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Postpolio Syndrome Medication

  • Author: Divakara Kedlaya, MBBS; Chief Editor: Stephen Kishner, MD, MHA  more...
 
Updated: Sep 15, 2015
 

Medication Summary

Medications, most of which address fatigue, have been used with only partial success in patients with postpolio syndrome (PPS). Contradictory information is reported on the use of antivirals.

Some authors have found no significant improvement with antivirals as compared with placebo. Amantadine may act to release dopamine from dopaminergic terminals and other central sites, but it has been studied in the treatment of fatigue in PPS patients and has not been shown to be beneficial.[35] Corticosteroids, such as high-dose prednisone, have been studied, but with no good results.[36] Modafinil has been studied for fatigue in PPS patients and has not shown to be beneficial.[37, 38]

A Cochrane review of the different treatments for PPS concluded that intravenous immunoglobulin, lamotrigine, muscle strengthening exercises, and static magnetic fields may be beneficial but need further investigation.[39]

A prospective study by Östlund et al indicated that patients with PPS who respond to intravenous immunoglobulin therapy tend prior to treatment to have reduced physical function, muscle atrophy in the lower extremities, and greater fatigue and pain levels, as well as a visual analogue scale score above 20. The study, which included 124 patients, found that those who did not respond to the treatment tended to have good physical function, less muscle atrophy in the lower extremities, low pain and fatigue levels, and good mental health.[40]

A study by Bertolasi et al found that a single 5-day course of intravenous immunoglobulin did not cause significant changes in fatigue, muscle strength, or pain in patients with PPS. However, health-related quality of life associated with mental activity was improved.[41]

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Anticholinesterases

Class Summary

Some authors have reported that one of the mechanisms for production of fatigue may be related to neuromuscular junction transmission deficits; however, treatment with anticholinesterases has been successful in only half of the cases. This low success rate has been attributed to the variety of neuromuscular junction defects believed to be present in postpolio syndrome. The mechanism of response to anticholinesterases also is unclear because some patients experience improvement in muscular strength, rather than improvement in fatigability.

A multicenter, randomized, double-blinded, placebo-controlled trial of a 6-month course of pyridostigmine 60 mg 3 times per day in 126 postpolio syndrome patients showed no significant differences between pyridostigmine and placebo-treated postpolio syndrome patients on measures of quality of life, isometric strength, fatigue, and serum insulinlike growth factor levels.[42]

Pyridostigmine (Mestinon)

 

Acts in smooth muscle, the CNS, and secretory glands where it blocks action of acetylcholine at parasympathetic sites and facilitates transmission of impulses across the myoneural junction.

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Immunoglobulins

Class Summary

Modulate activity of immune system.[43, 41]

Immunoglobulin intravenous (Gammagard, Sandoglobulin)

 

Intravenous immunoglobulin has been recently studied in the treatment of symptoms related to postpolio syndrome. Results show that it could be a supportive treatment option for subgroups of patients with postpolio syndrome. Further studies are needed to investigate this in more detail.

Features that may be relevant to its efficacy include neutralization of circulating myelin antibodies through anti-idiotypic antibodies; down-regulation of proinflammatory cytokines, including IFN-gamma; blockade of Fc receptors on macrophages; suppression of inducer T and B cells and augmentation of suppressor T cells; blockade of the complement cascade; promotion of remyelination; 10% increase in CSF IgG.

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Anticonvulsant agents

Class Summary

Lamotrigine may reduce morbidity of the disease.[44]

Lamotrigine (Lamictal)

 

Some preliminary studies suggest the efficacy of lamotrigine in enhancing the quality of life and symptoms of patients with postpolio syndrome. Further studies are needed.

Inhibits release of glutamate and inhibits voltage-sensitive sodium channels, leading to stabilization of neuronal membrane.

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Contributor Information and Disclosures
Author

Divakara Kedlaya, MBBS Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University School of Medicine; Medical Director, Physical Medicine and Rehabilitation and Pain Management, St Mary Corwin Medical Center

Divakara Kedlaya, MBBS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Colorado Medical Society, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Kat Kolaski, MD Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency Program Director, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Martin K Childers, DO, PhD Professor, Department of Neurology, Wake Forest University School of Medicine; Professor, Rehabilitation Program, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center

Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology

Disclosure: Allergan pharma Consulting fee Consulting

Gerald J Herbison, MD Professor, Department of Rehabilitation Medicine, Jefferson Medical College, Thomas Jefferson University

Disclosure: Nothing to disclose.

Flor M Muñiz, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, McMaster University, Hamilton, Ontario

Flor M Muñiz, MD is a member of the following medical societies: American Medical Association, Canadian Association of Physical Medicine and Rehabilitation, and Canadian Medical Association

Disclosure: Nothing to disclose.

References
  1. Halstead LS. Assessment and differential diagnosis for post-polio syndrome. Orthopedics. 1991 Nov. 14(11):1209-17. [Medline].

  2. March of Dimes Birth Defects Foundation. Post-polio syndrome: identifying best practices in diagnosis and care. http://www.marchofdimes.com/mission/polio.aspx. Available at http://www.polioplace.org/sites/default/files/files/MOD-%20Identifying.pdf. Accessed: November 15, 2013.

  3. Gonzalez H, Ottervald J, Nilsson KC, et al. Identification of novel candidate protein biomarkers for the post-polio syndrome - implications for diagnosis, neurodegeneration and neuroinflammation. J Proteomics. 2009 Jan 30. 71(6):670-81. [Medline].

  4. Bouza C, Munoz A, Amate JM. Postpolio syndrome: a challenge to the health-care system. Health Policy. 2005 Jan. 71(1):97-106. [Medline].

  5. Ramlow J, Alexander M, LaPorte R, Kaufmann C, Kuller L. Epidemiology of the post-polio syndrome. Am J Epidemiol. 1992 Oct 1. 136(7):769-86. [Medline].

  6. Quadros AA, Conde MT, Marin LF, Silva HC, Silva TM, Paula MB, et al. Frequency and clinical manifestations of post-poliomyelitis syndrome in a Brazilian tertiary care center. Arq Neuropsiquiatr. 2012 Aug. 70(8):571-3. [Medline].

  7. Ragonese P, Fierro B, Salemi G, Randisi G, Buffa D, D'Amelio M, et al. Prevalence and risk factors of post-polio syndrome in a cohort of polio survivors. J Neurol Sci. 2005 Sep 15. 236(1-2):31-5. [Medline].

  8. Bertolasi L, Acler M, dall'Ora E, Gajofatto A, Frasson E, Tocco P, et al. Risk factors for post-polio syndrome among an Italian population: a case-control study. Neurol Sci. 2012 Dec. 33(6):1271-5. [Medline].

  9. Berlly MH, Strauser WW, Hall KM. Fatigue in postpolio syndrome. Arch Phys Med Rehabil. 1991 Feb. 72(2):115-8. [Medline].

  10. Trojan DA, Arnold DL, Shapiro S, Bar-Or A, Robinson A, Le Cruguel JP, et al. Fatigue in post-poliomyelitis syndrome: association with disease-related, behavioral, and psychosocial factors. PM R. 2009 May. 1(5):442-9. [Medline].

  11. Romigi A, Pierantozzi M, Placidi F, et al. Restless legs syndrome and post polio syndrome: a case-control study. Eur J Neurol. 2015 Mar. 22 (3):472-8. [Medline].

  12. Trojan DA, Cashman NR. Post-poliomyelitis syndrome. Muscle Nerve. 2005 Jan. 31(1):6-19. [Medline].

  13. Bickerstaffe A, Beelen A, Nollet F. Change in physical mobility over 10 years in post-polio syndrome. Neuromuscul Disord. 2015 Mar. 25 (3):225-30. [Medline].

  14. Klein MG, Whyte J, Keenan MA, Esquenazi A, Polansky M. Changes in strength over time among polio survivors. Arch Phys Med Rehabil. 2000 Aug. 81(8):1059-64. [Medline].

  15. Stolwijk-Swüste JM, Beelen A, Lankhorst GJ, Nollet F. The course of functional status and muscle strength in patients with late-onset sequelae of poliomyelitis: a systematic review. Arch Phys Med Rehabil. 2005 Aug. 86(8):1693-701. [Medline].

  16. Fordyce CB, Gagne D, Jalili F, et al. Elevated serum inflammatory markers in post-poliomyelitis syndrome. J Neurol Sci. 2008 Aug 15. 271(1-2):80-6. [Medline].

  17. Stoelb BL, Carter GT, Abresch RT, et al. Pain in persons with postpolio syndrome: frequency, intensity, and impact. Arch Phys Med Rehabil. 2008 Oct. 89(10):1933-40. [Medline].

  18. Werhagen L, Borg K. Impact of pain on quality of life in patients with post-polio syndrome. J Rehabil Med. 2013 Feb. 45(2):161-3. [Medline].

  19. Portnoy S, Schwartz I. Gait characteristics of post-poliomyelitis patients: Standardization of quantitative data reporting. Ann Phys Rehabil Med. 2013 Oct. 56(7-8):527-41. [Medline].

  20. Vreede KS, Henriksson J, Borg K, Henriksson M. Gait characteristics and influence of fatigue during the 6-minute walk test in patients with post-polio syndrome. J Rehabil Med. 2013 Sep. 45(9):924-8. [Medline].

  21. Lira CA, Minozzo FC, Sousa BS, et al. Lung function in post-poliomyelitis syndrome: a cross-sectional study. J Bras Pneumol. 2013 Jun-Aug. 39 (4):455-60. [Medline].

  22. Söderholm S, Lehtinen A, Valtonen K, Ylinen A. Dysphagia and dysphonia among persons with post-polio syndrome - a challenge in neurorehabilitation. Acta Neurol Scand. 2010 Nov. 122(5):343-9. [Medline].

  23. Dean AC, Graham BA, Dalakas M, Sato S. Sleep apnea in patients with postpolio syndrome. Ann Neurol. 1998 May. 43(5):661-4. [Medline].

  24. Ring D, Vaccaro AR, Scuderi G, Klein G, Green D, Garfin SR. An association between the flat back and postpolio syndromes: a report of three cases. Arch Phys Med Rehabil. 1997 Mar. 78(3):324-6. [Medline].

  25. Chang KH, Lai CH, Chen SC, Hsiao WT, Liou TH, Lee CM. Body composition assessment in taiwanese individuals with poliomyelitis. Arch Phys Med Rehabil. 2011 Jul. 92(7):1092-7. [Medline].

  26. Correa JC, Rocco CC, de Andrade DV, et al. Electromyographic and neuromuscular analysis in patients with post-polio syndrome. Electromyogr Clin Neurophysiol. 2008 Nov-Dec. 48(8):329-33. [Medline].

  27. Davidson AC, Auyeung V, Luff R, Holland M, Hodgkiss A, Weinman J. Prolonged benefit in post-polio syndrome from comprehensive rehabilitation: a pilot study. Disabil Rehabil. 2009. 31(4):309-17. [Medline].

  28. Tersteeg IM, Koopman FS, Stolwijk-Swuste JM, Beelen A, Nollet F. A 5-year longitudinal study of fatigue in patients with late-onset sequelae of poliomyelitis. Arch Phys Med Rehabil. 2011 Jun. 92(6):899-904. [Medline].

  29. Atwal A, Giles A, Spiliotopoulou G, Plastow N, Wilson L. Living with polio and postpolio syndrome in the United Kingdom. Scand J Caring Sci. 2013 Jun. 27(2):238-45. [Medline].

  30. Koopman FS, Voorn EL, Beelen A, et al. No Reduction of Severe Fatigue in Patients With Postpolio Syndrome by Exercise Therapy or Cognitive Behavioral Therapy: Results of an RCT. Neurorehabil Neural Repair. 2015 Aug 7. [Medline].

  31. Skough K, Krossen C, Heiwe S, et al. Effects of resistance training in combination with coenzyme Q10 supplementation in patients with post-polio: a pilot study. J Rehabil Med. 2008 Oct. 40(9):773-5. [Medline].

  32. Skough K, Broman L, Borg K. Test-retest reliability of the 6-min walk test in patients with postpolio syndrome. Int J Rehabil Res. 2013 Jun. 36(2):140-5. [Medline].

  33. Chan KM, Amirjani N, Sumrain M, Clarke A, Strohschein FJ. Randomized controlled trial of strength training in post-polio patients. Muscle Nerve. 2003 Mar. 27(3):332-8. [Medline].

  34. Bertelsen M, Broberg S, Madsen E. Outcome of physiotherapy as part of a multidisciplinary rehabilitation in an unselected polio population with one-year follow-up: an uncontrolled study. J Rehabil Med. 2009 Jan. 41(1):85-7. [Medline].

  35. Stein DP, Dambrosia JM, Dalakas MC. A double-blind, placebo-controlled trial of amantadine for the treatment of fatigue in patients with the post-polio syndrome. Ann N Y Acad Sci. 1995 May 25. 753:296-302. [Medline].

  36. Dinsmore S, Dambrosia J, Dalakas MC. A double-blind, placebo-controlled trial of high-dose prednisone for the treatment of post-poliomyelitis syndrome. Ann N Y Acad Sci. 1995 May 25. 753:303-13. [Medline].

  37. Vasconcelos OM, Prokhorenko OA, Salajegheh MK, Kelley KF, Livornese K, Olsen CH, et al. Modafinil for treatment of fatigue in post-polio syndrome: a randomized controlled trial. Neurology. 2007 May 15. 68(20):1680-6. [Medline].

  38. Chan KM, Strohschein FJ, Rydz D, Allidina A, Shuaib A, Westbury CF. Randomized controlled trial of modafinil for the treatment of fatigue in postpolio patients. Muscle Nerve. 2006 Jan. 33(1):138-41. [Medline].

  39. Koopman FS, Uegaki K, Gilhus NE, Beelen A, de Visser M, Nollet F. Treatment for postpolio syndrome. Cochrane Database Syst Rev. 2011 Feb 16. CD007818. [Medline].

  40. Ostlund G, Broman L, Werhagen L, Borg K. Immunoglobulin treatment in post-polio syndrome: Identification of responders and non-responders. J Rehabil Med. 2015 Sep 3. 47 (8):727-33. [Medline].

  41. Bertolasi L, Frasson E, Turri M, Gajofatto A, Bordignon M, Zanolin E, et al. A randomized controlled trial of IV immunoglobulin in patients with postpolio syndrome. J Neurol Sci. 2013 Jul 15. 330(1-2):94-9. [Medline].

  42. Trojan DA, Collet JP, Shapiro S, Jubelt B, Miller RG, Agre JC, et al. A multicenter, randomized, double-blinded trial of pyridostigmine in postpolio syndrome. Neurology. 1999 Oct 12. 53(6):1225-33. [Medline].

  43. Gonzalez H, Sunnerhagen KS, Sjoberg I, et al. Intravenous immunoglobulin for post-polio syndrome: a randomised controlled trial. Lancet Neurol. 2006 Jun. 5(6):493-500. [Medline].

  44. On AY, Oncu J, Uludag B, et al. Effects of lamotrigine on the symptoms and life qualities of patients with post polio syndrome: a randomized, controlled study. NeuroRehabilitation. 2005. 20(4):245-51. [Medline].

  45. Diseases of the motor unit. DeLisa J, Gans B, eds. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1998. 1554-6.

 
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