotic support.