Post-Polio Syndrome - Symptoms

Symptoms

There are many possible symptoms of post-polio syndrome (PPS). The exact symptoms you may have depend on many factors, including which muscles were affected by the original polio infection. For most people, muscle weakness caused by PPS gets worse very gradually and may take many years to become noticeable. You may go through long periods of stability when your symptoms do not get any worse.

The symptoms of PPS may resemble those of amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease), a disease of the nerves that control movement (motor neurons) that usually leads to death within several years. Post-polio syndrome is not a form of ALS and usually is not life-threatening.

The most common symptoms of post-polio syndrome are:

• New muscle weakness.
• Fatigue.
• Muscle and joint pain.

New muscle weakness

Most people who have PPS develop new muscle weakness. In some cases the weakness is caused by wasting away (atrophy) of the muscle. This new muscle weakness is sometimes called post-polio progressive muscular atrophy.

Muscle weakness is most common in the muscles that were originally affected by polio. But many people with PPS find that muscles that were not paralyzed by polio are getting weaker as well. This is not because PPS is spreading. Instead, experts believe that these muscles were indeed affected by the polio virus, but the effect was not as severe. In fact, in most cases the person never knew that polio had affected the nerves that control those muscles.

In some cases new muscle weakness is caused by underuse of that muscle. This may happen if you stop using the muscle because of fatigue or pain in your joints or muscles.

Fatigue

Most people with PPS experience fatigue, which is a feeling of exhaustion, after a short period of activity. You may find that activities you were once were able to do without getting tired now cause fatigue. You may feel tired, lack energy, or have a heavy sensation in your muscles. When fatigue is severe, it can affect your ability to think or concentrate. You may even feel confused or sleepy. A short rest after activity usually can reduce your fatigue.

Muscle or joint pain

Many people with PPS have muscle or joint pain.

Even when it seems that you have completely recovered from polio, your muscles tend to be weaker than normal. To make up for this weakness, other muscles have to work harder. This is especially noticeable when you are walking. When muscles have to work overtime this way, it puts extra stress on muscles, joints, and tendons.

Over time, this extra stress may lead to muscle aches or cramping from overuse and joint or tendon pain from excess wear on joints and tendons. In many cases the pain is severe enough to limit your use of that part of your body. This resulting decrease in activity can lead to muscle weakness and can create a cycle of weakness, overuse of other muscles, and increased pain.

Symptoms of PPS, especially weakness and pain, can lead to difficulty in doing daily activities, such as getting dressed. This is most common among people who have shoulder or arm weakness.

New problems with walking or climbing stairs are also common in people with PPS. These problems occur most often in people who used braces, crutches, a cane, or some other aid while they were recovering from polio and then later in recovery found they could stop using the walking aid. The cause of this symptom is gradual loss of muscle strength, muscle and joint pain, and damage to joints (osteoarthritis) and tendons from the extra strain placed on them.

While PPS usually is not a life-threatening condition, you may experience complications, including:

• Swallowing problems. If your throat muscles were affected by polio, you may develop difficulty swallowing, which can lead to choking.
• Abnormal curvature of the spine. If the back muscles that support your spine were affected when you had polio, they may be too weak to support your spine. This can lead to abnormal curvature of the spine (scoliosis). Severe scoliosis can make breathing more difficult and can affect heart function.
• Breathing problems. Some people with PPS need help to improve their breathing. Even if you have only slight breathing trouble with PPS, you may need treatment to maintain lung function and prevent pneumonia.
• Sleep problems. Having trouble sleeping may be a problem for some people with PPS.
  • Sleep may be disturbed by restless legs syndrome, which makes you feel that you need to move your legs. Other abnormal movements while sleeping that disturb your rest may include muscle twitching and jerking.
  • Breathing problems, such as sleep apnea, may also disrupt sleep. Sleep apnea occurs when you frequently stop breathing for 10 to 15 seconds while you are sleeping. People who have sleep apnea usually snore loudly and do not sleep as deeply as they should.
  Having these types of sleeping problems may make you very sleepy during the daytime. Sleep problems can also contribute to fatigue.
• Cold intolerance. Many people with PPS cannot tolerate cold temperatures well.
• Stress. Stress and anxiety may occur after you get PPS. You may find it harder to fall asleep because of mental stress, which is often described as racing thoughts. Increased stress and anxiety are often caused by excessive worry about PPS and its symptoms.

As with many disabling chronic conditions, depression is common in people with PPS. But it may be difficult to diagnose in someone with PPS, because symptoms of fatigue, low energy, and sleep problems can occur with both conditions. You may assume that PPS is responsible for all of your symptoms when in fact depression may be contributing to them. Because proper treatment can often greatly improve symptoms of depression, it's important to look for and recognize the condition when it is present and to discuss it with your doctor.

Some symptoms of post-polio syndrome are also similar to those of fibromyalgia, a common condition that causes widespread muscle and soft tissue pain and tenderness. As with depression, proper diagnosis and treatment of fibromyalgia is extremely important in people with PPS.