Post-polio syndrome (PPS) is now recognized as a new neurological disorder that can develop in people with a past history of poliomyelitis. It has been given a unique code number in the 10th edition of the International Classification of Medial Disorders (ICD-10) in the Neurological Disorders section on Diseases of the Motor Unit. This allows it to be differentiated from simply a “late effect of the viral infection of poliomyelitis,” which has a code in the Infectious Diseases Section. [For a thorough discussion of coding and of names used for new weakness that begins years later after acute polio, see Handbook entries on Coding and on Post-Polio Muscular Atrophy, as well as read “ICD Codes and Some ‘Post-Polio Syndrome’ History” by Headley J; Post-Polio Health:Vol 32, No 2; Spring 2016.]
From a scientific research perspective the diagnosis of PPS is accurately given only to people who meet the following five criteria:
- a history of acute paralytic poliomyelitis with evidence of motor neuron loss;
- a period of partial or complete recovery followed by a period of stability of neurological functions;
- gradual or sudden onset of progressive new muscle weakness or abnormal muscle fatigability, with or without generalized fatigue, pain, muscle atrophy, breathing, or swallowing problems;
- symptoms persist for at least one year;
- exclusion of other neurological, medical, or orthopedic problems that account for the symptoms.
Thus, PPS becomes a diagnosis of exclusion and research is made difficult by the fact that a symptom may develop from more than one condition.
"Post-polio syndrome" is now used by polio survivors, their advocates, the media and much of the medical community to refer to increasing weakness and disability among aging polio survivors regardless of the likely reason(s) for the new disabling symptoms (see Theories).
The most common new symptoms are new weakness in muscles with or without known weakness from acute polio, fatigue problems, and pain problems. Less common new symptoms are breathing and swallowing problems, cold intolerance, and new muscle atrophy.
From a clinical perspective it can be useful to divide symptoms into two groups: neuromuscular and musculoskeletal. The neuromuscular symptoms are believed to be caused by a progressive deterioration of motor neurons (see Pathology). This deterioration results in new weakness and abnormal muscle fatigability. The musculoskeletal symptoms are more likely a result of wear and tear, as well as aging. The result is muscle pain and pain from osteoarthritis joints, inflamed tendons, strained ligaments, and mis-shaped joints. When pain problems reduce muscle use and activity levels, they can lead to new weakness and fatigue from disuse atrophy and deconditioning. Symptoms in one group can overlap and worsen symptoms in the other group. Thus, holistic and comprehensive management is most effective.
References
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