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Over the past decade the introduction of high dose intravenous immunoglobulin (IvIg) therapy has transformed the treatment of some neuromuscular diseases, particularly multifocal motor neuropathy with conduction block, for which there is no satisfactory alternative therapy. The appearance of this small multiauthor handbook on the use of IvIg in the treatment of neurological disorders is timely. It has been well edited to produce a clear, easily readable, and relatively even style. The tables are useful and well produced. In general, the authors have stuck to the brief of balancing the relative merits of IvIg and conventional therapies for their chosen neurological disorder. However, one or two have used the book as the vehicle for a more general discussion on their chosen disease, accompanied by relatively brief comments on the particular part played by IvIg therapy.
All regular users of IvIg therapy must be intrigued by the unsolved mystery of its mode of action. The first chapter of this book considers its possible modulatory effects on a myriad of immunological pathways and mechanisms. Initially we all assumed that IvIg contains pooled naturally occurring anti-idiotypes which neutralise the patient's own pathogenic antibodies. Yet pathogenic antibodies have not been identified as the cause of most inflammatory neuropathies which respond to IvIg, and after all this time searching one wonders whether they ever will be. It is surprising that nobody has reported whether IvIg contains natural anti-idiotypes to the well characterised antiacetylcholine receptor antibodies which occur in myasthenia gravis, a …