Post-Polio Syndrome (PPS)

What is Post-Polio Syndrome?

Polio, also known as poliomyelitis, is an acute infectious disease caused by poliovirus that seriously endangers children's health. Poliovirus is a neurotropic virus, which mainly impinges on motor nerve cells of the central nervous system and damages motor neurons of the anterior horn of the spinal cord. Patients are mostly 1-6 years old children, the main symptoms are fever, general discomfort, severe limb pain, irregular distribution, and severity of flaccid paralysis. Post-polio syndrome (PPS) is a rare disorder that mainly affects people who have been infected with polio that can lead to the dysfunction of the nerves and muscles. These PPS patients gradually experience fatigue, muscle and joints weakness. Several studies have suggested that PPS may be caused by reactivation of the virus, overregulation in nerve cells, or abnormal neural regeneration and differentiation in polio survivors.

Fig.1 Putative factors in the etiology of generalized fatigue in post-polio syndrome. (Li Hi Shing, 2019)

PPS Prevalence and Risk Factors

Recently, a wide variety of risk factors, such as aging, that are associated with PPS have been studied in different kinds of human populations. For example, recent reports have indicated that a close relationship between the frequency or severity of PPS disease and age. Moreover, many researchers have demonstrated that cigarette smoking and trauma have become the key risk factors of PPS. The results have shown that non-smoking and non-traumatic people are less likely to develop PPS. Meanwhile, people who have been vaccinated against polio are also less likely to get PPS. Besides, most middle-aged polio survivors are at high risk of PPS and deserve extensive attention and scientific management.

The PPS Treatment Options

Up to now, a battery of methods have been generated for the treatment of patients with PPS, including but not limited to:

• Physical therapy

The management of PPS is still based on rehabilitation training. In general, it includes lifestyle management, physical exercise, and personalized training. Exercise can increase muscle strength, improve muscle endurance and reduce fatigue. Training is designed by using alternating interval exercises to improve muscle function while ensuring adequate rest time. Furthermore, training in warm water reduces pain-killing muscles and reduces joint damage. Therefore, dynamic water sports are also a good alternative treatment for PPS patients.

• Drug Treatment

Currently, many attempts have been made to identify new inflammatory markers in the serum and CSF from PPS patients. Pilot studies have found that these markers can be a candidate target for discovering novel drugs against PPS. Also, a series of pain relievers have been broadly used to ease muscle and joint pain in PPS patients. In addition, several corticosteroids have been developed and evaluated their efficacies in enhancing muscle strength and improving fatigue of PPS patients.

• Intravenous Immunoglobulin

In the past few years of studies, intravenous immunoglobulin (IVIG) has proven its significant role in the treatment of neurological diseases and dysfunctions. IVIG is considered to have a positive effect on regulating CSF inflammatory cytokine levels in PPS patients. As a result, it has been considered as a potential treatment for PPS and can act via several mechanisms, including Fc-receptors regulation, B/T cells mediation, neutralization of pathogenic antibodies, as well as cytokine production. Among them, many products specific for Neural Proteins & Peptides and Neural Antibodies have been designed for PPS in pre-clinical trials.

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Reference

1. Li Hi Shing, S.; et al. Post-polio syndrome: more than just a lower motor neuron disease. Frontiers in neurology. 2019, 10: 773.