Intravenous Immunoglobulin Therapy in Postpoliomyelitis Syndrome

Abstract

Postpoliomyelitis syndrome is a new neurological disorder seen in individuals who survive remote poliomyelitis. An adequate diagnosis is important for treatment and prognosis. The diagnosis of postpoliomyelitis syndrome might be difficult as the diagnosis mostly depends on the patient's subjective description of the symptoms. The diagnostic criteria primarily depend on new and progressive muscle weakness, muscle fatigue, general fatigue, and pain in the absence of other disorders which may be similar to this syndrome. Furthermore, the postpoliomyelitis syndrome patients have reached an age when concomitant diseases are common. The possible etiology is that this entity of paralysis can be exploited by slowly progressive distal neuronal degeneration. Interestingly, this patient had primary upper limb polio paralysis and then new slowly progressive asymmetrical, muscle weakness in the contralateral lower limb. Few clinical trials using human intravenous immunoglobulin (IVIG) and pyridostigmine gave controversy about a specific treatment. In this case, we tried an IVIG therapy, but the weakness was progressively worsening and there was more atrophy in the muscle bulk of the affected muscle group. However, supportive treatment is also important to be planned. The aim of this case report is to describe the complexity of the diagnosis and treatment of such cases of the postpoliomyelitis syndrome in comparison to relevant literature.