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Polio & Post Polio Syndrome
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-
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-
Non-
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/ppspan dcm.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/dppll p.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-
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/term s.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 -
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 :-
- fatigue often overwhelming, both physical and mental,
- loss of muscle strength and/or use also in muscles below the line of clinically evident weakness at the time of the original infection.
- pain in muscles and joints.
- trouble breathing and/or swallowing
- problems sleeping
- intolerance of cold, causing muscle weakness and sometimes burning pain and/or discolouration in limbs
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-
For a detailed explanation read Non-
One theory is that the axonally sprouted nerve endings are dying off through over-
