Excerpt from the
Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors©
No curative medication is available for post-polio syndrome. Currently, medications can be used to treat the symptoms and to improve quality of life. Certain other conditions and diseases (elevated blood cholesterol levels, high blood pressure, heart disease and cancers) require use of medications with side effects that can exacerbate the general symptoms of post-polio syndrome, such as weakness and fatigue. These medications should be used, but with careful monitoring of the polio survivor's functioning.
Medications to reverse muscular atrophy or to improve muscle strength by stimulating motor nerve endings to reconnect with muscle fibers, called nerve growth factors, are all still experimental and are being tested currently for use with other neuromuscular diseases. Only insulin-like growth factor-1 (IGF-1), also known as myotrophin or somatomedin-C, has been scientifically studied in people with post-polio syndrome (Miller et al., 1997). (See following table for a summary of drug trials to date.) It brought no change in strength or fatiguability, but did improve recovery from fatigue after exercise. Human growth hormone has been given to increase a person's natural level of IGF-1, but showed little or no improvement in strength (Gupta et al., 1994).
Medications that protect the nerve-muscle connection (neuro-muscular junction) from new damage are called neuro-protective agents. Selegiline has been tested in a small clinical series of people with post-polio syndrome, bringing some possible improvement in symptoms but no clear stabilization of the disorder (Bamford et al., 1993). Although many people use over-the-counter antioxidant preparations of various types, these have never been formally tested to verify any ability to slow down the changes of post-polio syndrome.
Anabolic steroids, often used by body builders to improve muscle bulk and power, have been tried by polio survivors and other persons with neuromuscular diseases, but The Medical Letter on Drugs and Therapeutics reports that side effects, such as risk of prostate cancer in men and masculinization in women, greatly outweigh the potential benefits. Metabolic stimulants such as L-carnitine and co-enzyme Q, used to improve the ability of muscle to make energy and possibly reduce fatigue and improve strength, have also been tried by polio survivors (Lehmann, 1994), but have been associated with rare allergic reactions and insomnia. A placebo-controlled study of L-carnitine showed no significant difference between placebo and L-carnitine (Tesch, 1998).
Specific anti-fatigue drugs can act either in the brain (on pathways controlled by dopamine and noradrenaline) or by improving communication at the neuromuscular junction. These are, respectively, central and peripheral agents. Three centrally-acting anti-fatigue medications, amantadine, bromocriptine and selegiline, have been studied in post-polio syndrome. Amantadine provided no reduction in fatigue (Stein et al., 1995), but bromocriptine (Bruno et al., 1996) and selegiline studies suggested some benefit and may warrant further study. Pyridostigmine (Mestinon®), a peripherally-acting drug, has been scientifically tested because several clinical open trials (Seizert et al., 1994; Trojan & Cashman, 1995; Trojan et al., 1993) suggested improvement in fatigue. However, in a well-controlled, randomized, double-blinded study of pyridostigmine in people with post-polio syndrome, no improvement of fatigue better than placebo was found (Trojan et al., 1997). This excellent study illustrates the limitations of reporting a benefit from a medication based on small promising clinical open trials and quickly adopting its widespread use before a definitive scientific study is completed.
Medications for pain are used when rehabilitation techniques and rest do not give adequate relief. Overuse pain (see Pain) cannot be eliminated by medication, just covered up. When a true analgesic is required, whether it is as simple as acetaminophen or as strong as a narcotic, it should be taken in moderate amounts and on a schedule, not just when the pain is so severe that a higher dose is necessary. If taken together, mild antihistamines or anti-anxiety medication may make painkillers work better and at a lower dose, but do have their own side effects.
Many medications such as narcotics, sedatives, tranquilizers, sleeping pills, alcohol, antihistamines, antidepressants and anti-anxiety agents, may cause drowsiness as a side effect or may increase fatigue within the general population. Polio survivors who take these medications may experience an increase in polio-related weakness and fatigue. Always check the label or ask a pharmacist or physician about the side effects.
Diuretics and laxatives may deplete the body of essential minerals required by nerves and muscles for normal functioning. Many other drugs (antibiotics, chemotherapy agents, even megadoses of some vitamins such as B6) can contribute to nerve damage. Muscle relaxants and drugs similar to them in chemical structure (quinine, quinidine, procainamide), as well as other medications used for heart or blood pressure problems (beta blockers, calcium channel blockers), may add to polio-related weakness and fatigue. Anecdotal evidence suggests that cholesterol-lowering medications of the "statin" family may also increase polio-related weakness and fatigue. Polio survivors, particularly those with a lesser muscle mass, have anecdotally reported fewer and less dramatic side effects when taking a lower dose (determined through consultation with the physician) of a needed medication.
Polio survivors and their physicians should scrutinize all medications used to treat various medical problems to be assured that related conditions, such as fibromyalgia, elevated cholesterol, high blood pressure, etc., are appropriately treated, but with minimal effect on polio-related symptoms. Polio survivors are cautioned not to change essential medications without appropriate medical consultation or advice.