The Treatment of Post-Polio Syndrome

Introduction

To our knowledge, auriculotherapy as a modality in the management of post-polio syndrome (PPS) patients has not been reported. This study presents our experience in treating 12 such patients and the evaluation of their response over a two-year period. Our results have been very encouraging.

Polio is one of the oldest diseases known to man. In North America, acute polio is essentially nonexistant today. However in many countries polio is still present in epidemic proportions.

In 1985, Rotary International accepted the challenge to eradicate our planet of polio. Hopefully, this can be accomplished by the year 2005, the 100th anniversary of the founding of Rotary. The World Health Organization (WHO) and other groups have joined in a courageous battle which is being won. However, there are conservatively over 75,000 patients afflicted with PPS in the U.S. alone.1

Only in the last few years has PPS become recognized. It presents as new symptoms 20-45 years after the acute stage of the disease in approximately 25% of polio survivors.2 Since the last epidemic in the U.S. occurred in the early 1950s, we can surmise that a percentage of those survivors will experience sequelae of this dreaded disease.


The symptoms most commonly seen with PPS include unaccomstmed fatigue, joint and/or muscle pain, muscle weakness and loss of muscle use, respiratory problems, and depression. The criteria used in this study includes the following:
1. Confirmed case history of paralytic polio.
2. Electromyographic changes consistent with prior polio.
3. A period of recovery & stability between onset of polio and onset of new problems.
4. Gradual or abrupt onset of disuse weakness in affected and/or unaffected muscles which may be accompanied by excessive fatigue, depression, muscle and/or joint pain, decreased endurance and/or function, and muscle atrophy.
5. Exclusion of other conditions that might cause the problems cited above.

The following diagnosis must include the following:
1. Amyotrophic lateral sclerosis (ALS)
2. Multiple Sclerosis (MS)
3. Poliomytositis
4. Chronic fatigue syndrome
5. Candidiasis
6. Muscular Dystrophy
7. Spinal cord injuries
8. Spinal cord atrophy
9. Gullian-Barre' syndrome
10. Peripheral neuropathy
11. Coxsackievirus

Most physicians practicing today have never seen acute poliomyelitis and, therefore, are not acquainted with the disease. Unfortunately, some of these patients have been sent to psychiatric wards or to pain clinics because PPS was never considered in the differential diagnosis. Others have been dismissed as having depression or neurosis. To date, there are no laboratory tests that will help in the diagnosis of this disease.

Until now, there was little to offer patients with PPS. One could advise them regarding weight control and good nutrition, obtaining more rest and avoiding stress, the use of canes, braces, wheelchairs, physio-therapy, surgery, ventilators, and of becoming active in post-polio support groups. Also, they probably should receive flu and pneumonis vaccinations.

The patients in this study consisted of 12 people from the PPS support group in Springfield, Missouri. The diagnosis in each case had been made elsewhere and was confirmed in our clinic.

In this study, we did not make changes in their medical management, lifestyle, exercise programs, etc. The were all advised to continue with their present program and to been seen by their local doctor. This gave us an opportunity to more carefully evaluate the value of adding this modality to our mamentarium.

In all cases electrical stimulation therapy of war (auriculotherapy) and odonton points was carried out. The instrument used for this study was the feedback-controlled Electo-Acuscope [Electrical-Medical Inc. (EMI), Fountain Valley, CA] It was used to both locate each individual auricular point in the search mode and to stimulate each point using the treatment mode.

We used the point protocol for PPS provided by EMI (see figure 1) Each of the ear points (see figure 2) were stimulated bilaterally using the auricular treatment probe. Both ears were treated at the same point before going on to the next point in the order specified protocol. The intensity was set at 25 µ A. The frequencies used were varied from point to point and ranged from 2.5 to 10 Hz. The duration of electrostimulation also varied from point to point as shown in the PPS protocol.

Additionally, two Voll odonton points 3 (see figure 1) were stimulated with a dental probe (from EMI) designed for treating this microsystem. These two points were stimulated at an intensity of 200 µ A at 10Hz. The duration of electrostimulation also varied per Figure 1.

Additionally, if the patient reported pain in the hip, shoulder, elbow, etc., ear points for these areas were also stimulated with the auricular probe.

Each patient also received transcranial stimulation performed with electrode clips attached at the earlobes. The settings on the Electo-Acuscope were 200 µ A at 8 Hz for 20 minutes. (the objective of this procedure is to create homeostasis in the autonomic nervous system. The patient immediately becomes very relaxed and quite often falls alseep. After this treatment, the patient will often feel increased energy and general well-being.)

In most cases, there was a decrease in fatigue and weakness after the first or second sessions. In those cases that did not respond and in which there was a demostration of an imbalance of the three tissue layers in the ear based on the principles of Nogier, 4 we added treatment with body acupuncture. Specifically, we treated points CV-5 (Shimen), CV-12 (Zhongwan) and CV-17 (Tanzhong). Silver needles were inserted into these three points after carefully verifying their locations with the device. The needles were left in place for 10 minutes.

The entire treatment, including the paralysis protocol and body acupuncture, lasts less than one hour and the treatments are given every three to seven days.

All patients were followed up either in the office or by phone for a two-year period.

Overall, 66.7% (8/12) of the study subjects reported 100% relief from their symptoms, 16.7% (2/12) had 75% improvement and 16.7% (2/12) reported 20-40% improvement.

Results in 12 study subjects treated with the post-polio syndrome protocol
Percent Improvement No. subjects w/ polio onset atage <10 years No. subjects w/ polio onset atage „ 10 years Total Percentage
100 5 3 8 66.7
75 2 - 2 16.7
40 - 1 1 8.3
20 - 1 1 8.3
7 5 12 100.0

Polio onset at age <10 Years: In our evaluation of the therapy of the 12 patients treated, seven were under 10 years of age at the onset of polio. Four of these patients stated that following treatment in our clinic, they rapidly returned to their former state of health (pre-PPS) and had maintained this level of function for two years after therapy.

Of the other three patients in this group, one was very pleased and returned to her previous state of health (pre-PPS) except that she still had chronic depression which pre-dated the onset of PPS symptoms. A male patient had also been diagnosed elsewhere with depression three years prior to being seen in our clinic. When first seen, he complained of extreme fatigue and stated that previously he had always been energetic. He reported that he was in the process of losing his job because he had become so unproductive; as a result he was stressed and would occasionally hyperventilate. Overall, after auriculotherapy, he stated that he had regained 75% of his pre-PPS function.

A third patient in this group, a markedly obese male, stated that he, too, had regained 75% of his pre-PPS function. He reported that the severe pain in the shoulders and elbows was completely gone, but he had noted the return of fatigue and muscle weakness and requires respiratory support during the night. At the present time, he is being managed elsewhere for his recently acquired diabetes.

Polio onset at age „ 10 Years: Of the five patients who were over 10 years of age when they developed polio, three stated that the PPS symptoms had ceased following treatment at our clinic. However, one of these patients has to be retreated every year to maintain pre-PPS health.

Of the other two, one was a 69-year old male with parkinson's disease. After eight treatments, he stated that his weakness and fatigue was 40% decreased and that he was pain-free except following overexertion. He estimated that his footdrop had also improved by 40%.

The fifth patient in this group was a 48-year-old female with severe fatigue of five-year duration. She had previously been diagnosed with fibromyalgia. After four treatments she stated that the fatigue had decreased by 20% and the shoulder pain was 70% decreased.

All subjects in this group had other medical problems. The three patients whohad 100% response required 4 to 8 treatments. The two subjects with less favorable responses were treated 8 to 14 times.

Occasionally a patient may begin to experience a return of symptoms after 6 to 18 months. In the few instances we have obvserved, when given "booster," or repeat treatment, they were quickly returned to their pre-PPS state of health.

The treatment protocol provided by the manufacturer of the Electro-Acuscope is the result of their independent research. They stress the importance of following the point treatment order, much of which is based on the principles of Reinhold Voll.3

A method that I highly recommend when a patient has painful areas-one that was not used in this study- is as follows: The patient identifies the area of pain. By palpation with firm pressure the most active trigger points can be located. These points are then treated with the Electro-Acuscope until the trigger point is eliminated. This usually takes less than two minutes per visit.

Additionally, the Electro-Acuscope is to my knowledge the only electrical therapy device on the market that is designed to self-regulate, i.e., the waveform is continuously controlled and adjusted as a result of the tissue impedance. This instrument is also used for many kinds of accelleration of tissue repair and pain management.5

It is not within the scope of this report to present a controlled study of the benefits of this modality. Our purpose is rather to bring it to the attention of:
1. The primar physician who may be seeing these patients, and
2. medical centers with post-polio clinics and the resources to conduct in-depth studies and to implement refinements in this technique.

Using this non-invasive, simple and inexpensive modality requiring treatment of relatively short-duration, improvement of symptoms of patients with post-polio syndrome has been rapid and apparently long-lasting in a majority of cases. The PPS patients who had other existing medical problems did not respond as well as those without such problems and were the only ones who did not experience excellent results. However, all the subjects reported being "very pleased" with their improvement. The modality of auriculotherapy shows promise of being a successful and definitive therapy for patients with post- polio syndrome.

Post-polio syndrome treatment protocol for use with the Electro-Acuscope ® from EMI
1. Treat in the 1 to 12 order specified. Both ears are treated with the same point before going on to the next point.
2. UCLA point nomenclature (see Oleson T:Auriculotherapy Manual,1992).
3. AT1 and C17 are each treated with two separate settings, and therefore appear twice in the protocol. Treat with each combination in the order specified.
4. Voll odonton/American nomenclature.

1. TF1 ShenmenFrequency: 8 HzIntensity: 25 µ ATimer: 6 secs, 4 times 2. A1 Upper Cervical VertebraeFrequency: 2.5 HzIntensity: 25 µ ATimer: 8 secs, 3 times 3. AT1 Occiput. AtlasFrequency: 8 HzIntensity: 25 µ ATimer: 6 secs, 5 times
4. AT1c Occiput. AtlasFrequency: 2 HzIntensity: 25 µ ATimer: 8 secs, 4 times 5. WT5 Pain Control PointFrequency: 2.5 HzIntensity: 25 µ ATimer: 6 secs, 3 times 6. W6 Lumbar, Sympath. gang.Frequency: 10 HzIntensity: 25 µ ATimer: 6 secs, 5 times
7. C17 Trachea, Vagus NerveFrequency: 2.5 HzIntensity: 25 µ ATimer: 6 secs, 3 times 8. C16 Ipsilateral Lung, HeartFrequency: 8 HzIntensity: 25 µ ATimer: 6 secs, 5 times 9. H1 Zero PointFrequency: 8 HzIntensity: 25 µ ATimer: 6 secs, 3 times
10. TF4 Triangular FossaFrequency: 10 HzIntensity: 25 µ ATimer: 8 secs, 3 times 11. Upper Center Back Roof of Mouth *Frequency: 10 HzIntensity: 200 µ ATimer: 6 secs, 7 times 12. Right Retro Molar *Frequency: 8 HzIntensity: 200 µ ATimer: 8 secs, 5 times
· Application is calculated for use with special dental electrode with the Electro-Acuscope.

References

1. Young, GR: Occupational Therapy and the post-polio syndrome. Amer J Occup Ther,1988;(june):97.

2. Staas, Jr, WE, Director, Magge Rehabilitation Hospital, Philadelphia, PA, personal communicaiton; and Fletcher DJ: Recognizing and managing postpolio syndrome. Geriatric Consultant, 1990; (May/June): 12.

3. Voll R:Interrelations of Odontons and Tonsils to Organs, Fields of Disturbance and Tissue Systems, Schuldt H (English trans). Medinzinisch Literarische Verlag, Uelzen, Germany, 1978.

4. Noiger PFM:From Auriculotherapy to Auriculomedicine. Maisonnevue, Paris, 1983.

5. Biedbach MC:Acupun. Elect.1989; 14(1>:43-60.

TILMELD NYHEDSBREV