Laboratory Studies

Obtain a complete blood count (CBC) and cerebrospinal fluid analysis to exclude conditions other than postpolio syndrome. Also obtain swallowing studies.

Imaging Studies

Computed tomography (CT) scanning and magnetic resonance imaging (MRI) can be ordered to rule out other possible diagnoses or structural neurologic processes (eg, stroke, multiple sclerosis, tumor).

Other Tests

Electrodiagnostic studies^[6]are used to rule out other neurologic or neuromuscular disorders in the differential diagnosis. The following 5 phases of electrodiagnostic study findings of anterior horn cell disease have been recognized:

Acute myelitis (first month)
Early recovery (2-12 mo)
Late recovery
Functional stability
Late changes during functional stability (eg, fasciculations, positive waves, fibrillations, increased amplitude and duration of motor unit potentials)

In postpolio syndrome (PPS), sensory conductions should be normal; motor conductions usually are normal but may be slow. In late stages, amplitude decreases significantly.

Single-fiber electromyography reveals increased jitter and blocking. This observation is related to the fact that in PPS, variable degrees and different types of neuromuscular transmission failure have been found in affected patients who had associated histologic signs of reinnervation in their muscle biopsies.

Functional and structural abnormalities of neuromuscular junctions are common, but not necessary, conditions for the diagnosis of PPS. These neuromuscular junction transmission defects typically are observed in the early stage of the neuronal degeneration that produces PPS. Whether neuromuscular junction transmission defects increase with the passage of time is unclear.

Histologic Findings

In the chronically denervated muscles of patients with postpolio syndrome, there are secondary myopathic features, including endomysial inflammation and rare vacuolated fibers.

Treatment & Management

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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.