Makindo Medical Notes

Related Subjects: |Poliomyelitis |Post Polio Syndrome |Anterior Horn Cell diseases

🧠 About Post-Polio Syndrome (PPS)

• PPS is a late complication of poliomyelitis that develops decades after recovery from the initial infection.
• Typically arises 15–40 years after acute polio, affecting survivors who had regained function but later experience new deterioration.
• Estimated to affect 25–50% of polio survivors.

⚠️ Aetiology

• Not due to reactivation of poliovirus — no active infection.
• Believed to result from progressive degeneration of enlarged motor units formed during recovery from polio (surviving motor neurons sprout to reinnervate denervated fibres, but these eventually fail).
• Risk higher in patients with severe initial polio, greater functional recovery, and high physical activity demands.

🩺 Clinical Features

• Gradually worsening muscle weakness, often in the same muscles affected during polio.
• Excessive fatigue, often out of proportion to activity.
• Muscle wasting/atrophy — can also occur in muscles not previously involved.
• Joint and muscle pain, particularly in weight-bearing joints due to altered biomechanics.
• Cold intolerance in affected limbs due to impaired circulation and reduced muscle bulk.
• Reduced mobility, increasing falls risk, and eventual dependence on assistive devices.

🔬 Investigations

• Electromyography (EMG): Evidence of chronic denervation and reinnervation.
• MRI: May show signal changes in anterior horn cells but mainly used to exclude alternative pathology.
• Poliovirus serology: Antibody titres low; no evidence of viral reactivation.
• Other tests (e.g. thyroid, CK, autoimmune screening) help rule out mimics such as motor neuron disease, myopathies, or hypothyroidism.

💊 Management

• No disease-modifying treatment — care is symptomatic and supportive.
• Physiotherapy: Gentle strengthening and stretching; avoid overuse to prevent further muscle fatigue.
• Energy conservation: Pacing, rest breaks, and use of braces, orthotics, or wheelchairs when required.
• Pain control: NSAIDs, heat therapy, massage, and joint protection strategies.
• Psychological support: Counselling and support groups to manage the emotional burden of progressive disability.
• Regular monitoring: Neurorehabilitation programs to preserve independence and function.

📚 Key Point

PPS is not infectious and does not indicate viral recurrence. It represents a late degenerative process in previously injured motor units, requiring lifelong multidisciplinary management.