Post-Polio Syndrome

Lauro S. Halstead, M.D.

Director, Post-Polio ProgramNational Rehabilitation Hospital

Washington, D.C.February 24, 2005

A. A Brief History of Polio

B. What is PPS, Anyway?

C. Do We Know the Cause of PPS?

D. How Do You Diagnose PPS?

E. How in the World Do You Treat It?

F. Is There/Should There Be Any Outreach?

Post-Polio Syndrome

Outline

A. Acute Paralytic Polio

1. Virus

2. Contaminated water/food

3. Affinity for motor (muscle) nerves

4. Kills/injures motor nerves

5. Results in weakness/paralysis

Post-Polio Syndrome

A. Acute Paralytic Polio-2

• Sporadic vs. epidemic disease• Ancient Egypt• 1916 – NYC: First major U.S. epidemic• 1920s – 1950s: Ever larger epidemics• 1952 - > 50,000 persons, mostly children

Post-Polio Syndrome

A. Acute Paralytic Polio-3

• Miracle of the vaccines• 1955 – Salk (killed, injection)

• 1961 – Sabin (weakened, oral)

• 1972 - Last case in U.S.

• 1991 - Last case in Western Hemisphere

• 2004 - < 1000 cases worldwide

Post-Polio Syndrome

B. What is PPS?

1. A neurological condition

2. New symptoms many years after

acute polio - typically 30-50 yrs.

3. New symptoms appear after a period of neurological stability

4. Major sxs- New weakness, loss of function, intense fatigue, pain in muscles/joints

Post-Polio Syndrome

C. What is the Cause of PPS?

1. Basically, tired/overworked motor nerves

leading to new weakness/fatigue/pain

2. Maybe immunologic component

Post-Polio Syndrome

D. Diagnosis

• 5 Criteria• History of acute polio• Period of recovery• Period of stability• Onset of new weakness (and other

symptoms)• Exclude other causes of new symptoms

Post-Polio Syndrome

F. Treatment

1. Rehabilitation – often ‘low tech’• Change in lifestyle• Energy conservation• “Bracing and pacing” • Exercise normal or strong muscles

2. Medications• NGF, Stem cells, Immunoglobulins

Post-Polio Syndrome

F. Symptom Management : Specific Examples

1. Home

O.K.BUT COULD BE BETTER

BETTER