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Post-polio syndrome patients treated with intravenous immunoglobulin: a double-blinded randomized controlled pilot study.
Eur J Neurol. 2007 Jan;14(1):60-5.
Farbu E, Rekand T, Vik-Mo E, Lygren H, Gilhus NE, Aarli JA.
Department of Neurology, Haukeland University Hospital, Bergen, Norway.
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Post-polio
syndrome (PPS) is characterized by new muscle weakness, atrophy,
fatigue and pain developing several years after the acute polio. Some
studies suggest an ongoing inflammation in the spinal cord in these
patients. From this perspective, intravenous immunoglobulin (IvIg)
could be a therapeutic option.
We performed a double-blinded randomized
controlled pilot study with 20 patients to investigate the possible
clinical effects of IvIg in PPS. Twenty patients were randomized to
either IvIg 2 g/kg body weight or placebo. Primary endpoints were
changes in pain, fatigue and muscle strength 3 months after treatment.
Surrogate endpoints were changes in cerebrospinal fluid (CSF) cytokine
levels. Secondary endpoints were pain, fatigue and isometric muscle
strength after 6 months. Patients receiving IvIg reported a significant
improvement in pain during the first 3 months, but no change was noted
for subjective fatigue and muscle strength. CSF levels of tumour
necrosis factor-alpha (TNF-alpha) were increased compared with patients
with non-inflammatory neurological disorders. In conclusion, in this
small pilot study no effect was seen with IvIg treatment on muscle
strength and fatigue, however IvIg treated PPS patients reported
significantly less pain 3 months after treatment. TNF-alpha was
increased in the CSF from PPS patients. The results are promising, but
not conclusive because of the low number of patients studied.
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