June 22, 2012
Dear Mayo Clinic:
How is post-polio syndrome diagnosed? Are there any new treatments for it?
Post-polio syndrome refers to a group of symptoms that can surface decades — often up to 30 or 40 years — after a person has polio.
In previous generations, polio was a much-feared illness. But as a result of the now-famous Salk vaccine, polio was virtually wiped out in developed countries in the mid-1950s. The World Health Organization, or WHO, almost accomplished worldwide elimination of polio by the early 2000s. But because of political turmoil, the WHO could not reach all the areas where polio still occurs. As a result, there have been recent polio outbreaks. They have been largely limited to isolated epidemics in areas of central Africa, with rarer cases in central Asia.
No polio epidemics have happened in the United States since the introduction of polio vaccination. There remains, however, a large population of people who were infected with polio before the start of vaccination programs who continue to live with significant muscle weakness as a result of the disease. In the United States, that number is about 250,000.
Years after the initial illness, many polio survivors have symptoms of worsening weakness, pain and fatigue. This group of symptoms has been called "post-polio syndrome." The people who have muscle weakness from polio are at highest risk for post-polio syndrome, while those who recovered without muscle weakness are at lower risk for developing this syndrome later in life.
About two-thirds or more of people left with muscle weakness after their polio attack go on to develop post-polio syndrome. Fortunately, in most cases the symptoms get worse slowly and remain mild. A small number, however, may be more significantly affected and need to make lifestyle adjustments or use adaptive equipment to help them stay mobile.
There is no specific diagnostic test for post-polio syndrome. Doctors usually diagnose it by excluding other possible causes for a person's symptoms. For example, it is very common for polio survivors to develop degenerative arthritis at an early age. This often comes from the unnatural stress they put on their joints over a lifetime of living with muscle weakness. Other overuse problems are also common in people who have had polio. They include chronic tendonitis, bursitis and other musculoskeletal problems. Once these conditions have been ruled out, post-polio syndrome can be considered.
No treatment is currently available that can repair or restore the strength of muscles affected by post-polio syndrome. The goal of treatment is to effectively manage the symptoms and keep people with this condition as comfortable and independent as possible.
Energy conservation and rest are important for those dealing with post-polio syndrome. This may include pacing one's physical activity throughout the day, and alternating it with frequent periods of rest. Assistive devices, such as leg braces, a cane, walker or, in rare cases, a wheelchair or motorized scooter, may also help conserve energy and improve mobility.
Physical therapy is often recommended for people who have post-polio syndrome. Stretching and range of motion exercises can be very helpful. In some cases, pain medication may be needed as well. Aggressive muscle strengthening programs are discouraged because they do not appear to actually improve muscle strength. They also can raise a person's risk for more overuse injuries.
Although there is not a cure for post-polio syndrome, most polio survivors with this condition are able to manage it well with the help of their health care team. Many continue to lead productive, independent lives well into their late-senior years.
— Eric J. Sorenson, M.D., Neurology, Mayo Clinic, Rochester, Minn.