title: Treatment for postpolio syndrome.
abstract: BACKGROUND
  Postpolio syndrome (PPS) may affect survivors of paralytic poliomyelitis and is characterised by a complex of neuromuscular symptoms leading to a decline in physical functioning. The effectiveness of pharmacological treatment and rehabilitation management in PPS is not yet established.
  
  
  OBJECTIVE
  To review systematically the effects of any treatment for PPS compared to placebo, usual care or no treatment.
  
  
  METHODS
  We searched the following databases on 1 October 2010: Cochrane Neuromuscular Disease Group Specialized Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO and CINAHL Plus from inception to September 2010.
  
  
  METHODS
  Randomised and quasi-randomised trials of any form of pharmacological or non-pharmacological treatment for people with PPS. The primary outcome was self-perceived activity limitations and secondary outcomes were muscle strength, muscle endurance, fatigue, pain and adverse events.
  
  
  METHODS
  Two authors independently selected eligible studies, assessed risk of bias and extracted data.
  
  
  RESULTS
  Nine pharmacological (modafinil, intravenous immunoglobulin, pyridostigmine, lamotrigine, amantadine, prednisone) and three non-pharmacological (muscle strengthening, rehabilitation in a warm climate (i.e. temperature ± 25°C, dry and sunny) and a cold climate (i.e. temperature ± 0°C, rainy or snowy), static magnetic fields) studies were included in this review. None of the included studies was completely free from any risk of bias and the most prevalent risk of bias was lack of blinding.There is moderate quality evidence that intravenous immunoglobulin has no beneficial effect on activity limitations and there is inconsistency in the evidence for effectiveness on muscle strength and pain. Results of one trial provide very low quality evidence that lamotrigine might be effective in reducing pain and fatigue, resulting in fewer activity limitations. Data from two single trials suggest that muscle strengthening of thumb muscles (very low quality evidence) and static magnetic fields (moderate quality evidence) are beneficial for improving muscle strength and pain, respectively, with unknown effects on activity limitations. Finally, there is evidence varying from very low quality to high quality that modafinil, pyridostigmine, amantadine, prednisone and rehabilitation in a warm or cold climate are not beneficial in PPS.
  
  
  CONCLUSIONS
  Due to insufficient good quality data and lack of randomised studies it is impossible to draw definite conclusions on the effectiveness of interventions for PPS. Results indicate that IVIG, lamotrigine, muscle strengthening exercises and static magnetic fields may be beneficial but need further investigation.
authors.affiliation: Department of Rehabilitation, University of Amsterdam Academic Medical Center, PO Box 22660, Amsterdam, North Holland, Netherlands, 1100 DD.
authors.forename: Fieke Sophia
authors.initials: FS
authors.lastname: Koopman
authors.forename: Kimi
authors.initials: K
authors.lastname: Uegaki
authors.forename: Nils Erik
authors.initials: NE
authors.lastname: Gilhus
authors.forename: Anita
authors.initials: A
authors.lastname: Beelen
authors.forename: Marianne
authors.initials: M
authors.lastname: de Visser
authors.forename: Frans
authors.initials: F
authors.lastname: Nollet
mesh_terms: D003080:Cold Temperature; D005081:Exercise Therapy / Q000379:methods; D006358:Hot Temperature; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D000077213:Lamotrigine; D018763:Muscle Fatigue; D053580:Muscle Strength; D016262:Postpoliomyelitis Syndrome / Q000188:drug therapy / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D014227:Triazines / Q000627:therapeutic use
chemical_list: D016756:Immunoglobulins, Intravenous; D014227:Triazines; D000077213:Lamotrigine