Related Subjects:
|Poliomyelitis
|Post Polio Syndrome
|Anterior Horn Cell diseases
|Transverse myelitis
|Acute Disseminated Encephalomyelitis
|Cervical spondylosis
|Spinal Cord Anatomy
|Acute Disc Prolapse
|Spinal Cord Compression
|Spinal Cord Haematoma
|Foix-Alajouanine syndrome
|Cauda Equina
|Conus Medullaris syndrome
|Anterior Spinal Cord syndrome
|Central Spinal Cord syndrome
|Brown-Sequard Spinal Cord syndrome
🧠 About
- 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.
