Bromocriptine in the Treatment of Post-Polio Fatigue

A pilot study with implications for the pathophysiology of fatigue

Richard L. Bruno, HD, PhD et al.

American Journal of Physical Medicine and Rehabilitation, 1996; 75(5): 340-347.Richard L. Bruno, Ph.D.,1,2 Jerald R. Zimmerman, M.D.,1,2 Susan Creange, M.A.,1 Todd Lewis, Ph.D.,1 Terry Molzen, M.A.,1 and Nancy M. Frick, M.Div, Lh.D.3

Abstract

Objective: Determine the effectiveness of bromocriptine in the treatment of severe and disabling post-polio fatigue.

Design: Placebo-controlled drug trial in a pilot series of patients.

Setting: Outpatient rehabilitation hospital.

Patients: Of 83 patients without comorbidities who completed treatment with the Post-Polio Service, 5 of 8 patients who had paralytic polio and continued to report moderate to severe daily fatigue after complying with conservative treatments for post-polio fatigue agreed to be studied.

Intervention: Placebo was given for four weeks followed by increasing doses of bromocriptine mesylate (Parlodel ̈) administered at noon for 28 days reaching a total dose of 12.5 mg/day.

Main Outcome Measures: Daily logs of subjective fatigue and cognitive difficulties.

Results: Three of the subjects reported symptom improvement on bromocriptine but not on placebo. However, all subjects experienced nausea on bromocriptine, likely eliminating blinding. Drug responders had clinically impaired performance on neuropsychological tests of attention and information processing speed. Logged daily difficulty with attention, cognition, word finding memory, staying awake and fatigue on awakening were significantly negatively correlated with days on bromocriptine, but not with days on placebo, in drug responders.

Conclusions: A double-blind, placebo-controlled multicenter study will be needed to confirm bromocriptine's effectiveness in treating attentionally impaired polio survivors whose severe and disabling fatigue does not responded to conservative treatment.

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