Post-polio syndrome: clinical manifestations and cerebrospinal fluid markers

Post-polio syndrome (PPS) refers to a constellation of new neurological, musculoskeletal and general symptoms occurring in survivors of poliomyelitis decades after acute paralytic and nonparalytic disease. The common manifestations of PPS include generalized, central and peripheral fatigue, muscle weakness and musculoskeletal pain. The pathogenesis of PPS remains obscure. Three prevailing hypotheses have been advanced: stress-induced degeneration of surviving neurons, persistent poliovirus replication or virus reactivation and immune-mediated damage. The diagnosis of PPS is based on medical history and clinical examination, since no specific diagnostic tests are available. In the light of recent studies demonstrating a partial beneficial effect of intravenous immunoglobulin, this article will focus on cerebrospinal fluid biomarkers reflecting disease activity and pathogenic processes in PPS.