post-polio syndrome
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Introduction
Progressive muscle weakness developing 20-30 years after poliomyelitis.
Pathology
- dysfunction of surviving motor neurons
- slow disintegration of axon terminals
- late denervation of muscles
- reactivation of latent or persistent poliovirus in the central nervous system may occur in some patients
Clinical manifestations
- mild to moderate deterioration in function
- fatigue
- muscle pain
- fasciculations
- muscle weakness
- onset is gradual
- manifestations may stabilize or progress to muscle atrophy
- extremities are often affected
- respiratory muscle &/or bulbar involvement
- severe dysphagia
- choking
- aspiration
- sleep apnea
Management
- non-fatiguing exercise is the treatment of choice[3]
- lifestyle adjustments & assitive devices
- lamotrigine might be effective in reducing pain & fatigue, resulting in fewer activity limitations.[4]
- medications reported to exacerbate post-polio syndrome
- other medications to avoid:
- barbiturates
- phenytoin (Dilantin)
- anti-psychotic medications
- antibiotics
- metoclopramide (Reglan)
- intravenous immune globulin unlikely to produce significant improvements in pain, fatigue, or muscle strength[5]
More general terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 823, 1236
- ↑ M. Wasaka, St. Mary's Medical Center
- ↑ Jump up to: 3.0 3.1 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
- ↑ Jump up to: 4.0 4.1 Koopman FS, Uegaki K, Gilhus NE et al Treatment for postpolio syndrome. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD007818. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21328301
Koopman FS, Beelen A, Gilhus NE et al. Treatment for postpolio syndrome. Cochrane Database Syst Rev. 2015;(5):CD007818 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25984923 https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007818.pub3/full - ↑ Jump up to: 5.0 5.1 Huang YH, Chen HC, Huang KW et al Intravenous immunoglobulin for postpolio syndrome: a systematic review and meta-analysis. BMC Neurol. 2015 Mar 22;15:39. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25886512 PMCID: PMC4379590 Free PMC article.
- ↑ National Institute of Neurological Disorders and Stroke (NINDS) Post-Polio Syndrome https://catalog.ninds.nih.gov/pubstatic//12-4030/12-4030.pdf