Journal ArticleDOI
A multicenter, randomized, double-blinded trial of pyridostigmine in postpolio syndrome
Daria A. Trojan,J. P. Collet,Stan Shapiro,Burk Jubelt,Robert G. Miller,James C. Agre,Theodore L. Munsat,Dave Hollander,Rup Tandan,C. Granger,A Robinson,Lois Finch,Thierry Ducruet,Neil R. Cashman +13 more
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TLDR
This study showed no significant differences between pyridostigmine and placebo-treated PPS patients on measures of quality of life, isometric strength, fatigue, and IGF-I serum levels at 6 months.Abstract:
Background: Postpoliomyelitis syndrome (PPS) is likely due to degeneration and dysfunction of terminal axons of enlarged postpolio motor units. Age-related decline in growth hormone and insulin-like growth factor (IGF-I) may be a contributing factor. Neuromuscular junction abnormalities and decreased IGF-I levels may respond to the anticholinesterase pyridostigmine, with consequent improvement in strength, fatigue, and quality of life. Objectives: To determine the effect of pyridostigmine in PPS on health-related quality of life, isometric muscle strength, fatigue, and serum IGF-I levels; and to assess the safety of pyridostigmine in PPS. Methods: The study was a multicenter, randomized, double-blinded, placebo-controlled trial of a 6-month course of pyridostigmine 60 mg three times per day in 126 PPS patients. The primary data analysis compared mean changes of outcomes between treatment and control groups at 6 months using an intention to treat approach. Secondary analyses included a comparison of outcomes at 6 and 10 weeks, and in compliant patients. Results: The study showed no significant differences in pyridostigmine and placebo-treated patients with regard to changes in quality of life, isometric strength, fatigue, and IGF-I serum levels at 6 months in the primary analysis and in compliant patients. There were no differences in outcomes at 6 and 10 weeks between groups. However, very weak muscles (1 to 25% predicted normal at baseline) were somewhat stronger ( p = 0.10, 95% CI of difference −9.5 to 73.3%), and in compliant patients IGF-I was somewhat increased ( p = 0.15, 95% CI of difference −6.4 to 44.8 ng/mL) at 6 months with the medication. Pyridostigmine was generally well tolerated. Conclusions: This study showed no significant differences between pyridostigmine and placebo-treated PPS patients on measures of quality of life, isometric strength, fatigue, and serum IGF-I.read more
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Fatigue in neurological disorders
Abhijit Chaudhuri,Peter O. Behan +1 more
TL;DR: A state of pre-existing relative hypocortisolaemia might sensitise the hypothalamic-pituitary-adrenal axis to development of persistent central fatigue after stress.
Journal ArticleDOI
Post-poliomyelitis syndrome.
Daria A. Trojan,Neil R. Cashman +1 more
TL;DR: Although there is no specific treatment for PPS, an interdisciplinary management program can be useful in controlling symptoms and contributing factors may be aging, overuse, and disuse.
Journal ArticleDOI
EFNS guideline on diagnosis and management of post‐polio syndrome. Report of an EFNS task force
Elisabeth Farbu,Nils Erik Gilhus,Michael P. Barnes,K. Borg,M. de Visser,A. Driessen,Robin S. Howard,Frans Nollet,J. Opara,E. Stalberg +9 more
TL;DR: In this paper, the authors present diagnostic criteria for post-polio syndrome (PPS) and evaluate the existing evidence for therapeutic interventions, and recommend Halstead's definition of PPS from 1991 as diagnostic criteria.
Journal ArticleDOI
Characteristics and Management of Postpolio Syndrome
Burk Jubelt,James C. Agre +1 more
TL;DR: The course of PPS has been reported to have an average progression based on strength measurements of 1% to 2% per year, and despite the fact that the course is relatively slow, PPS can present with multiple symptoms and signs.
Journal ArticleDOI
Management of postpolio syndrome
TL;DR: Postpolio syndrome is characterised by the exacerbation of existing or new health problems, most often muscle weakness and fatigability, general fatigue, and pain, after a period of stability subsequent to acute polio infection.
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