EFNS guideline on diagnosis and management of post‐polio syndrome. Report of an EFNS task force

Abstract

Post‐polio syndrome (PPS) is characterized by new or increased muscular weakness, atrophy, muscle pain and fatigue several years after acute polio. The aim of the article is to prepare diagnostic criteria for PPS, and to evaluate the existing evidence for therapeutic interventions. The Medline, EMBASE and ISI databases were searched. Consensus in the group was reached after discussion by e‐mail. We recommend Halstead's definition of PPS from 1991 as diagnostic criteria. Supervised, aerobic muscular training, both isokinetic and isometric, is a safe and effective way to prevent further decline for patients with moderate weakness (Level B). Muscular training can also improve muscular fatigue, muscle weakness and pain. Training in a warm climate and non‐swimming water exercises are particularly useful (Level B). Respiratory muscle training can improve pulmonary function. Recognition of respiratory impairment and early introduction of non‐invasive ventilatory aids prevent or delay further respiratory decline and the need for invasive respiratory aid (Level C). Group training, regular follow‐up and patient education are useful for the patients’ mental status and well‐being. Weight loss, adjustment and introduction of properly fitted assistive devices should be considered (good practice points). A small number of controlled studies of potential‐specific treatments for PPS have been completed, but no definitive therapeutic effect has been reported for the agents evaluated (pyridostigmine, corticosteroids, amantadine). Future randomized trials should particularly address the treatment of pain, which is commonly reported by PPS patients. There is also a need for studies evaluating the long‐term effects of muscular training.

Effects of Dăoyĭn Qìgōng in postpolio syndrome patients with cold intolerance

“…A study conducted in Brazil reported that CI, among other symptoms, is more prevalent among women (75%) 8 . In this study, our patients were predominantly female, which is consistent with other PPS studies conducted in Brazil 4,5 as well as internationally [17][18][19] . In Brazil, the predominance of female patients is attributed to the fact that women seek health services more often than men (excluding one case in which gender predominance was reversed) 20 .…”

“…In Brazil, the predominance of female patients is attributed to the fact that women seek health services more often than men (excluding one case in which gender predominance was reversed) 20 . The average age of patients in this study was 48.3 years, that is similar to Brazilian and international studies in which an average age of 50 to 63 years was reported 17,21,22 . The level of patient schooling averaged 13.20±1.57 years.…”

Total Hip Arthroplasty Performed in Patients with Residual Poliomyelitis: Does it Work?

“…The mild pain at the end of the day that patients reported could be related to postpolio muscle pain in the paralytic group and remnant leg length discrepancy in the contralateral group, but this is speculative. We recommend abductor strengthening exercises in the paralytic group [4,12,38].…”

Pyridostigmine: Postpoliomyelitis Syndrome

“…Although the exact incidence has not been established, symptoms occur decades after recovery from acute polio. [1][2][3] Pyridostigmine, an anticholinesterase agent, inhibits the hydrolysis of acetylcholine, prolonging its effects in the neuromuscular junction. Studies suggest that neuromuscular junction transmission in postpoliomyelitis syndrome may improve with anticholinesterases.…”