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Post-Polio Syndrome: Pathophysiology and Clinical Management
Anne Carrington Gawne and Lauro S. Halstead

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VII. CLINICAL FEATURES OF POSTPOLIO SYNDROME.

A variety of studies over the past 10 years demonstrate that the majority of post-polio patients develop similar symptoms, the frequency and relative rank of these are taken from a number of studies and shown in Table 3.[13,72,73,76,77] Of these reports, two are population based (Codd and Ramlow), one is based on a questionnaire (Halstead), and the remainder are clinically based, which accounts for the relative differences in the prevalence of symptoms. In addition to the more frequent symptoms, other problems that have been reported include increased sleep requirements, dizziness, syncope, and headaches. Major new functional problems are listed in Table 4.[72,74,75,77]

TABLE 3
Comparison of Most Common New Symptoms in Subjects with a History of Paralytic Polio Reported in Six Studies

Symptom Codd[77]
N = 28
Halstead[72]
N = 132
Chetwynd[76]
N = 694
Agre[75]
N = 79
Ramlow[13]
N = 474
Halstead[74]
N = 539
Fatigue 59% 89%[a] 48% 86% 34% 87%[a]
Joint Pain 74%[a] 71% 60%[a] 77% 42%[a] 80%
Muscle Pain 48% 71% 52% 86% 38% 79%
New Weakness 71% N/A 47% 69% 38% N/A
  Affected muscle 66% 69% N/A 80% N/A 87%
  Unaffected muscle 15% 50% N/A 53% N/A 77%
Cold Sensitivity 46% 29% N/A N/A 26% N/A
a = Most frequent symptom.
Note: N = Number of subjects reported.

TABLE 4
Most Common New Functional Problems in Persons with a History of Paralytic Polio Reported in Four Studies

Functional
Problem
Codd[77]
N = 28
Halstead[72]
N = 132
Agre[75]
N = 79
Halstead[74]
N = 539
Difficulty walking 25%[a] 63%[a] N/A 85%[a]
Difficulty climbing Stairs N/A 61% 67%[a] 82%
Difficulty with ADLS 14% 17% 16% 62%
a = Most common new problem.
Note: N = Number of subjects reported.

In general, the patients most at risk for developing new problems are those who experienced more severe polio at onset, although some patients with typical post-polio symptoms had seemingly very mild polio with excellent clinical recovery. Table 5 summarizes the factors associated with progressive weakness.[47,48] Inasmuch as the age at onset of polio is a factor, persons who were older when they contracted polio appear to be at an increased risk for new neurologic symptoms. The onset of these new problems is most commonly insidious, but in many persons they are precipitated by specific events such as a minor accident, period of bed rest, or weight gain. Patients characteristically say that a similar event several years earlier would not have caused the same decline in health and function. Likewise, new problems may begin when coexisting medical problems such as diabetes develop or worsen. More specific details regarding these complaints are covered later in this article.

The time course for the development of late symptoms is fairly characteristic, as demonstrated in Figure 9. While the range between the initial episode and onset of symptoms is 8 to 71 years, the mean interval is around 35 years.[78]

TABLE 5 Factors Associated with the Development of Progressive Weakness.[47,48]
Age of initial infection more than 10 years old. [a]
History of hospitalization.
Ventilator use.
Paralytic involvement in all four limbs.
More weakness at time of acute polio.
A longer time since acute infection.
Recent weight gain.
Muscle pain associated with exercise.
Greater age at time of presentation to clinic.

a. Reports differ from study to study.

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