Post-polio syndrome

Background

• May also be referred to as late onset polio symptoms, and overlaps with post-polio muscular dysfunction and post-polio muscular atrophy

Epidemiology

• Occurs in 15 to 80% of patients with previous polio

Clinical Manifestations

• Musculoskeletal:
  • Fatigue and decreased endurance
  • Increased skeletal deformities, such as scoliosis, causing deterioration in functioning
  • Joint pain
• New muscle weakness and atrophy
  • New muscle weakness (may be in muscles originally affected or in those originally spared)
  • New muscular atrophy
  • Occasional pain and fasciculations
  • New bulbar, respiratory, or sleep difficulties

Diagnostic Criteria

Halstead Criteria

• First described in 19851 and updated in 19912
• Requires all of the following:
  • Confirmed history of polio.
  • Partial or fairly complete neurological and functional recovery after the acute episode.
  • Period of at least 15 years with neurological and functional stability.
  • Gradual or abrupt onset of new neurogenic weakness.
  • Two or more of the following health problems occurring after the stable period:
    • Extensive fatigue
    • Muscle and/or joint pain
    • New weakness in muscles previously affected or unaffected
    • New muscle atrophy
    • Functional loss
    • Cold intolerance
  • No other medical explanation found

Further Reading

• EFNS guideline on diagnosis and management of post-polio syndrome. Eur J Neurol. 2006;13(8):795-801. doi: 10.1111/j.1468-1331.2006.01385.x