As the population of polio survivors continues to age, it is crucial for clinicians and health systems to recognize the significance of Post-Polio Syndrome (PPS). This condition is often under-diagnosed or misinterpreted as simply a result of aging or arthritis. Providing appropriate rehabilitation and support for polio survivors experiencing PPS is vital.
While it is well-known that poliomyelitis can lead to acute paralysis, global vaccination efforts have dramatically reduced the incidence of the disease in many regions. However, the long-term effects experienced years or even decades after recovery from polio are less frequently discussed. Survivors may develop PPS, a condition that highlights the extended repercussions of polio, indicating that recovery is not the end of their journey.
The poliovirus primarily attacks motor neurons in the spinal cord, resulting in muscle weakness or paralysis in some patients. Although many survivors achieve significant recovery due to the nervous system”s ability to form compensatory connections, these adaptations may begin to fail over time. PPS typically manifests as new muscle weakness, fatigue, and joint pain, with symptoms appearing 15 to 40 years post-infection. Estimates suggest that PPS could affect between 25% to 40% of polio survivors, but other reports indicate it might be as high as 80% depending on the criteria used.
The exact cause of PPS remains unclear, but the prevailing theory suggests that after the initial infection, surviving motor neurons extend their connections to compensate for damaged neurons. Over the years, these neurons can become overworked and start to deteriorate. Factors such as natural aging, stress, and muscle disuse or overuse may also play a role. Some studies have indicated structural changes, such as atrophy of spinal cord grey matter in PPS patients, which correlate with functional decline.
In my clinical experience, I often hear polio survivors express concerns about their health, stating, “I was fine for many years, but now I am not able to walk as far anymore, I am fatigued more easily, my polio leg is weaker again, and I have more joint pain.” These statements reflect the classic symptoms of PPS, which can manifest as weakness in previously affected limbs or even in areas that were never impacted by the original illness. Additional symptoms may include fatigue, muscle cramps, joint pain, sleep disturbances, and cold intolerance.
Although PPS does not typically lead to mortality, significant muscle involvement can result in serious complications such as falls, fractures, or breathing and swallowing difficulties. With the aging population of polio survivors, the prevalence of PPS is becoming an increasing global concern. Many individuals who survived the polio epidemics of the 1940s to 1960s are now older adults facing the challenges associated with PPS.
Currently, there is no cure for PPS, and treatment focuses on managing symptoms to help individuals maintain mobility. Gentle physical therapy and low-impact exercises are essential to preserving muscle function without excessive fatigue, as overexertion can exacerbate tiredness. Simple strategies like taking breaks, pacing daily activities, and using mobility aids can save energy. A combination of physiotherapy, heat application, and mild medications often provides significant relief from pain and improvements in walking ability, offering hope for better management of PPS.
As the population of polio survivors continues to age, it is essential for healthcare professionals to be cognizant of PPS. This condition is frequently overlooked or incorrectly attributed to normal aging or arthritis. Ongoing vigilance involves inquiring about an individual”s history of polio when encountering older patients with new onset weakness or fatigue, evaluating other potential causes, and developing a comprehensive care plan.
From a public health perspective, the situation serves as a powerful reminder of the long-term benefits of vaccination. Preventing polio not only averts the immediate illness but also eliminates the future burden of PPS. Survivors of polio may find that their journey does not end after recovery, as they can face new challenges decades later. It is imperative for medical professionals to recognize PPS, treat it appropriately, and assist patients in adapting to these changes rather than allowing them to endure silently. For those who survived polio, it is important to understand that if they notice new fatigue, weakness, or pain, they should not dismiss these symptoms as merely aging. Instead, they should consult their physician about PPS to receive the necessary rehabilitation and support, ensuring that their mobility and quality of life remain within their control.
Dr. Keni Ravish Rajiv serves as a senior consultant in neurology and is the head of the epilepsy service at Aster Whitefield Hospital in Bengaluru.
