Post-Polio Syndrome: Pathophysiology and Clinical Management
Anne Carrington Gawne and Lauro S. Halstead
Because all evidence suggests that the pathological processes involved are benign, post-polio syndrome is not life-threatening unless there is severe pulmonary involvement or a swallowing disorder. Dalakas et al. (1986) found an average loss of strength of 1% per year in 27 persons followed for a mean of 8.2 years. This represents a rate of natural progression, as no one in the group studied was being treated to combat or modify the weakness. Although the long-term effects of such interventions remain to be studied, many clinicians have reported that patients who conscientiously adjust their lifestyles do improve, often increasing strength and stabilizing function. If weakness is, in part, due to overwork of the motor unit combined with musculoskeletal overuse, then interventions designed to reduce the metabolic demand on the overextended motor unit could conceivably alter this rate of decline. Munin, on the other hand, studied seven patients with quadriceps strength less than 5/5, new weakness and fatigue on one side and a contralateral leg without new weakness. They tested strength objectively with an isokinetic, isometric protocol. They saw no decline on either side over a 4-year period. However, EMGs were not done to confirm AHCD, and the level activity was not monitored. Therefore, before conclusive statements can be made about prognosis, well-controlled, long-term studies need to be performed. In the meantime, we must use our best clinical judgement.
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Created: 5th June 2000
Last modification: 25th January 2010.