Poliomyelitis

Poliomyelitis is a neurological disease caused by the poliovirus. Thanks to the systematic vaccination campaigns that began in 1963, the disease has been effectively eliminated locally since the late 1960s, and the last domestic case was recorded in 1988. In recent years, new cases have appeared only among immigrant populations or after travel to countries where polio is still endemic.

Most patients seen in the clinic today are not new infections — they are survivors of childhood polio who are now dealing with the long-term consequences of the disease.

Over the years, people who had polio in childhood may develop a range of movement disorders on a neurological basis: scoliosis, tendon problems in the back, peripheral nerve entrapments, difficulty walking or dependence on a wheelchair, respiratory insufficiency, osteoporotic fractures, and gradual loss of function and independence.

A smaller subset go on to develop what is called **post-polio syndrome** — new muscle weakness added to the pre-existing deficit, with no other cause to explain it. This new weakness may or may not be accompanied by fatigue, muscle pain, muscle atrophy, and further loss of function. Electromyography (EMG) can confirm the diagnosis according to the Halstead criteria.

At present, the best treatment is prevention of functional decline — through close follow-up with an experienced clinician, well-indicated surgical interventions, and consistent maintenance rehabilitation.

Management focuses on preventing or minimising deformities and maximising the patient's capacity at home and in the community. The child (and later the adult) is best cared for by a multidisciplinary team, which may include:

- Nursing coordinator - Neurosurgeon — a surgeon specialising in operations on the brain and spinal cord - Neurologist — a physician specialising in conditions of the brain, spinal cord, and nerves - Physical and occupational therapists - Orthopaedic surgeon — a surgeon specialising in conditions of the muscles, ligaments, tendons, and bones - Orthotist — a specialist who designs and fits braces and splints

When conservative and interventional care cannot correct a specific problem, surgery is considered:

- **Orthopaedic surgery** — for hip dislocations, ankle and foot deformities, and contracted muscles. - **Neurosurgery for spasticity** — including botulinum toxin (Botox) injection, selective dorsal rhizotomy, and intrathecal baclofen pumps.