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Post-polio syndrome (PPS) is a condition that causes muscle weakness and atrophy in people who have previously had polio. PPS typically occurs 10 to 40 years after the initial polio infection, and its symptoms include muscle pain, fatigue, and breathing or swallowing problems. The exact cause of PPS is unknown, but it is believed to be related to the breakdown of nerve cells damaged by the poliovirus during the initial infection. This results in the loss of muscle strength and atrophy over time.
| Characteristics | Values |
|---|---|
| What is it? | Post-polio syndrome (PPS) |
| Who does it affect? | People who have had polio |
| When does it occur? | 10-40 years after the initial polio infection |
| What are the symptoms? | Muscle weakness, muscle atrophy, muscle pain, joint pain, fatigue, breathing or swallowing problems, scoliosis |
| What causes it? | Gradual degeneration of nerve cells (motor neurons) in the brainstem or spinal cord that were damaged by the poliovirus |
| How does it cause muscle atrophy? | The poliovirus damages or destroys motor neurons, which affects the communication between the brain and muscles. Surviving motor neurons grow new nerve ends to connect with other muscle fibres, but this puts the neurons under stress, causing them to slowly break down and resulting in muscle weakness and atrophy. |
| Is it contagious? | No, but the poliovirus is highly contagious |
| Is there a cure? | No, but treatments focus on managing symptoms |
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What You'll Learn
Post-polio syndrome (PPS)
The cause of PPS is still unknown, but there are several theories. One theory suggests that during recovery from polio, nerve cells (neurons) in the affected muscles may regrow many smaller branches (dendrites) from the large branches (axons) of nerve cells. These dendrites take over the function of neurons that the poliovirus killed. After years of functioning beyond their capacity, the nerve cells weaken and lose their ability to maintain the dendrites, causing the dendrites to shrink and the whole muscle to weaken. Another theory is that the poliovirus "sleeps" in the nervous system and reactivates later, causing PPS. It is also possible that the immune system gets confused and attacks the body's own nerves.
PPS causes gradual muscle weakness and atrophy. The severity of symptoms can vary from person to person. Other symptoms include muscle pain and twitches, joint pain, fatigue, and skeletal deformities such as curvature of the spine (scoliosis). Severe cases of PPS can resemble the symptoms of amyotrophic lateral sclerosis (ALS), but it is not a form of that condition. PPS is rarely life-threatening, but the symptoms can significantly interfere with a person's ability to function independently.
There is no cure for PPS, so treatment focuses on managing symptoms and improving quality of life. Specific strategies that can help manage PPS symptoms include non-fatiguing exercises, assistive devices, physical therapy, occupational therapy, and medicines.
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Nerve cells weaken and lose function
Post-polio syndrome (PPS) is a condition that can affect people several years after an initial polio infection. It causes muscle weakness and atrophy, and currently has no cure. The poliovirus infects the body by affecting nerve cells called motor neurons, which carry messages between the brain and muscles. Motor neurons consist of three basic components: the cell body, a major branching fiber (axon), and numerous smaller branching fibers (dendrites).
When the poliovirus infects the body, it often damages or destroys many motor neurons. As a result, the remaining neurons sprout new, smaller branches (dendrites) from the large branches (axons) of nerve cells. This promotes the recovery of muscle use, but it may also stress the nerve cell body when trying to nourish the additional fibers. Over time, this stress may cause the gradual breakdown of the sprouted fibers and, eventually, the neuron itself.
During recovery from polio, nerve cells (neurons) in the affected muscles may regrow many smaller branches (dendrites) from the large branches (axons) of nerve cells. However, after years of functioning beyond their capacity, the nerve cells weaken and lose their ability to maintain the dendrites. The dendrites then shrink, and the whole muscle becomes weaker.
In summary, nerve damage induced muscle loss is primarily based on muscle fiber atrophy, not the loss of muscle fibers. Muscle atrophy is caused by a decrease in protein synthesis and an increase in protein breakdown.
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Muscle weakness and atrophy
Post-polio syndrome (PPS) is a disorder of the nerves and muscles that can affect people who have previously had polio. It is characterised by a collection of symptoms that generally occur at least 10 to 40 years after the initial polio infection. PPS causes gradual muscle weakness and atrophy, with symptoms including slowly progressive muscle weakness, muscle pain and twitches, joint pain, and skeletal deformities such as scoliosis. The severity of symptoms can vary from person to person, and there is currently no cure for PPS.
During a polio infection, the poliovirus affects nerve cells called motor neurons, which carry messages between the brain and muscles. The poliovirus particularly affects the motor neurons in the spinal cord, damaging or destroying many of them. As a result, the remaining motor neurons sprout new, smaller branches (dendrites) to compensate for the loss. This helps to regain muscle strength during recovery from the initial polio infection.
However, over time, the additional stress on the motor neurons from maintaining these extra branches may lead to their breakdown. This results in the loss of muscle strength, causing muscle weakness and atrophy associated with PPS. The gradual degeneration of nerve cells in the brainstem or spinal cord damaged by the poliovirus could also contribute to PPS. Factors such as the severity of the initial polio infection, age at onset, and the extent of recovery may influence the likelihood of developing PPS.
The diagnosis of PPS involves a comprehensive approach to rule out other conditions with similar symptoms. A neurological exam can help identify muscle weakness and atrophy, and electromyography (EMG) can assess muscle electrical activity. Blood tests, muscle biopsies, and imaging scans, such as MRI or CT, may also be utilised to aid in diagnosing PPS and understanding the extent of nerve and muscle involvement.
While there is no cure for PPS, treatment focuses on managing symptoms and improving quality of life. Prescribed exercise programs, assistive devices, physical therapy, occupational therapy, and medications can help individuals manage PPS symptoms and maintain their independence. It is important for individuals experiencing new or changing symptoms to consult with healthcare professionals to receive appropriate assessments and support.
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Breathing and swallowing difficulties
Post-polio syndrome (PPS) is a condition that causes muscle weakness and atrophy in people who have previously had polio. PPS usually occurs 10 to 40 years after the initial recovery from polio. The severity of PPS symptoms varies from person to person, but they tend to progress slowly. PPS is not contagious, but the poliovirus is.
PPS can cause breathing difficulties when the muscles involved in breathing become weaker. This can lead to shortness of breath, sleep apnoea, and an increased risk of chest infections. Sleep apnoea occurs when the walls of the throat relax and narrow during sleep, interrupting normal breathing. This can result in extreme sleepiness during the day, headaches, and increased fatigue.
Swallowing difficulties are also a common symptom of PPS. The muscles required for chewing and swallowing may weaken, leading to coughing or choking when eating or drinking. Dysphagia, or difficulty swallowing, may also manifest as hoarseness, low volume, or a nasal-sounding voice, especially after speaking for a while or when tired. Many people with swallowing problems also experience breathing issues, such as difficulty clearing the throat, and may be at risk of aspiration pneumonia, caused by inhaling food particles into the lungs.
The late effects of polio, including PPS, are not caused by reinfection with the poliovirus but by factors related to the original infection. PPS is thought to be caused by the breakdown of nerve cell branches (dendrites) that compensated for nerves destroyed or damaged by the poliovirus. Over time, these nerve cells weaken and lose their ability to maintain the dendrites, leading to muscle weakness and atrophy.
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No cure, only symptom management
Polio, or poliomyelitis, is an infectious disease caused by the poliovirus. The virus affects the nerve cells called motor neurons that carry messages between the brain and the muscles. The poliovirus particularly affects the motor neurons in the spinal cord.
The poliovirus is highly contagious and can be spread through faecal-oral transmission (e.g. poor hygiene, ingestion of contaminated food or water) or via the oral-oral route. The incubation period ranges from three to six days for non-paralytic polio. If the disease progresses to cause paralysis, this usually occurs within 7 to 21 days.
While polio has no cure, most people will recover fully. However, some people experience lasting muscle weakness or paralysis. In less than 1% of cases, polio causes permanent paralysis of the arms, legs, or breathing muscles. In rare cases, polio can lead to breathing failure or death.
Those who have recovered from polio may develop post-polio syndrome (PPS) years later. PPS causes gradual muscle weakness and atrophy and affects people differently. It is believed that PPS occurs when nerve cells weaken and lose their ability to maintain the dendrites, which are the smaller branches of nerve cells. The dendrites then shrink, causing the whole muscle to weaken. PPS can also cause muscle pain and twitches, joint pain, and skeletal deformities such as scoliosis.
Currently, there is no cure for PPS, and treatment focuses on managing symptoms. People with PPS may be referred to physiotherapists or exercise physiologists to help with weakness, pain, or mobility problems. Respiratory therapy may also be recommended for breathing difficulties. Joining a support group can also help people cope with PPS.
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Frequently asked questions
Post-polio syndrome (PPS) is a condition that can affect people several years after an initial polio infection. It causes gradual muscle weakness and atrophy.
There are several theories as to what causes post-polio syndrome, but no one knows for sure. One theory is that it could be due to the recovery from the initial polio infection. During recovery from polio, nerve cells (neurons) in the affected muscles may regrow many smaller branches (dendrites) from the large branches (axons) of nerve cells. After years of functioning beyond their capacity, these dendrites then shrink, and the whole muscle becomes weaker.
The most common first sign of post-polio syndrome is a gradual new weakening in your muscles that were previously affected when you had polio. Symptoms include slowly progressive muscle weakness, muscle atrophy, muscle pain and twitches, joint pain, and skeletal deformities such as curvature of the spine (scoliosis).
