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Polio & Post Polio Syndrome


POLIO

Poliomyelitis [coming from the Greek for Grey, Matter and Inflammation] also known as Polio and Infantile Paralysis, is an acute viral infectious disease caused by one of three enteroviruses (there are more than 70):

Polio type I [Brunhilde],

Polio type II [Lansing] and

Polio type III [Leon]


From Egyptian stele [18th Dynasty, 1403-1365 BC thought to represent a polio victim] and other writings it is thought that Polio has existed for thousands of years but it was not until the late 1880’s that major epidemics were seen, mostly caused by Polio type I.




Diagnosis

At the time of viral infection, depending on the level of damage to each area of the body, the diagnostic name was given to the highest level of clinically evident nerve damage and classified to:-

Abortive Polio: Symptoms do not include neurologic symptoms. Mainly gastrointestinal upset and sore throat. Polio virus can be isolated from throat washings and stool. Interpretation: Polio virus growing in gut and throat lymphatic tissue and has not migrated to the spinal cord or brain. Post-Polio Syndrome would be unlikely in these cases because of the lack of neurological involvement to any appreciable extent.

Non-paralytic Polio: Symptoms include neurological symptoms: Headache, stiff neck, muscle stiffness and spasms along with other muscular symptoms. Muscle strength testing at this time and after fever breaks does not show weakness, however, there is probably undetectable permanent nerve damage to some extent.

Paralytic Polio: All of the above symptoms but in addition residual weakness and lingering paralysis of some muscles.

Which is further classified depending on the area of the body where the most damage was clinically evident.

Spinal polio: where the paralysis involves the skeletal muscles supplied by the spinal nerves

Bulbar polio: where there is involvement of the muscles supplied by the cranial nerves. This type was seen in about 5 to 35% of cases (depending on the epidemic0 and led to problems of breathing, swallowing and speech.

Spinal/Bulbar polio: where both areas of the body were affected.

The following two facts are important to take into consideration:-

1. The first descriptions in medical literature appeared in 1875 when 4 case histories were reported in the French literature by Carriere, Raymond, and Cornhill & Lepine. Their patients, all young men, had paralytic polio in infancy and developed new weakness not only in previously affected muscles but also in muscles believed to be uninvolved. They all had physically demanding jobs and performed repetitive activities. [http://www.poliosurvivorsnetwork.org.uk/archive/lincolnshire/library/gawne/ppspandcm.html]

2.   Professor WJW Sharrard in 1955 reported in The Distribution of the Permanent Paralysis in the Lower Limb in Poliomyelitis that ‘ Motor cell destruction was always much more severe than would have been expected. One case in which there had never been any demonstrable weakness in any muscle in the lower limbs had suffered losses of up to 40 per cent of the normal number of cells in some cell columns. [http://www.poliosurvivorsnetwork.org.uk/archive/lincolnshire/library/sharrard/dppllp.html]

These demonstrate that there were considerable levels of damage below which weakness was not clinically evident at the time of the diagnostic examination and that it is possible for polio survivors to now have new issues in that area of their bodies.

No set pattern of nerve damage.

Damage to the nerves from the virus is varied in level and area/s of the body. Dr. Marinos Dalakas likened it to standing polio survivors in front of a white sheet, throwing a bucket of black paint at them and at the same time hitting a wind machine with millions of settings, a different one for each person. This means there is no set pattern to the damage caused to the body by a polio virus making health professionals lives much more difficult.


[Artwork by Chris Salter]


Recovery

Simply, a muscle has a number of nerves supplying it to work. The polio virus kills and damages nerves and the resulting ability depends on the numbers remaining. Recovery was possible because nerves that were not affected grew extra [axonally sprouted] nerve endings that reinnervated some muscle fibres that had lost their nerve supply.















POST POLIO SYNDROME

Terminology
There are a variety of terms that have been used in medical articles over the last three decades. Unstable polio, late effects of polio, post polio muscular atrophy, post polio sequelae and post polio syndrome. [www.poliosurvivorsnetwork.org.uk/archive/lincolnshire/library/usa/terms.html]

The most commonly accepted terms now are the Late Effects of Polio {LEOP} and Post-Polio Syndrome {PPS}

The Late Effects Of Polio
which encompasses anything happening after having POLIO that is affecting how the polio survivor is managing.

[Post Polio Newsletter, Dec 2010 Vol. 21 No. 4, Post Polio Network of Western Australia.  www.upnaway.com/poliowa]

Post Polio Syndrome
Terminology being used to describe the new symptoms being experienced by polio survivors following best recovery and stable years of function are:

http://www.poliosurvivorsnetwork.org.uk/archive/lincolnshire/library/usa/terms.html

Criteria for a Diagnosis is
1.  A history of remote paralytic polio or findings on history, physical  examination results, and laboratory studies  compatible with polio virus  damage of the central nervous system in earlier life. [Halstead L, MD -   Silver J, MD Am. J. Phys. Med. & Rehab. Jan/Feb 2000]

2.  A  period where we recovered.

3.  A stable period of functioning, from 10 to 50+ years.

4.  New symptoms for which there is no other explanation of :-


For several decades there has been a tendency to require a history of paralytic polio before any diagnosis of PPS will be considered. Such a pre-requisite is not supported by medical papers written in the 1950's and earlier that report evidence of a level of neuronal damage by the polio virus that does not present any clinical signs of paralysis at the time of infection. Hence, a history of non-paralytic polio does not preclude new PPS symptoms or a diagnosis of PPS when all other possible conditions have been excluded.

For a detailed explanation read Non-Paralytic Polio and PPS by Marcia Falconer, Ph.D. cell biology and Eddie Bollenbach, M.A. biology. A Lincolnshire Post-Polio Library publication. http://www.poliosurvivorsnetwork.org.uk/archive/lincolnshire/library/falconer/nonparalytic.html]

One theory is that the axonally sprouted nerve endings are dying off through over-use.