5/06/2010

Intravenous Immunoglobulin

Intravenous Immunoglobulin Treatment
for Improving Muscle Strength
Kristian Borg, MD, PhD, Division of Rehabilitation Medicine, Karolinska Institute,
Danderyd University Hospital, Stockholm, Sweden, kristian.borg@ki.se
Post-Polio Syndrome, described as weakness and atrophy in
skeletal muscles, occurs when there is a failure in capacity of a
nerve cell body to maintain large motor units. The large motor
units are supported when the capacity for re-innervation is greater
than denervation. Eventually this mechanism reaches an upper limit
leading to muscle weakness. The cause of the denervation is unknown
at the moment.

An ongoing inflammatory process in
the central nervous systems of postpolio
patients has been described in
some studies, but has not been found
in other studies.

Our study in 2002 found an increase
of cytokine production in the central
nervous system of post-polio patients.
We know that:

􀀓 Cytokine levels are greater when
there is an inflammation.

􀀓 Cytokine levels are higher in people
with multiple sclerosis (MS), a
known neuroinflammatory disorder.
􀀓 The level of the increase in the
post-polio patients was almost the
same as in the MS patients.

We checked older studies to see what
work had been done.
􀀓 Dinsmore reported an effect of prednisone
in high doses and the effect
eroded as the doses were lowered.

􀀓 Ann Bailey, MD, at Warm Springs,
Georgia, in the early ‘80s, treated 80
patients with the oral vaccination,
and 50 of those patients reported a
positive effect on their symptoms.*

Due to her results and to the pattern
of the cytokine increase, we began an

References
Gonzalez, H., Khademi, M.,
Andersson, M., Wallström, E.,
Borg, K. & Olsson, T. Prior
poliomyelitis—evidence of cytokine
production in the central nervous
system. J Neurol Sci 2002; 205:
9-13.
Gonzalez, H., Khademi, M. &
Andersson, M., et al. Prior
poliomyelitis-IvIg treatment
reduces proinflammatory cytokine
production. J Neuroimmunol
2004; 150(1-2):139-44.
Kaponides, G., Gonzalez, H.,
Olsson, T. & Borg, K. Effect of
intravenous immunoglobulin in
patients with post-polio syndrome—
an uncontrolled pilot
study. J Rehabil Med 2006, 38
(2); 138-40.

Gonzalez, H., Stibrant
Sunnerhagen, K., Sjöberg, I.,
Kaponides, G., Olsson, T. & Borg,
K. Intravenous immunoglobulin
for the post-polio syndrome; a
randomized controlled trial,
2006, Lancet Neurology, in press.
open, uncontrolled study using intravenous
immunoglobulin (IvIg) in 16
post-polio patients.

We were able to down modulate the
cytokines, but what is the gain for the
patient? We next developed a multicenter
placebo-controlled study, doubleblinded
in 135 post-polio patients.
(In the former study, we used 90 grams
of IvIg; 30 grams daily for 3 days.)
In this study, we used 30 grams for
3 days, repeated twice. We noted an
increase of muscle strength of 4.3% in
the post-polio patients. In the placebo
group, muscle strength was decreased
by 5.7%. This was statistically significant.

The natural course of decrease in
strength was 5.7% in one-half year.
The benefit: Post-polio patients selected
for the study had an increase in cytokine
levels, indicating inflammation
in the central nervous system. The
inflammation was down-modulated
by the intravenous immunoglobulin
(IvIg) and down-modulated inflammation
led to increased muscle
strength and should result in a better
quality of life. s

Cytokines are small secreted proteins which mediate and
regulate immunity, inflammation and hematopoiesis
(the development of blood cells).
*Using oral polio vaccine to treat PPS is not
an accepted practice www.post-polio.org

Clasificación Internacional de Enfermedades Codifico al Síndrome de Post Polio con el Código G14 Síndrome Postpolio   Incluye :  Síndrome postpoliomielítico  Excluyéndolo del código B91Secuelas de poliomielitis

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