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Evidence summaries

Treatment for Postpolio Syndrome

In postpolio syndrome intravenous immunoglobulin is probably not beneficial on activity limitations. There was no conclusive data on any other treatment options studied. Level of evidence: "C"

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).

Clinical comments

Note

Date of latest search:

References

  • Koopman FS, Beelen A, Gilhus NE et al. Treatment for postpolio syndrome. Cochrane Database Syst Rev 2015;5():CD007818. [PubMed].

Primary/Secondary Keywords