4/05/2011

Tratamiento para SPP una teoría más- de la Universidad de Amsterdam

El tratamiento para el síndrome postpolio.FS Koopman, K Uegaki, NE Gilhus, Beelen A, de M Visser, Nollet F.
Departamento de Rehabilitación de la Universidad de Amsterdam, el Centro Médico Académico, PO Box 22660, Amsterdam, Holanda Septentrional, Países Bajos, 1100 DD.

Resumen
El síndrome postpolio (SPP) puede afectar a los supervivientes de la poliomielitis paralítica y se caracteriza por un complejo de síntomas neuromusculares que conduce a una disminución en el funcionamiento físico. La eficacia del tratamiento farmacológico y la gestión de la rehabilitación en EPA no se ha establecido aún.
OBJETIVOS: Revisar sistemáticamente los efectos de cualquier tratamiento para la EPA en comparación con el placebo, la atención habitual o ningún tratamiento.
Estrategia de búsqueda: Se realizaron búsquedas en las bases de datos el 1 de octubre de 2010: Cochrane de Enfermedades Neuromusculares Registro Especializado del Grupo, el Registro Cochrane Central de Ensayos Controlados, MEDLINE, EMBASE, PsycINFO y Plus CINAHL desde su inicio hasta septiembre de 2010.
Criterios de selección: Ensayos aleatorios y cuasialeatorios de cualquier forma de tratamiento farmacológico o no farmacológico para las personas con SPP. El resultado primario fue la percepción subjetiva de limitaciones en la actividad y los resultados secundarios fueron la fuerza muscular, resistencia muscular, fatiga, dolor y eventos adversos.
Recopilación y análisis de datos Dos autores seleccionaron de forma independiente los estudios elegibles, evaluaron el riesgo de sesgo y extrajeron los datos.
PRINCIPALES RESULTADOS:
 Nueve farmacológicos (inmunoglobulina modafinilo, por vía intravenosa, piridostigmina, la lamotrigina, la amantadina, prednisona) y tres no farmacológicos (para fortalecer los músculos, la rehabilitación en un clima caliente (es decir, la temperatura ± 25 ° C, seco y soleado) y un clima frío ( es decir, la temperatura ± 0 ° C, lluvia o nieve), los campos magnéticos estáticos) se incluyeron estudios en esta revisión. 
Ninguno de los estudios incluidos fue completamente libre de cualquier riesgo de sesgo y el riesgo de mayor prevalencia de sesgo fue la falta   de placebo.


* Hay pruebas de calidad moderada que la inmunoglobulina intravenosa no tiene ningún efecto beneficioso sobre las limitaciones de la actividad y no hay incoherencia en la evidencia de la efectividad en la fuerza muscular y el dolorLos resultados de un ensayo aportar pruebas de muy baja calidad que la lamotrigina podría ser eficaz para reducir el dolor y la fatiga, dando lugar a limitaciones en la actividad menos. Los datos de dos ensayos individuales sugieren que el fortalecimiento muscular de los músculos del pulgar (muy pruebas de baja calidad) y los campos magnéticos estáticos (pruebas de calidad moderada) son beneficiosos para mejorar la fuerza muscular y el dolor, respectivamente, con efectos desconocidos sobre las limitaciones de la actividad. Por último, hay evidencia de que varían de muy baja calidad a la alta calidad que modafinil, piridostigmina, la amantadina, la prednisona y la rehabilitación en un clima cálido o frío no son beneficiosos en EPA.

Conclusiones de los revisores: Debido a la insuficiencia de datos de buena calidad y la falta de estudios aleatorios, es imposible sacar conclusiones definitivas sobre la eficacia de las intervenciones para PPS. Los resultados indican que la inmunoglobulina intravenosa, la lamotrigina, ejercicios de fortalecimiento muscular y los campos magnéticos estáticos pueden ser beneficiosos, pero necesitan más investigación.
PMID: 21328301 [PubMed - Medline]
English


Treatment for postpolio syndrome.

Department of Rehabilitation, University of Amsterdam Academic Medical Center, PO Box 22660, Amsterdam, North Holland, Netherlands, 1100 DD.

Abstract

BACKGROUND: Postpolio syndrome (PPS) may affect survivors of paralytic poliomyelitis and is characterised by a complex of neuromuscular symptoms leading to a decline in physical functioning. The effectiveness of pharmacological treatment and rehabilitation management in PPS is not yet established.
OBJECTIVES: To review systematically the effects of any treatment for PPS compared to placebo, usual care or no treatment.  
SEARCH STRATEGY: We searched the following databases on 1 October 2010: Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO and CINAHL Plus from inception to September 2010.
SELECTION CRITERIA: Randomised and quasi-randomised trials of any form of pharmacological or non-pharmacological treatment for people with PPS. The primary outcome was self-perceived activity limitations and secondary outcomes were muscle strength, muscle endurance, fatigue, pain and adverse events.
DATA COLLECTION AND ANALYSIS: Two authors independently selected eligible studies, assessed risk of bias and extracted data.
MAIN RESULTS: Nine pharmacological (modafinil, intravenous immunoglobulin, pyridostigmine, lamotrigine, amantadine, prednisone) and three non-pharmacological (muscle strengthening, rehabilitation in a warm climate (i.e. temperature ± 25°C, dry and sunny) and a cold climate (i.e. temperature ± 0°C, rainy or snowy), static magnetic fields) studies were included in this review. None of the included studies was completely free from any risk of bias and the most prevalent risk of bias was lack of blinding.There is moderate quality evidence that intravenous immunoglobulin has no beneficial effect on activity limitations and there is inconsistency in the evidence for effectiveness on muscle strength and pain. Results of one trial provide very low quality evidence that lamotrigine might be effective in reducing pain and fatigue, resulting in fewer activity limitations. Data from two single trials suggest that muscle strengthening of thumb muscles (very low quality evidence) and static magnetic fields (moderate quality evidence) are beneficial for improving muscle strength and pain, respectively, with unknown effects on activity limitations. Finally, there is evidence varying from very low quality to high quality that modafinil, pyridostigmine, amantadine, prednisone and rehabilitation in a warm or cold climate are not beneficial in PPS.
AUTHORS' CONCLUSIONS: Due to insufficient good quality data and lack of randomised studies it is impossible to draw definite conclusions on the effectiveness of interventions for PPS. Results indicate that IVIG, lamotrigine, muscle strengthening exercises and static magnetic fields may be beneficial but need further investigation.
PMID: 21328301 [PubMed - indexed for MEDLINE]


Post-polio syndrome patients treated with intravenous immunoglobulin: a double-blinded randomized controlled pilot study.

Department of Neurology, Haukeland University Hospital, Bergen, Norway. elfa@sir.no



Intravenous immunoglobulin for post-polio syndrome: a randomised controlled trial

Corresponding AuthorDr Henrik Gonzalez MD PhD a bKatharina Stibrant Sunnerhagen MD PhD cInger Sjöberg MD dGeorgios Kaponides MD a b,Tomas Olsson MD PhD eKristian Borg MD PhD a b

Summary

Background

Survivors of poliomyelitis often develop increased or new symptoms decades after the acute infection, known as post-polio syndrome. Production of proinflammatory cytokines within the CNS indicates an underlying inflammatory process, accessible for immunomodulatory treatment. We did a multicentre, randomised, double-blind, placebo-controlled study of intravenous immunoglobulin in post-polio syndrome.

Methods

142 patients at four university clinics were randomly assigned infusion of either 90 g in total of intravenous immunoglobulin (n=73) or placebo (n=69) during 3 consecutive days, repeated after 3 months. Seven patients were withdrawn from the study. Thus, 135 patients were assessed per protocol. Primary endpoints were muscle strength in a selected study muscle and quality of life as measured with the SF-36 questionnaire (SF-36 PCS). Secondary endpoints were 6-minute walk test (6MWT), timed up and go (TUG), muscle strength in muscles not chosen as the study muscle, physical activity scale of the elderly (PASE), visual analogue scale (VAS) for pain, multidimensional fatigue inventory (MFI-20), balance, and sleep quality. Outcome tests were done immediately before the first infusion and 3 months after the second infusion. This study is registered with ClinicalTrials.gov, number NCT00160082.

Findings

Compared with baseline, median muscle strength differed by 8·3% between patients receiving intravenous immunoglobulin and placebo, in favour of the treatment group (p=0·029). SF-36 PCS did not differ significantly between the groups after treatment (p=0·321). Differences in the subscale vitality score (p=0·042) and PASE (p=0·018) favoured the active treatment group. MFI-20, TUG, muscle strength in the muscles not chosen as the study muscle, 6MWT, balance, and sleep quality did not differ between groups. For the whole study population there was no significant change in pain, as determined by VAS. Nevertheless, patients who reported pain at the study start improved in the intervention group but not in the placebo group (p=0·037). Intravenous immunoglobulin was well tolerated.

Interpretation

Intravenous immunoglobulin could be a supportive treatment option for subgroups of patients with post-polio syndrome. Further studies on responding subgroups, long-term effects, and dosing schedules are needed.



XEPOL Immonogobulina Intravenosa Medicamento Para SPP Publicado en el 2006. 



Efecto de la inmunoglobulina intravenosa en pacientes con síndrome post-polio - unestudio piloto no controlado. Kaponides G, H González, T Olsson, Borg, K.Departamento de Ciencias de la Salud Pública, División de Medicina de Rehabilitación, Estocolmo, Suecia.
Resumen OBJETIVO: Analizar los cambios en la fuerza muscular, el rendimientofísico y la calidad de vida durante la inmunoglobulina intravenosa (IgIV) en pacientescon síndrome post-polio.  http://postpoliolitaffac.wordpress.com/2010/08/04/xepol-immonogobulina-intravenosa-medicamento-para-spp-publicado-en-el-2006-2/

 PRESS RELEASE ON MEXICO'S
2ND ANNUAL POST POLIO SYNDROME SYMPOSIUM

Nota *
Hasta el momento el más avanzado estudio realizado sobre  el Tratamiento para personas con Post Polio es el Dr. Henrick Gonzalez y Dr. Kristian Borg  y en la Conferencia que se realizara este año en Copenhagen, Denmark - August 31st - September 2nd 2011, seguramente el Dr. González comentará lo  más novedoso http://www.polioconference.com/

Dr. Brian Joseph, PhD. (Harvard) brought us up to date on IV Gamma Globulin Studies of

Dr. H. Gonzalez! Dr. Kristian Borg and Henrick Gonzalez in Sweden have been working for
many years testing the benefits of IV Gamma Globulin for PPS patients. 

Dr. Joseph asked Dr. Henrik Gonzalez about their test results since their last release in 2008. 
Dr. Joseph explained that the tests being done in Sweden by
Dr. Henrick Gonzalez and Dr.  Kristian Borg had proven to be successful
and their research into the cause of PPS was “revolutionary

1.   The study proved gamma helps PPS.

2.  The study shows we have fragments of polio protein in our spinal cords, which causes our immune systems to continue to battle the polio virus that was there.  This and not dying neurons is what is causing PPS by weakening our immune systems.  Our body is still in the fight mode to kill off the tiny polio fragments in our bodies.  This does not mean we still have polio,  just remnants of the old virus our immune systems are still attacking, causing further degeneration.

 3.  And even more importantly, they have found a blood test to tell if you have PPS!   


                                                                                                                               
                                                       Dr. Brian Joseph Ph.D. (Harvard)


APPLAC México a la vanguardia en el Síndrome de Post Polio

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ... Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

Erradicación de La poliomielitis

Polio Tricisilla Adaptada