| WHEN A POLIO SURVIVOR presents with
nonspecific symptoms such as weakness and fatigue, how do you determine whether they are due to postpolio syndrome or to an unrelated problem?
Postpolio syndrome is a neurologic disorder defined by a collection of symptoms occurring decades after a patient has recovered from an initial infection with the poliovirus. New muscle weakness is the hallmark, but breathing or swallowing problems, fatigue, myalgias, and cold intolerance are frequently also present.
In this review, we discuss the criteria for diagnosing postpolio syndrome, guidelines for ruling out other conditions, and treatment strategies to optimize function in postpolio patients.
1 MILLION POLIO SURVIVORS
There are probably at least 1 million polio survivors in the United States, though not all have residual effects. Worldwide, there are millions more. Polio eradication is ongoing, and it is hoped that new cases will be completely eliminated over the next few years.
ACUTE POLIOMYELITIS MAY BE SUBCLINICAL
Historically and even recently, acute poliomyelitis has been thought of as having distinct presentations:
Abortive polio, which presents as a minor illness of fever, malaise, sore throat, anorexia, myalgias, and headache
Nonparalytic polio, which presents as aseptic meningitis
Paralytic polio, which presents as severe back, neck, and muscle pain, with the rapid or gradual development of paralysis.1
In fact, however, the acute viral illness is probably more of a spectrum, in which there are subclinical cases of paralysis that in the past would have been classified as nonparalytic.2 This concept is important because although most patients who are at risk for postpolio syndrome had well-recognized “paralytic” polio, others who were never diagnosed with polio or were thought to have had “nonparalytic” polio may also be at risk for postpolio syndrome.
An estimated 60% of “paralytic” polio survivors are affected by postpolio syndrome.3 The prevalence in those who had subclinical illness is unknown.
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