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.