Diagnostic Considerations

These include the following:

Anemia
Chronic infection
Collagen disorders
Deconditioning
Depression
Hypothyroidism
Infectious myopathy
Myasthenia gravis
Weakness due to aging
Weight gain

Investigators initially believed that poliovirus could cause amyotrophic lateral sclerosis (ALS), but there is no evidence of this risk. Studies that show an association between both pathologies are infrequent and are greatly outnumbered by negative reports. The role, if any, of nonparalytic polio and polio vaccines in ALS is not clear. With such a high proportion of the population having antibodies to polio, it may not be feasible to differentiate ALS with respect to the presence or absence of polio antibodies. Still, further long-term studies of the classical and Western Pacific forms of ALS with respect to past polio outbreaks are desirable.

Differential Diagnoses

Workup

Lo JK, Robinson LR. Postpolio syndrome and the late effects of poliomyelitis. Part 1. pathogenesis, biomechanical considerations, diagnosis, and investigations. Muscle Nerve. 2018 Dec. 58 (6):751-9. [QxMD MEDLINE Link]. [Full Text].
Lo JK, Robinson LR. Post-polio syndrome and the late effects of poliomyelitis: Part 2. treatment, management, and prognosis. Muscle Nerve. 2018 Dec. 58 (6):760-9. [QxMD MEDLINE Link]. [Full Text].
Halstead LS. Assessment and differential diagnosis for post-polio syndrome. Orthopedics. 1991 Nov. 14(11):1209-17. [QxMD MEDLINE Link].
Polio Australia Inc. The Late Effects of Polio: Introduction to Clinical Practice. Available at http://www.postpolio.org.nz/__data/assets/pdf_file/0016/56050/The-Late-Effects-of-Polio-Introduction-to-Clinical-Practice.pdf. 2012; Accessed: August 14, 2017.
March of Dimes Birth Defects Foundation. Post-polio syndrome: identifying best practices in diagnosis and care. http://www.marchofdimes.com/mission/polio.aspx. Available at http://www.polioplace.org/sites/default/files/files/MOD-%20Identifying.pdf. Accessed: Aug 11, 2017.
Correa JC, Rocco CC, de Andrade DV, et al. Electromyographic and neuromuscular analysis in patients with post-polio syndrome. Electromyogr Clin Neurophysiol. 2008 Nov-Dec. 48(8):329-33. [QxMD MEDLINE Link].
Tersteeg IM, Koopman FS, Stolwijk-Swuste JM, Beelen A, Nollet F. A 5-year longitudinal study of fatigue in patients with late-onset sequelae of poliomyelitis. Arch Phys Med Rehabil. 2011 Jun. 92(6):899-904. [QxMD MEDLINE Link].
Atwal A, Giles A, Spiliotopoulou G, Plastow N, Wilson L. Living with polio and postpolio syndrome in the United Kingdom. Scand J Caring Sci. 2013 Jun. 27(2):238-45. [QxMD MEDLINE Link].
Duncan A, Batliwalla Z. Growing older with post-polio syndrome: social and quality-of-life implications. SAGE Open Med. 2018. 6:2050312118793563. [QxMD MEDLINE Link]. [Full Text].
Gonzalez H, Ottervald J, Nilsson KC, et al. Identification of novel candidate protein biomarkers for the post-polio syndrome - implications for diagnosis, neurodegeneration and neuroinflammation. J Proteomics. 2009 Jan 30. 71(6):670-81. [QxMD MEDLINE Link].
Bouza C, Munoz A, Amate JM. Postpolio syndrome: a challenge to the health-care system. Health Policy. 2005 Jan. 71(1):97-106. [QxMD MEDLINE Link].
Wendebourg MJ, Weigel M, Richter L, et al. Spinal cord gray matter atrophy is associated with functional decline in post-polio syndrome. Eur J Neurol. 2022 May. 29 (5):1435-45. [QxMD MEDLINE Link]. [Full Text].
Li Hi Shing S, Lope J, Chipika RH, Hardiman O, Bede P. Extra-motor manifestations in post-polio syndrome (PPS): fatigue, cognitive symptoms and radiological features. Neurol Sci. 2021 Feb 26. [QxMD MEDLINE Link].
Ramlow J, Alexander M, LaPorte R, Kaufmann C, Kuller L. Epidemiology of the post-polio syndrome. Am J Epidemiol. 1992 Oct 1. 136(7):769-86. [QxMD MEDLINE Link].
Quadros AA, Conde MT, Marin LF, Silva HC, Silva TM, Paula MB, et al. Frequency and clinical manifestations of post-poliomyelitis syndrome in a Brazilian tertiary care center. Arq Neuropsiquiatr. 2012 Aug. 70(8):571-3. [QxMD MEDLINE Link].
Ragonese P, Fierro B, Salemi G, Randisi G, Buffa D, D'Amelio M, et al. Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors. J Neurol Sci. 2005 Sep 15. 236(1-2):31-5. [QxMD MEDLINE Link].
Bertolasi L, Acler M, dall'Ora E, Gajofatto A, Frasson E, Tocco P, et al. Risk factors for post-polio syndrome among an Italian population: a case-control study. Neurol Sci. 2012 Dec. 33(6):1271-5. [QxMD MEDLINE Link].
Thakral M, Lacroix AZ, Molton IR. Sex/gender disparities in health outcomes of individuals with long-term disabling conditions. Rehabil Psychol. 2019 May. 64 (2):221-8. [QxMD MEDLINE Link].
Berlly MH, Strauser WW, Hall KM. Fatigue in postpolio syndrome. Arch Phys Med Rehabil. 1991 Feb. 72(2):115-8. [QxMD MEDLINE Link].
McNalley TE, Yorkston KM, Jensen MP, et al. Review of secondary health conditions in postpolio syndrome: prevalence and effects of aging. Am J Phys Med Rehabil. 2015 Feb. 94 (2):139-45. [QxMD MEDLINE Link]. [Full Text].
Trojan DA, Arnold DL, Shapiro S, Bar-Or A, Robinson A, Le Cruguel JP, et al. Fatigue in post-poliomyelitis syndrome: association with disease-related, behavioral, and psychosocial factors. PM R. 2009 May. 1(5):442-9. [QxMD MEDLINE Link].
Romigi A, Pierantozzi M, Placidi F, et al. Restless legs syndrome and post polio syndrome: a case-control study. Eur J Neurol. 2015 Mar. 22 (3):472-8. [QxMD MEDLINE Link].
Trojan DA, Cashman NR. Post-poliomyelitis syndrome. Muscle Nerve. 2005 Jan. 31(1):6-19. [QxMD MEDLINE Link].
Bickerstaffe A, Beelen A, Nollet F. Change in physical mobility over 10 years in post-polio syndrome. Neuromuscul Disord. 2015 Mar. 25 (3):225-30. [QxMD MEDLINE Link].
Klein MG, Whyte J, Keenan MA, Esquenazi A, Polansky M. Changes in strength over time among polio survivors. Arch Phys Med Rehabil. 2000 Aug. 81(8):1059-64. [QxMD MEDLINE Link].
Stolwijk-Swüste JM, Beelen A, Lankhorst GJ, Nollet F. The course of functional status and muscle strength in patients with late-onset sequelae of poliomyelitis: a systematic review. Arch Phys Med Rehabil. 2005 Aug. 86(8):1693-701. [QxMD MEDLINE Link].
Fordyce CB, Gagne D, Jalili F, et al. Elevated serum inflammatory markers in post-poliomyelitis syndrome. J Neurol Sci. 2008 Aug 15. 271(1-2):80-6. [QxMD MEDLINE Link].
Stoelb BL, Carter GT, Abresch RT, et al. Pain in persons with postpolio syndrome: frequency, intensity, and impact. Arch Phys Med Rehabil. 2008 Oct. 89(10):1933-40. [QxMD MEDLINE Link].
Werhagen L, Borg K. Impact of pain on quality of life in patients with post-polio syndrome. J Rehabil Med. 2013 Feb. 45(2):161-3. [QxMD MEDLINE Link].
Portnoy S, Schwartz I. Gait characteristics of post-poliomyelitis patients: Standardization of quantitative data reporting. Ann Phys Rehabil Med. 2013 Oct. 56(7-8):527-41. [QxMD MEDLINE Link].
Vreede KS, Henriksson J, Borg K, Henriksson M. Gait characteristics and influence of fatigue during the 6-minute walk test in patients with post-polio syndrome. J Rehabil Med. 2013 Sep. 45(9):924-8. [QxMD MEDLINE Link].
Lira CA, Minozzo FC, Sousa BS, et al. Lung function in post-poliomyelitis syndrome: a cross-sectional study. J Bras Pneumol. 2013 Jun-Aug. 39 (4):455-60. [QxMD MEDLINE Link].
Söderholm S, Lehtinen A, Valtonen K, Ylinen A. Dysphagia and dysphonia among persons with post-polio syndrome - a challenge in neurorehabilitation. Acta Neurol Scand. 2010 Nov. 122(5):343-9. [QxMD MEDLINE Link].
Dean AC, Graham BA, Dalakas M, Sato S. Sleep apnea in patients with postpolio syndrome. Ann Neurol. 1998 May. 43(5):661-4. [QxMD MEDLINE Link].
Marin LF, Carvalho LBC, Prado LBF, Oliveira ASB, Prado GF. Restless legs syndrome is highly prevalent in patients with post-polio syndrome. Sleep Med. 2017 Sep. 37:147-50. [QxMD MEDLINE Link].
Ring D, Vaccaro AR, Scuderi G, Klein G, Green D, Garfin SR. An association between the flat back and postpolio syndromes: a report of three cases. Arch Phys Med Rehabil. 1997 Mar. 78(3):324-6. [QxMD MEDLINE Link].
Chang KH, Lai CH, Chen SC, Hsiao WT, Liou TH, Lee CM. Body composition assessment in taiwanese individuals with poliomyelitis. Arch Phys Med Rehabil. 2011 Jul. 92(7):1092-7. [QxMD MEDLINE Link].
Davidson AC, Auyeung V, Luff R, Holland M, Hodgkiss A, Weinman J. Prolonged benefit in post-polio syndrome from comprehensive rehabilitation: a pilot study. Disabil Rehabil. 2009. 31(4):309-17. [QxMD MEDLINE Link].
Curtis A, Lee JS, Kaltsakas G, et al. The value of a post-polio syndrome self-management programme. J Thorac Dis. 2020 Oct. 12 (Suppl 2):S153-62. [QxMD MEDLINE Link]. [Full Text].
Koopman FS, Voorn EL, Beelen A, et al. No Reduction of Severe Fatigue in Patients With Postpolio Syndrome by Exercise Therapy or Cognitive Behavioral Therapy: Results of an RCT. Neurorehabil Neural Repair. 2015 Aug 7. [QxMD MEDLINE Link].
Bruno RL, Frick NM. Stress and "type A" behavior as precipitants of post-polio sequelae: the Felician/Columbia Survey. Birth Defects Orig Artic Ser. 1987. 23 (4):145-55. [QxMD MEDLINE Link].
Skough K, Krossen C, Heiwe S, et al. Effects of resistance training in combination with coenzyme Q10 supplementation in patients with post-polio: a pilot study. J Rehabil Med. 2008 Oct. 40(9):773-5. [QxMD MEDLINE Link].
Skough K, Broman L, Borg K. Test-retest reliability of the 6-min walk test in patients with postpolio syndrome. Int J Rehabil Res. 2013 Jun. 36(2):140-5. [QxMD MEDLINE Link].
Voorn EL, Koopman FS, Brehm MA, et al. Aerobic Exercise Training in Post-Polio Syndrome: Process Evaluation of a Randomized Controlled Trial. PLoS One. 2016. 11 (7):e0159280. [QxMD MEDLINE Link]. [Full Text].
Chan KM, Amirjani N, Sumrain M, Clarke A, Strohschein FJ. Randomized controlled trial of strength training in post-polio patients. Muscle Nerve. 2003 Mar. 27(3):332-8. [QxMD MEDLINE Link].
Da Silva CP, Szot CL, deSa N. Whole body vibration on people with sequelae of polio. Physiother Theory Pract. 2019 Jun. 35 (6):554-64. [QxMD MEDLINE Link].
Bertelsen M, Broberg S, Madsen E. Outcome of physiotherapy as part of a multidisciplinary rehabilitation in an unselected polio population with one-year follow-up: an uncontrolled study. J Rehabil Med. 2009 Jan. 41(1):85-7. [QxMD MEDLINE Link].
Stein DP, Dambrosia JM, Dalakas MC. A double-blind, placebo-controlled trial of amantadine for the treatment of fatigue in patients with the post-polio syndrome. Ann N Y Acad Sci. 1995 May 25. 753:296-302. [QxMD MEDLINE Link].
Dinsmore S, Dambrosia J, Dalakas MC. A double-blind, placebo-controlled trial of high-dose prednisone for the treatment of post-poliomyelitis syndrome. Ann N Y Acad Sci. 1995 May 25. 753:303-13. [QxMD MEDLINE Link].
Vasconcelos OM, Prokhorenko OA, Salajegheh MK, Kelley KF, Livornese K, Olsen CH, et al. Modafinil for treatment of fatigue in post-polio syndrome: a randomized controlled trial. Neurology. 2007 May 15. 68(20):1680-6. [QxMD MEDLINE Link].
Chan KM, Strohschein FJ, Rydz D, Allidina A, Shuaib A, Westbury CF. Randomized controlled trial of modafinil for the treatment of fatigue in postpolio patients. Muscle Nerve. 2006 Jan. 33(1):138-41. [QxMD MEDLINE Link].
Koopman FS, Beelen A, Gilhus NE, de Visser M, Nollet F. Treatment for postpolio syndrome. Cochrane Database Syst Rev. 2015 May 18. CD007818. [QxMD MEDLINE Link].
Generali JA, Cada DJ. Pyridostigmine: Postpoliomyelitis Syndrome. Hosp Pharm. 2016 May. 51 (5):367-9. [QxMD MEDLINE Link]. [Full Text].
Ostlund G, Broman L, Werhagen L, Borg K. Immunoglobulin treatment in post-polio syndrome: Identification of responders and non-responders. J Rehabil Med. 2015 Sep 3. 47 (8):727-33. [QxMD MEDLINE Link].
Bertolasi L, Frasson E, Turri M, Gajofatto A, Bordignon M, Zanolin E, et al. A randomized controlled trial of IV immunoglobulin in patients with postpolio syndrome. J Neurol Sci. 2013 Jul 15. 330(1-2):94-9. [QxMD MEDLINE Link].
Trojan DA, Collet JP, Shapiro S, Jubelt B, Miller RG, Agre JC, et al. A multicenter, randomized, double-blinded trial of pyridostigmine in postpolio syndrome. Neurology. 1999 Oct 12. 53(6):1225-33. [QxMD MEDLINE Link].
Gonzalez H, Sunnerhagen KS, Sjoberg I, et al. Intravenous immunoglobulin for post-polio syndrome: a randomised controlled trial. Lancet Neurol. 2006 Jun. 5(6):493-500. [QxMD MEDLINE Link].
On AY, Oncu J, Uludag B, et al. Effects of lamotrigine on the symptoms and life qualities of patients with post polio syndrome: a randomized, controlled study. NeuroRehabilitation. 2005. 20(4):245-51. [QxMD MEDLINE Link].

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Author

Divakara Kedlaya, MBBS Locum Provider, Physical Medicine and Rehabilitation and Pain Management

Divakara Kedlaya, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kat Kolaski, MD Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Clinical Professor, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Martin K Childers, DO, PhD Professor, Department of Neurology, Wake Forest University School of Medicine; Professor, Rehabilitation Program, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center

Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology

Disclosure: Allergan pharma Consulting fee Consulting

Gerald J Herbison, MD Professor, Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University

Disclosure: Nothing to disclose.

Flor M Muñiz, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, McMaster University, Hamilton, Ontario

Flor M Muñiz, MD is a member of the following medical societies: American Medical Association, Canadian Association of Physical Medicine and Rehabilitation, and Canadian Medical Association

Disclosure: Nothing to disclose.