Major research findings

Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute infection by the Poliomyelitis virus. 15 、 10 、 18 、 1 、 2 、 7 、 9 . PPS is characterized by new muscle weakness and/or muscle fatigability that occurs many years after the initial poliomyelitis illness. 7 . The symptoms are new muscle weakness, decreased muscle endurance, fatigue, muscle pain, joint pain, cold intolerance, and this typical clinical entity is reported from different parts of the world. 15 . The pathophysiology behind PPS is not fully understood, but a combination of distal degeneration of enlarged motor units caused by increased metabolic demands and the normal aging process, in addition to inflammatory mechanisms, are thought to be involved. 15 . There is no diagnostic test for PPS, and the diagnosis is based on a proper clinical workup where all other possible explanations for the new symptoms are ruled out. 15 .

Intravenous immunoglobulin (IVIG) has been tried in three studies, all having positive results. 15 . IVIG could probably be a therapeutic alternative, but the potential benefit is modest, and some important questions are still unanswered, in particular to which patients this treatment is useful, the dose, and the therapeutic interval. 15 . A statistically significant increase of the SF-36 sub domains bodily pain, vitality, social function, role emotional, and the mental compound score (MCS) was found at the 6-month follow-up. 13 . A significant decrease of pain was found in patients who reported pain intensity over VAS of 20 mm, in patients younger than 65 years of age and in patients who had paresis in the lower extremities. 13 . IVIG leads to increase of quality of life at 6-month follow-up for SF-36 regarding sub domains of bodily pain, vitality, social function, role emotional, as well as for pain. 13 .

L-Citrulline is known to change muscular metabolism synthesis by raising nitric oxide (NO) levels and increasing protein synthesis. 10 . This investigator-initiated, randomised, placebo-controlled, double-blind, trial aims to demonstrate that L-citrulline positively influences muscle function and increases muscular energy production in patients with PPS. 10 . Patients receiving L-Citrulline walked 17.5 longer in the 6 min walking distance test when compared to placebo group, however not statistically significant (95% CI = -14.69; 49.68, p = 0.298). 3 . None of the secondary endpoints showed a statistically significant change in the L-Citrulline group when compared to placebo group. 3 . The motor function measure showed a change of -0.78 (95% CI= [-3.39; 1.83] p = 0.563). 3 . Muscle degeneration of leg muscles assessed with quantitative MRI indicated no significant change (estimate= -0.01, 95% CI =-0.13; 0.11, p = 0.869). 3 . L-Citrulline was safe and well tolerated. 3 .

Modafinil has been shown to reduce fatigue in patients with multiple sclerosis. 21 . A double-blind, placebo-controlled study to assess its efficacy in the disabling symptom of post-polio fatigue. 21 . Fifty-four percent of patients given amantadine and 43% given placebo reported a decrease in fatigue; however, the visual analogue scales and fatigue severity scales failed to reflect any improvement. 21 . Our findings suggest that amantadine is not significantly better than placebo in reducing the sensation of fatigue in post-polio syndrome, and that the measures we employed were insensitive to capture the subjective response experienced by a few patients. 21 . To determine if modafinil can improve fatigue in patients with post-polio syndrome. 17 .

Treatment summary

Individuals experiencing post-polio sequelae (PPS) are usually advised to make significant lifestyle changes to lessen symptoms and prevent further decline in function. 22 . As specialists in energy conservation and work simplification, occupational therapyists increasingly are being called on to evaluate and treat these patients. 22 . Over the past 2 years, an occupational therapy educational program has been developed to educate patients about their condition and about ways to implement lifestyle changes while preserving the ability to do valued activities. 22 . This article describes the components of a thorough occupational therapy evaluation and the design and functional outcomes of a successful occupational therapy educational program to treat PPS. 22 . The basic principle of management of PPS lies in physical activity, individually tailored training programs, and lifestyle modification. 15 . Muscle weakness and muscle pain may be helped with specific training programs, in which training in warm water seems to be particularly helpful. 15 . Properly fitted orthoses can improve the biomechanical movement pattern and be energy-saving. 15 . Fatigue can be relieved with lifestyle changes, assistive devices, and training programs. 15 . Respiratory insufficiency can be controlled with noninvasive respiratory aids including biphasic positive pressure ventilators. 15 . Pharmacologic agents like prednisone, amantadine, pyridostigmine, and coenzyme Q10 are of no benefit in PPS. 15 .

Benefits and Risks

Benefits summary

Treatment for PPS can improve quality of life, strengthen muscles, improve mobility, and reduce fatigue. 13 、 12 、 3 、 10 、 17 、 21 .

Risks summary

Treatment for PPS can have side effects. IVIG can cause side effects such as headaches and fever. 13 、 12 . L-citrulline has been found to be safe, but long-term effects are unknown. 3 、 10 . Modafinil can cause side effects such as insomnia and digestive problems. 17 、 21 .

Comparison between studies

Commonalities among studies

Many studies suggest that a combination of rehabilitation, assistive devices, and medication is important for the treatment of PPS. 15 、 7 、 22 、 14 .

Differences among studies

Various medications have been tried for the treatment of PPS, but there are few established effective treatments. Further research is needed on the efficacy of each medication. 11 、 3 、 13 、 10 、 17 、 21 .

Consistency and contradictions in the results

Treatment outcomes for PPS can vary greatly from patient to patient. 11 、 3 . Therefore, long-term follow-up studies are needed to evaluate the effectiveness of treatment. 13 、 12 、 7 .

Notes on the application to real life

It is important to select the appropriate treatment for PPS based on the individual's condition and symptoms. 15 、 7 、 22 . Changing treatment methods on your own can be dangerous, so it is recommended to consult with your doctor. 1 、 2 .

Current limitations of research

Research on PPS treatment is still insufficient. 15 、 7 . In particular, there is a lack of research on long-term effects and safety. 13 、 12 、 3 、 10 .

Future research directions

Further research is needed to verify the effectiveness and safety of PPS treatment methods. 15 、 7 . The development of treatment methods tailored to the individual condition of each patient is also required. 1 、 2 .

Conclusion

PPS is a condition that affects polio survivors years after recovery from an initial acute infection by the Poliomyelitis virus. 15 、 10 、 18 、 1 、 2 、 7 、 9 . Various medications have been tried for the treatment of PPS, but there are few established effective treatments. Further research is needed on the efficacy of each medication. 11 、 3 、 13 、 10 、 17 、 21 . When seeking treatment for PPS, it is important to consult with your doctor and choose the appropriate treatment method. 1 、 2 .

List of treatments

Rehabilitation, assistive devices, IVIG, L-Citrulline, Modafinil