PostPolio Syndrome

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Post-Polio Syndrome

• Lauro S. Halstead, M.D.
• Director, Post-Polio Program
• National Rehabilitation Hospital
• Washington, D.C.
• February 24, 2005

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Post-Polio Syndrome
Outline

• A Brief History of Polio
• What is PPS, Anyway?
• Do We Know the Cause of PPS?
• How Do You Diagnose PPS?
• How in the World Do You Treat It?
• Is There/Should There Be Any Outreach?

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A. Acute Paralytic Polio
Post-Polio Syndrome

• Virus
• Contaminated water/food
• Affinity for motor (muscle) nerves
• Kills/injures motor nerves
• Results in weakness/paralysis

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A. Acute Paralytic Polio-2
Post-Polio Syndrome

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

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A. Acute Paralytic Polio-3
Post-Polio Syndrome

• 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 - lt 1000 cases worldwide

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B. What is PPS?
Post-Polio Syndrome

• 1. A neurological condition
• 2. New symptoms many years after
• acute polio - typically 30-50 yrs.
• New symptoms appear after a period of
  neurological stability
• Major sxs- New weakness, loss of function,
  intense fatigue, pain in muscles/joints

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C. What is the Cause of PPS?
Post-Polio Syndrome

• Basically, tired/overworked motor nerves
• leading to new weakness/fatigue/pain
• 2. Maybe immunologic component

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D. Diagnosis
Post-Polio Syndrome

• 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

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F. Treatment
Post-Polio Syndrome

• Rehabilitation often low tech
• Change in lifestyle
• Energy conservation
• Bracing and pacing
• Exercise normal or strong muscles
• Medications
• NGF, Stem cells, Immunoglobulins

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F. Symptom Management
Specific Examples
1. Home
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O.K. BUT COULD BE BETTER
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BETTER