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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

References

1.Codd, MB, Mulder, DW, Kurland, LT, Beard, CM, O’Fallon, WM.Poliomyelitis in Rochester, Minnesota, 1935–1955: Epidemiology and long-term sequelae. A preliminary report. In: Halstead, LS, Wiechers, DO, eds. Late Effects of Poliomyelitis. Miami, FL: Symposia Foundation, 1985: 121–134.Google Scholar
2.Halstead, LS, Weichers, DO, Rossi, CD.Late effects of poliomyelitis: a national survey. In: Halstead, LS, Wiechers, DO, eds. Late Effects of Poliomyelitis. Miami, FL: Symposia Foundation, 1985: 11–31.Google Scholar
3.Cashman, NR, Maselli, R, Wollman, RL, et al. Late denervation in patients with antecedent paralytic poliomyelitis. N Engl J Med 1987; 317: 7–12.CrossRefGoogle ScholarPubMed
4.Halstead, LS, Rossi, CD.Post-polio syndrome: clinical experience with 132 consecutive outpatients. In: Halstead, LS, Wiechers, DO, eds, Research and Clinical Aspects of the Late Effects of Poliomyelitis. White Plains, NY: March of Dimes Birth Defects Foundation, 1987: 13–26.Google Scholar
5.Trojan, DA, Cashman, NR.Treatment of fatigue in the post-poliomyelitis syndrome with pyridostigmine. Arch Phys Med Rehabil 1989; 70: A42 (abstract).Google Scholar
6.Jubelt, B, Cashman, NR.Neurological manifestations of the post-polio syndrome. Crit Rev Neurobiol 1987; 3: 199–220.Google ScholarPubMed
7.Engel, AG.Acquired autoimmune myasthenia gravis. In: Engel, AG, Banker, BQ, eds, Myology. New York, NY: McGraw Hill Inc., 1986: 1925–1954.Google Scholar
8.Mulder, DW, Lambert, EH, Eaton, LM.Myasthenic syndrome in patients with amyotrophic lateral sclerosis. Neurology 1959; 9: 627–631.CrossRefGoogle ScholarPubMed
9.Stalberg, E, Ekstedt, J, Broman, A.Neuromuscular transmission in myasthenia gravis studied with single fiber electromyography. J Neurol Neurosurg Psychiatry 1974; 37: 540–547.CrossRefGoogle Scholar
10.Stalberg, E, Schwartz, MS, Trontelj, JV.Single fiber electromyography in various processes affecting the anterior horn cell. J Neurol Sci 1975; 24: 403–415.CrossRefGoogle ScholarPubMed
11.Denys, EH, Norris, FH.Amyotrophic lateral sclerosis impairment of neuromuscular transmission. Arch Neurol 1979; 36: 202–225.CrossRefGoogle ScholarPubMed
12.Bernstein, LP, Antel, JP.Motor neuron disease: decremental response to repetitive nerve stimulation. Neurology 1981; 31: 204–207.CrossRefGoogle Scholar
13.Hodes, R.Electromyographic study of defects of neuromuscular transmission in human poliomyelitis. Arch Neurol Psychiatr 1948; 60: 457–473.CrossRefGoogle ScholarPubMed
14.Wiechers, DO, Hubbell, SL.Late changes in the motor unit after acute poliomyelitis. Muscle Nerve 1981; 4: 524–528.CrossRefGoogle ScholarPubMed
15.Dalakas, MC, Elder, G, Hallett, M, et al. A long-term follow-up study of patients with post-poliomyelitis neuromuscular symptoms. N Engl J Med 1986; 314: 959–963.CrossRefGoogle ScholarPubMed
16.Wiechers, DO.New concepts of the reinnervated motor unit revealed by vaccine-associated poliomyelitis. Muscle Nerve 1988; 11: 356–368.CrossRefGoogle ScholarPubMed
17.Trojan, DA, Gendron, D, Cashman, NR.Anticholinesterase-responsive neuromuscular junction transmission defects in post-poliomyelitis fatigue. J Neurol Sci 1993; 114: 170–177.CrossRefGoogle ScholarPubMed
18.Trojan, DA, Gendron, D, Cashman, NR.Stimulation frequency-dependent neuromuscular junction transmission defects in patients with prior poliomyelitis. J Neurol Sci 1993; 118: 150–157.CrossRefGoogle ScholarPubMed
19.Bradley, WG.Recent views on amyotrophic lateral sclerosis with emphasis on electrophysiological studies. Muscle Nerve 1987; 10: 490–502.CrossRefGoogle ScholarPubMed
20.Klingman, J, Chui, H, Corgiat, M, Perry, J.Functional recovery: a major risk factor for the development of postpoliomyelitis muscular atrophy. Arch Neurol 1988; 45: 645–647.CrossRefGoogle Scholar
21.Hare, TW, Hakki, AH, Lowenthal, DT, lskandrian, AS, Segal, BL.Simplified scale for rating perceived exertion in patients with coronary artery disease. Ann Sports Med 1985; 2: 64–68.Google Scholar
22.Granger, CV.Health accounting: functional assessment of the long-term patient. In: Kottke, FJ, Stillwell, GK, Lehmann, JF, eds. Krusssen’s Handbook of Physical Medicine and Rehabilitation. Philadelphia, PA: W.B. Saunders, 1982: 253–274.Google Scholar
23.Munsat, TL.Anticholinesterase abuse in myasthenia gravis. J Neurol Sci 1984; 64: 5–10.CrossRefGoogle ScholarPubMed
24.Engel, AG, Lambert, EH, Santa, T.Study of long-term anti-cholinesterase therapy: effects on neuromuscular transmission and on motor end-plate fine structure. Neurology 1973: 23: 1273–1281.CrossRefGoogle ScholarPubMed
25.Hudson, CS, Rash, JE, Tiedt, TN, Albuquerque, EX.Neostigmine-induced alterations at the mammalian neuromuscular junction. II. Ultrastructure. J Pharm Exp Ther 1978; 205: 340–356.Google Scholar
26.Keeler, JR, Hurst, CG, Dunn, MA.Pyridostigmine used as a nerve agent pretreatment under wartime conditions. JAMA 1991: 266: 693–695.CrossRefGoogle ScholarPubMed
27.Cook, JE, Wenge, B, Kolka, MA.Chronic pyridostigmine bromide administration: side effects among soldiers working in a desert environment. Military Med 1992; 157: 250–254.CrossRefGoogle Scholar
28.Kilfoil, M, St Pierre, DM, Trojan, DA, Cashman, NR.The effects of pyridostigmine (Mestinon) on isokinetic evaluation of fatigue in subjects with post-poliomyelitis syndrome. Phys Ther 1992; 72: S112 (abstract).Google Scholar
29.Gow, PJ, Stokes, M, Edwards, RHT.Investigations of neuromuscular performance in post-polio patients: a practical approach. In: Halstead, LS, Wiechers, DO, eds. Research and Clinical Aspects of the Late Effects of Poliomyelitis, White Plains, NY: March of Dimes Birth Defects Foundation, 1987: 293–300.Google Scholar
30.Kohl, SJ.Emotional responses to the late effects of poliomyelitis. In: Halstead, LS, Wiechers, DO, eds. Research and Clinical Aspects of the Late Effects of Poliomyelitis. White Plains. NY: March of Dimes Birth Defects Foundation, 1987: 135–143.Google Scholar
31.Fischer, DA.Sleep-disordered breathing as a late effect of poliomyelitis. In: Halstead, LS, Wiechers, DO, eds. Research and Clinical Aspects of the Late Effects of Poliomyelitis. White Plains, NY: March of Dimes Birth Defects Foundation, 1987: 115–120.Google ScholarPubMed
32.Halstead, LS.Post-polio syndrome: definition of an elusive concept. In: Munsat, TL, ed. Post-Polio Syndrome. Boston. MA: Butterworth-Heinemann, 1991: 23–28.Google Scholar
33.Bruno, RL, Frick, NM, Cohen, J.Polioencephalitis, stress, and the etiology of post-polio sequelae. Orthopedics 1991; 14: 1269–1276.CrossRefGoogle ScholarPubMed
34.Trojan, DA, Cashman, NR.Fibromyalgia is common in a post-poliomyelitis clinic. Arch Neurol 1995 (in press).CrossRefGoogle Scholar
35.Munsat, TL, Andres, P, Thibideau, L.Preliminary observations on long-term muscle force changes in the post-polio syndrome. In: Halstead, LS, Wiechers, DO, eds. Research and Clinical Aspects of the Late Effects of Poliomyelitis. White Plains, NY: March of Dimes Birth Defects Foundation, 1987: 329–334.Google Scholar
36.Perry, J, Barnes, G, Gronley, JK.The post-polio syndrome: an overuse phenomenon. Clin Orth Rel Res 1988; 233: 145–162.CrossRefGoogle Scholar
37.Sharma, KR, Kent-Braun, J, Mynhier, MA, Weiner, MW, Miller, RG.Excessive muscular fatigue in the postpoliomyelitis syndrome. Neurology 1994; 44: 642–646.CrossRefGoogle ScholarPubMed
38.Fletcher, RH, Fletcher, SW, Wagner, EH.Clinical epidemiology: the essentials. Baltimore, MD: Williams and Wilkins, 1988: 140.Google Scholar