SMASAC Working Group Post Polio Syndrome - Scottish Health On ...

Scottish Medicines and Scientific Advisory Committee Working Group
Post Polio Syndrome/Late Effects of Polio
If the patient appears to have PPS/LEOP, are the symptoms mechanical
or due to new neurological deterioration?
If the symptoms do appear to be due to a polio related process, there is
then a need to differentiate mechanical issues from new neurological
weakness. This is done initially by history and examination. On
examination, the patient’s gait, their limb length, their back, range of
movement in the joints and muscle weakness must all be assessed. Nerve
entrapments (more common in post polio patients) should be excluded.
Degenerative joint changes may occur either in the affected limb or in
unaffected limbs which have been compensating for weakness elsewhere.
If the patient has pain, neurogenic pain must be differentiated from locally
determined nocioceptive pain. Orthopaedic procedures, such as joint
replacement, or other interventions should be considered for mechanical
problems.
Attribution of new weakness to PPS/LEOP can be difficult when it is in a
part of the body previously affected in the acute attack. Sometimes
patients manage until they reach a critical threshold in muscles which
have been affected mildly or subclinically in the acute attack such that
they cannot function any longer. PPS/LEOP should be considered only
after excluding other causes for changing patterns of weakness,
deterioration in muscle or physical function or decreasing muscle mass.
Very few patients with post polio will be young adults and muscle bulk
diminishes with increasing age. There is often considerable difficulty in
determining how much new muscle weakness is due to PPS/LEOP rather
than other diseases, disuse or age related decline in muscle function. The
measures taken to exclude other disease may be helpful in deciding that
there is a new process going on rather than simple age-related
deterioration.
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