Treatment of reflex sympathetic dystrophy in children using a prostacyclin analog: preliminary results.

UNLABELLED: The aim of our study was to evaluate Iloprost, a prostacyclin analog, for treatment of reflex sympathetic dystrophy in children not responsive to conservative treatment. Seven female patients with a mean age of 9 years (range, 6-11 years) diagnosed with reflex sympathetic dystrophy Stage II were treated with infusions of Iloprost given on three consecutive days. Additionally, all patients had physiotherapy and were offered psychologic consultation. One day after the final infusion, all seven patients were free of pain and achieved full weightbearing. The side effects of Iloprost were headache in all patients and vomiting in two patients. Two patients experienced relapse--one patient at 3 months and the other patient 5 months after primary treatment--but both were free of pain by 5 days after a second series of infusions. During a mean followup of 30 months all patients remained asymptomatic. Our preliminary results suggest that temporary sympathicolysis with Iloprost, physiotherapy, and psychologic counseling is a safe and an effective treatment of reflex sympathetic dystrophy in children with a long history of symptoms or in those who do not respond to conservative treatment. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Instructions for Authors for a complete description of levels of evidence.