What are the effects of different treatments in people with postpolio syndrome (PPS)?
PPS is a condition that can affect polio survivors years after recovery from an initial paralytic attack by the polio virus. PPS is characterised by progressive or new muscle weakness or decreased muscle endurance in muscles that were previously affected by the polio infection and in muscles that were seemingly unaffected. Other symptoms may include generalised fatigue and pain. These symptoms often lead to a decline in physical functioning, for example trouble walking. Theof this was to assess the benefits and harms of different drugs and rehabilitation treatments compared to (a pill or procedure without any physiological effect), usual care or no treatment.
We searched scientific databases to find all studies on treatments for PPS up to July 2014. We found 13 studies involving a total of 675 participants that were of sufficient quality to include in this. Ten studies evaluated the effects of drugs (modafinil, immunoglobulin (IVIg), pyridostigmine, lamotrigine, amantadine, prednisone), and three studies evaluated other treatments (muscle strengthening, rehabilitation in a warm climate (that is temperature ± 25°C, dry and sunny) and a cold climate (that is temperature ± 0°C, rainy or snowy), static magnetic fields).
Key results and quality of the evidence
IVIg is a treatment in which antibodies that have been purified from donated blood are given as an infusion into a vein over a period of time. There was moderate- and low-quality evidence that IVIg has no beneficial effect on activity limitations in the short term and long term, respectively. Evidence foron muscle strength was inconsistent, as results differed across studies. IVIg caused minor side effects in a substantial proportion of the participants.
Lamotrigine is a drug used to helpcertain kinds of epilepsy and to treat bipolar psychiatric disorder. Results of one provided very low-quality evidence that lamotrigine might be effective in reducing pain and fatigue, resulting in fewer activity limitations, and in this it was well-tolerated. We based these conclusions on results of only one small with important limitations in design.
There was very low-quality evidence that muscle strengthening of thumb muscles is safe and beneficial for improving muscle strength. Again, we based these conclusions on results of only one smallwith important limitations in design, and they are applicable only to thumb muscles.
Static magnetic fields is ain which electrical currents are applied to the skin with the intention of reducing pain. There was moderate-quality evidence that static magnetic fields are safe and beneficial for reducing pain directly after treatment, although functional effects on activity limitations and long-term effects are unknown.
Finally, there was 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.