Post-Polio Syndrome

1. Post-Polio Syndrome Lauro S. Halstead, M.D. Director, Post-Polio Program National Rehabilitation Hospital Washington, D.C. February 24, 2005

2. Post-Polio Syndrome Outline • A Brief History of Polio • What is PPS, Anyway? • Do We Know the Cause of PPS? • How Do You Diagnose PPS? • How in the World Do You Treat It? • Is There/Should There Be Any Outreach?

3. Post-Polio Syndrome A. Acute Paralytic Polio • Virus • Contaminated water/food • Affinity for motor (muscle) nerves • Kills/injures motor nerves • Results in weakness/paralysis

4. Post-Polio Syndrome A. Acute Paralytic Polio-2 • Sporadic vs. epidemic disease • Ancient Egypt • 1916 – NYC: First major U.S. epidemic • 1920s – 1950s: Ever larger epidemics • 1952 - > 50,000 persons, mostly children

5. Post-Polio Syndrome A. Acute Paralytic Polio-3 • Miracle of the vaccines • 1955 – Salk (killed, injection) • 1961 – Sabin (weakened, oral) • 1972 - Last case in U.S. • 1991 - Last case in Western Hemisphere • 2004 - < 1000 cases worldwide

6. Post-Polio Syndrome B. What is PPS? 1. A neurological condition 2. New symptoms many years after acute polio - typically 30-50 yrs. • New symptoms appear after a period of neurological stability • Major sxs- New weakness, loss of function, intense fatigue, pain in muscles/joints

8. Post-Polio Syndrome C. What is the Cause of PPS? • Basically, tired/overworked motor nerves leading to new weakness/fatigue/pain 2. Maybe immunologic component

14. Post-Polio Syndrome D. Diagnosis • 5 Criteria • History of acute polio • Period of recovery • Period of stability • Onset of new weakness (and other symptoms) • Exclude other causes of new symptoms

16. Post-Polio Syndrome F. Treatment • Rehabilitation – often ‘low tech’ • Change in lifestyle • Energy conservation • “Bracing and pacing” • Exercise normal or strong muscles • Medications • NGF, Stem cells, Immunoglobulins

17. F. Symptom Management : Specific Examples 1. Home

19. O.K. BUT COULD BE BETTER

20. BETTER