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post-polio syndrome

Progressive muscle weakness developing 20-30 years after poliomyelitis. Pathology: 1) dysfunction of surviving motor neurons 2) slow disintegration of axon terminals 3) late denervation of muscles 4) reactivation of latent or persistent poliovirus in the central nervous system may occur in some patients Clinical manifestations: 1) mild to moderate deterioration in function 2) fatigue 3) muscle pain 4) fasciculations 5) muscle weakness 6) onset is gradual 7) manifestations may stabilize or progress to muscle atrophy 8) extremities are often affected 9) respiratory muscle &/or bulbar involvement a) severe dysphagia b) choking c) aspiration d) sleep apnea Management: 1) non-fatiguing exercise is the treatment of choice [3] 2) lifestyle adjustments & assitive devices 3) lamotrigine might be effective in reducing pain & fatigue, resulting in fewer activity limitations. [4] 4) medications reported to exacerbate post-polio syndrome a) antihyperlipidemic agents - gemfibrozil (Lopid) - lovastatin (Mevacor) b) beta-blockers - metoprolol (Lopressor) - propranolol (Inderal) c) neuromuscular junction blockers - succinylcholine - pancuronium - vencuronium - tubocurarine 5) other medications to avoid: a) barbiturates b) phenytoin (Dilantin) c) anti-psychotic medications - lithium - phenothiazines d) antibiotics - tetracycline - aminoglycosides e) metoclopramide (Reglan) f) intravenous immune globulin unlikely to produce significant improvements in pain, fatigue, or muscle strength [5]

Related

poliomyelitis

General

syndrome myelitis infectious complication; infectious sequella

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 823, 1236
  2. M. Wasaka, St. Mary's Medical Center
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  4. Koopman FS, Uegaki K, Gilhus NE et al Treatment for postpolio syndrome. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD007818. Review. PMID: 21328301 - Koopman FS, Beelen A, Gilhus NE et al. Treatment for postpolio syndrome. Cochrane Database Syst Rev. 2015;(5):CD007818 PMID: 25984923 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007818.pub3/full
  5. Huang YH, Chen HC, Huang KW et al Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis. BMC Neurol. 2015 Mar 22;15:39. PMID: 25886512 PMCID: PMC4379590 Free PMC article.
  6. National Institute of Neurological Disorders and Stroke (NINDS) Post-Polio Syndrome https://catalog.ninds.nih.gov/pubstatic//12-4030/12-4030.pdf