Treatment of reflex sympathetic dystrophy in hemiplegic patients by iontophoresis

ABSTRACT

To evaluate the efficacy and safety of tap water iontophoresis in the treatment of reflex sympathetic dystrophy [RSD] in stroke patients and to compare it with other types of physical therapy. Prospective randomized controlled study, with six months follow up. Forty five Saudi patients with hemiplegia following cerebrovascular disease [either cerebral hemorrhage or infarction] who had been suffering from reflex sympathetic dystrophy [RSD] of one upper extremity for less than one year. RSD was diagnosed if four typical symptoms were present in the upper extremity. Three groups, each with 15 cases were established. All three groups received medical treatment. Patients were assigned to 24 weeks' treatment with physical therapy [PT] in group I, tap water iontophoresis in group II and medical treatment only in group III [control group]. The reduction in symptoms was assessed objectively and subjectively by improvement in impairment level sum score [ISS] over 6 months by [student's t test]. A difference of 5 ISS points between the groups was defined as being clinically relevant. Furthermore, severity of disability and handicap was measured and tested exploratively [Wilcoxon; alpha=0.05]. Forty five patients were included. The mean age of the patients was 63.6 [ +/- 5.8] years, the mean time since the stroke was 8.7 [ +/- 1.7] months and the mean duration of symptoms was 3.1 +/- 1.4 months. Iontophoresis and to a lesser extent PT resulted in a significant and also more rapid improvement in the ISS as compared with the controls [5 and 4 ISS points repectively]. On a disability and a handicap levels, no difference was found between the groups. The side effects reported with tap water iontophoresis were all mild and transient. Tap water iontophoresis and physical therapy contribute to the recovery from the RSD of the upper extremity. Iontophoresis is a, safe and useful treatment modality for RSD