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Post-polio syndrome

INTRODUCTION

Paralytic poliomyelitis was a major cause of morbidity and death throughout the world during the first half of the 20th century. In 1952, shortly before the introduction of the polio vaccine, more than 20,000 cases were reported in the US [1]. Introduction of the inactivated polio vaccine in 1954 resulted in a dramatic decline of new polio cases; with widespread vaccination fewer than 10 new cases of paralytic polio are reported per year in the United States [2,3].

However, a 1987 survey estimated that there were 640,000 Americans living with the sequelae of paralytic polio [4]. These sequelae are static for many and reflect the state of recovery reached after the initial disease. Although not well studied, most survivors experience a modest decline in function and muscle strength over many years that may reflect the natural history of old polio [5].

Other patients, however, experience a syndrome of new or progressive disability, usually occurring decades after the disease itself. These new symptoms are quite variable, and include increased muscle weakness, focal or generalized muscle atrophy, fatigue, pain, and decreased ambulatory abilities. It has become clear that this condition, called post-polio syndrome (PPS), has both neurologic and non-neurologic components. Certain symptoms are quite common, while others are experienced by only a minority of patients with new complaints.

The clinical findings, etiology, and treatment of PPS will be reviewed here. Issues regarding polio vaccination are discussed separately. (See "Poliovirus vaccination" and "Standard childhood immunizations".)

EPIDEMIOLOGY OF POST-POLIO SYNDROME

Estimates of the incidence and prevalence of PPS vary greatly according to the criteria used for establishing the diagnosis. If patients are simply asked whether they have experienced new symptoms related to prior polio, about one-half report that they have [6]. Symptoms reported include weakness as well as pain, fatigability, and concentration difficulty. However, if new, progressive weakness is a criterion, the frequency drops to approximately 20 to 30 percent of polio survivors [4]. On average, the onset of new symptoms occurs approximately 35 years after the initial polio episode, but the delay can range between 8 and 71 years [7-10]. PPS occurs sooner in patients with more severe original disease [9,11].
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