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

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

3. A. Acute Paralytic Polio 1.Virus 2.Contaminated water/food 3.Affinity for motor (muscle) nerves 4.Kills/injures motor nerves 5.Results in weakness/paralysis Post-Polio Syndrome

4. 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 Post-Polio Syndrome

5. 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 Post-Polio Syndrome

6. B. What is PPS? 1. A neurological condition 2. New symptoms many years after acute polio - typically 30-50 yrs. 3.New symptoms appear after a period of neurological stability 4.Major sxs- New weakness, loss of function, intense fatigue, pain in muscles/joints Post-Polio Syndrome

8. C. What is the Cause of PPS? 1.Basically, tired/overworked motor nerves leading to new weakness/fatigue/pain 2. Maybe immunologic component Post-Polio Syndrome

14. 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 Post-Polio Syndrome

16. F. Treatment 1.Rehabilitation – often ‘low tech’ Change in lifestyle Energy conservation “Bracing and pacing” Exercise normal or strong muscles 2.Medications NGF, Stem cells, Immunoglobulins Post-Polio Syndrome

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

19. O.K. BUT COULD BE BETTER

20. BETTER