including post-exertional malaise as a hallmark symptom and the fact
that "there is no diagnostic test for PPS, the diagnosis is based on a
proper clinical workup where all other possible explanations for the
new symptoms are ruled out."
More-
Update on current and emerging treatment options for post-polio
syndrome- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909497/?tool=3Dpubme=
d
Characteristics and Management of Postpolio Syndrome-
http://jama.ama-assn.org/content/284/4/412.extract
Postpolio syndrome: unanswered questions regarding cause, course, risk
factors, and therapies-
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(10)70110-1/f=
ulltext
Management of postpolio syndrome-
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(10)70095-8/f=
ulltext
---------------------------------------------------------------------------=
-------------
How polio has returned to haunt its victims in old age
By Lois Rogers
Last updated at 7:47 AM on 9th August 2011
Valerie Brewster contracted polio at the age of eight =97 one of dozens
of children affected by an outbreak at a municipal paddling pool in
Leeds.
She had the classic symptoms of the disease =97 nausea, muscle stiffness
and high fever. But a year later her school doctor told her she=92d made
a good recovery.
So when she developed muscle weakness at the age of 61 and had to walk
with a stick, she had no idea it could have been linked to that
childhood illness.
But in fact she was suffering from post-polio syndrome =97 a condition
where the virus, which lies dormant in the bodies of polio sufferers
for many years, becomes active and starts triggering symptoms.
Epidemics of polio swept through Britain=92s schools and playgrounds for
much of the 20th century, leaving many facing a slow death from
paralysis or a lifetime marred by deformity.
Although by the mid-Sixties the disease was believed to have been
wiped out by vaccination, the virus is returning to haunt the
estimated 120,000 polio survivors living in the UK.
And, as with tuberculosis, there is also a renewed threat of polio as
people travel to Britain from countries where it was never
successfully eradicated.
Polio is caused by a virus which attacks nerve cells in the brain and
spinal cord. It is spread via human faeces and leads to muscle
weakness and painful spasms, followed by paralysis and sometimes death
when the lungs are affected.
Post-polio syndrome is believed to affect at least eight out of ten of
the survivors. Although the syndrome was first described by doctors in
the Eighties, the scale of the problem is only just emerging, as more
polio survivors live long enough to develop it.
Doctors are divided about whether this is the result of a sudden
reactivation of the dormant virus in their bodies, or a consequence of
abnormal re-growth of nerves damaged by the original infection.
Whatever the cause, the result is a cruel return of symptoms, meaning
that many who battled the effects of withered limbs with leg irons and
built-up shoes face the possibility of life in a wheelchair or, in the
worst cases, reliance on ventilators to supply oxygen to damaged
lungs.
=91It is a disaster for many of these people =97 a tragedy,=92 says Carolyn
Young, professor of neurology at The Walton Centre in Liverpool, who
is leading the first research project on the syndrome, in more than
200 people aged 50 and over.
It is hoped to find out which treatment or medications might best
reduce symptoms.
Polio has not been reported in Britain since the mid-Sixties, but
there are a number of celebrity survivors, including actors Mia Farrow
and Donald Sutherland, film director Francis Ford Coppola, celebrity
academic David Starkey, and singers Judy Collins and Neil Young.
All are at risk from this re-emergence of symptoms, for which there is
no recognisable trigger, no diagnostic test, and no cure.
Professor Young=92s results are being presented at an international
conference in Copenhagen this summer, which will discuss ways of
helping the 700,000 people across Europe at risk from the syndrome.
Many doctors are too young to remember the polio outbreaks of the
Sixties and do not put two and two together with their patients=92
symptoms. Some think it down to ageing, or other conditions such as
chronic fatigue syndrome.
Professor Young says: =91It takes many years to get a diagnosis.
'Our patients say GPs are completely unaware of its existence, and it
is a sad fact that people who have a history of these kinds of symptom
often do not get the same level of interest or attention if they
complain of new ones.=92
She believes post-polio syndrome is only now starting to emerge
because polio victims, like the rest of the population, are surviving
to greater ages =97 long enough for the ravaging effects of the virus to
re-assert themselves.
When Valerie Brewster first contracted polio, she spent the whole of
that year=92s school summer holiday in bed with severe neck pain. The
family doctor dismissed her as =91lazy=92 and insisted she had =91summer
flu=92.
It was only after she had returned to school that a sharp-eyed school
doctor noticed telltale signs of residual muscle weakness and fatigue.
He concluded she had been an unnoticed victim among that year=92s other
cases.
Like many polio sufferers, Valerie received no specific treatment.
Only in the most severe cases were patients put into an =91iron lung=92
machine to aid breathing.
Pressure would be raised in the machine to force air into the victim=92s
semi-paralysed lungs, and then lowered so it would flow out again. It
saved thousands of lives.
Now 67, Valerie who lives in Scarborough, North Yorkshire, with her
retired fireman husband Colin, 71, says she remained chronically tired
for the whole of the school autumn term, but a year later she was
considered to have made a good recovery.
She left school at 16 and started work as a secretary. But although
she married at 19 and had three children, she has experienced a
variety of intermittent problems.
=91By the time I was 20, I started getting really bad back pain,=92 she say=
s.
=91Ten years went by and eventually I went to see an osteopath who said
I had scoliosis =97 curvature of the spine =97 and one leg half-an-inch
shorter than the other.
=91I was told I would need to walk with a stick, but there was never any
mention of the after-effects of polio. It is like a silent disease in
this country. No one thinks of it or talks about it.=92
Six years ago new pain emerged in her legs, a result, she was told, of
sciatica. It was only in 2009 that she happened to read a magazine
article about the new diagnosis of post-polio syndrome.
=91It took me two or three weeks to pluck up the courage to ring the
doctor, because I knew I would be told that these problems would get
worse.=92
She was finally diagnosed by a neurologist in Sheffield, who relayed
the grim news that walking would become progressively harder. Ironing,
cooking and other domestic chores are also difficult because of the
muscle fatigue they cause.
Although physiotherapy or muscle-relaxing drugs may help people like
Valerie, specialists are unsure about exactly what sort of treatment
might work best.
The British Polio Fellowship, which supports the research project at
the Walton Centre, is concerned that despite The World Health
Organisation=92s international vaccination programme, the disease has
never been eradicated and continues to attack children in India, Nepal
and Afghanistan.
It has also re-appeared in Nigeria because of malicious rumours that
the Western-donated vaccine is harmful, while a renewed threat to
Britain has emerged from our growing contact with Eastern Europe.
=91We can never be complacent about this, even with vaccination,=92 says
Professor Young.
=91We thought tuberculosis had been dealt with, but that has re-emerged
in new treatment-resistant strains. That is why it is vital that we
try to understand how this disease works and how we can treat its
effects.=92
---------------------------------------------
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