Treatment for Postpolio Syndrome

Summary

A Cochrane review [Abstract] 1 included 12 studies with a total of 539 patients with postpolio syndrome. Nine studies were pharmacological (modafinil, intravenous immunoglobulin (IVIg), pyridostigmine, lamotrigine, amantadine and prednisone) and three were non-pharmacological (muscle strengthening, rehabilitation in a warm climate (i.e. temperature ± 25°C, dry and sunny) and a cold climate (.e. temperature ± 0°C, rainy or snowy) and static magnetic fields). Meta-analysis showed no significant difference between the IVIg and placebo groups in activity limitations as measured with the Physical Component Summary of the Short Form-36 Health Survey (SF-36 PCS) in either the short term (MD 2.35; 95% CI -0.06 to 4.76) or long term (MD -0.51; 95% CI -4.63 to 3.60; 2 studies, n=185) and there is inconsistency in the evidence for effectiveness on muscle strength and pain. Lamotrigine might be effective in reducing pain and fatigue, resulting in fewer activity limitations (MD -23.70; 95% CI -35.35 to -12.05; 1 study, n=30). Muscle strengthening of thumb muscles (MD 39.00; 95% CI 6.12 to 71.88; 1 study, n=10) and static magnetic fields (MD 4.10; 95% CI 2.75 to 5.45; 1 study, n=50) are beneficial for improving muscle strength and pain, respectively, with unknown effects on activity limitations. Finally, there is evidence that modafinil (MD 1.28; 95% CI -3.56 to 6.12, 1 study, n=36), pyridostigmine (MD 2.10; 95% CI -3.64 to 7.84; 1 study, n=126), amantadine (RR 2.55; 95% CI 0.81 to 7.95; 1 study, n=25), prednisone (RR 1.13; 95% CI 0.75 to 1.70; 1 study, n=17) and rehabilitation in a warm (MD -1.70; 95% CI -3.47 to 0.07) or cold (MD -2.90; 95% CI -4.73 to -1.07) climate (1 study, n=88) are not beneficial.

Comment: The quality of the evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes), and imprecise results (limited study size for each comparison).