AN OPEN TRIAL OF PYRIDOSTIGMINE IN POSTPOLIOMYELITIS SYNDROME

Background: One of the major symptoms of postpoliomyelitis syndrome (P PS) is disabling generalized fatigue. Subjects with PPS also report mu scle fatiguability and display electrophysiologic evidence of antichol inesterase-responsive neuromuscular junction transmission defects, sug gesting that anticholinesterase therapy may be useful in the managemen t of disabling fatigue. Methods: We initiated an open trial of the ora l anticholinesterase pyridostigmine, up to 180 mg per day, in 27 PPS p atients 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 medicati on. 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. P yridostigmine responders were significantly more fatigued than non-res ponders on the pre-treatment Hare score, but were not significantly di fferent with regard to age, sex, age at acute poliomyelitis, or severi ty of acute poliomyelitis. Conclusions: Pyridostigmine may be useful i n the management of fatigue in selected patients with PPS. Response to pyridostigmine may be predicted by severity of pre-treatment fatigue.