BROMOCRIPTINE IN THE TREATMENT OF POSTPOLIO FATIGUE - A PILOT-STUDY WITH IMPLICATIONS FOR THE PATHOPHYSIOLOGY OF FATIGUE

Fatigue is the most commonly reported and most disabling of all post-p olio sequelae (PPS). Bromocriptine mesylate (Parlodel) was employed in a placebo-controlled trial in five survivors of paralytic polio who c ontinued to report moderate to severe daily fatigue after complying wi th the conservative treatments prescribed for PPS, Placebo was given f or 4 wk followed by increasing doses of bromocriptine mesylate, admini stered at 12:00 pm for 28 days, which reached a total dose of 12.5 mg/ day. Three subjects reported marked symptom improvement on bromocripti ne but not on placebo. Their reported difficulty with attention, conce ntration, word finding, mind wandering, memory thinking clearly, and f atigue on awakening was significantly negatively correlated with days on bromocriptine but not with days on placebo. Before the drug trial b egan, responders had clinically impaired performance on neuropsycholog ic tests of attention and information processing speed, more than twic e as many hyperintensities on magnetic resonance imaging of the brain, abnormally low fasting adrenocorticotropic hormone levels, and nearly double the mean plasma prolactin level compared with nonresponders. T he implications of these findings for the pathophysiology of fatigue a re discussed. A double-blind, placebo-controlled, multicenter study wi ll be needed to confirm bromocriptine's efficacy in treating attention ally and neurophysiologically impaired polio survivors whose severe an d disabling fatigue does not respond to conservative therapies.