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An Open Trial of Pyridostigmine in Post-poliomyelitis Syndrome

Published online by Cambridge University Press:  18 September 2015

Daria A. Trojan  and
Neil R. Cashman
Daria A. Trojan*
Affiliation:
Department of Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal
Neil R. Cashman
Affiliation:
Department of Neurology, Montreal Neurological Institute and Hospital, McGill University, Montreal
*
Montreal Neurological Institute, 3801 University Street, Montreal, Quebec, Canada H3A 2B4
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Abstract

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Background

One of the major symptoms of postpoliomyelitis syndrome (PPS) is disabling generalized fatigue. Subjects with PPS also report muscle fatiguability and display electrophysiologic evidence of anticholinesterase-responsive neuromuscular junction transmission defects, suggesting that anticholinesterase therapy may be useful in the management of disabling fatigue.

Methods

We initiated an open trial of the oral anticholinesterase pyridostigmine, up to 180 mg per day, in 27 PPS patients with generalized fatigue and muscle fatiguability. Response to pyridostigmine was assessed with the Hare fatigue scale, the modified Barthel index for activities of daily living, and a modified Klingman mobility index.

Results

Two patients could not tolerate the medication. After one month of therapy, 16 patients (64%) reported a reduction in fatigue on the Hare fatigue scale; three of 16 showed improvement on the modified Barthel index for activities of daily living, and two of 16 experienced improvement on a modified Klingman mobility index. Pyridostigmine responders were significantly more fatigued than non-responders on the pre-treatment Hare score, but were not significantly different with regard to age, sex, age at acute poliomyelitis, or severity of acute poliomyelitis.

Conclusions

Pyridostigmine may be useful in the management of fatigue in selected patients with PPS. Response to pyridostigmine may be predicted by severity of pre-treatment fatigue.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 22 , Issue 3 , August 1995 , pp. 223 - 227
Copyright
Copyright © Canadian Neurological Sciences Federation 1995

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