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Review
Intravenous immunoglobulin in neurological disease: a specialist review
  1. C M Wiles14,
  2. P Brown1,
  3. H Chapel2,
  4. R Guerrini3,
  5. R A C Hughes4,
  6. T D Martin5,13,
  7. P McCrone6,
  8. J Newsom-Davis7,
  9. J Palace8,
  10. J H Rees9,
  11. M R Rose10,
  12. N Scolding11,
  13. A D B Webster12
  1. 1Sobell Department of Neurophysiology, Institute of Neurology, Queen Square, London WCIN 3BG, UK
  2. 2Department of Clinical Immunology, Oxford Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
  3. 3Neurosciences Unit, Institute of Child Health and Great Ormond Street Hospital for Children, Mecklenburgh Square, London WC1N 2AP, UK
  4. 4Department of Neuroimmunology, Hodgkin Building, GKT School of Medicine, Guy's Hospital, London SE1 1UL, UK
  5. 5Genesis Marketing Consultants, LLC, 30192 Highway M, Sedalia, Missouri 65301, USA
  6. 6Centre for the Economics of Mental Health, Institute of Psychiatry, Kings College, London SE5 8AF, UK
  7. 7Department of Clinical Neurology, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE, UK
  8. 8Department of Neurology, Radcliffe Infirmary, Oxford, UK
  9. 9National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
  10. 10Department of Neurology, Kings College Hospital, Denmark Hill, London SE5 8AZ, UK
  11. 11Institute of Clinical Neurosciences, Frenchay Hospital, Bristol BS16 1LE, UK
  12. 12Department of Immunology, The Royal Free Hospital, Pond Street, London NW3 2QG, UK
  13. 13Genesis Marketing Consultants, 30192 Highway M, Sedalia, Missouri 65301, USA
  14. 14Department of Medicine (Neurology), University of Wales College of Medicine, Cardiff CF14 4XX, UK
  1. Correspondence to: 
 Professor CM Wiles, Tenovus Building, Department of Medicine (Neurology), University of Wales College of Medicine, Cardiff CF14 4X, UK; 
 wiles{at}cf.ac.uk

Abstract

Treatment of neurological disorders with intravenous immunoglobulin (IVIg) is an increasing feature of our practice for an expanding range of indications. For some there is evidence of benefit from randomised controlled trials, whereas for others evidence is anecdotal. The relative rarity of some of the disorders means that good randomised control trials will be difficult to deliver. Meanwhile, the treatment is costly and pressure to “do something” in often distressing disorders considerable. This review follows a 1 day meeting of the authors in November 2000 and examines current evidence for the use of IVIg in neurological conditions and comments on mechanisms of action, delivery, safety and tolerability, and health economic issues. Evidence of efficacy has been classified into levels for healthcare interventions (tables 1 and 2).

  • intravenous immunoglobulin
  • peripheral neuropathy, immune regulation
  • tolerability
  • safety
  • health economics
  • IVIg, intravenous immunoglobulin
  • CIDP, chronic inflammatory demyelinating polyradiculoneuropathy
  • GBS, Guillain-Barré syndrome
  • MMN, multifocal motor neuropathy
  • MG, myasthenia gravis
  • LEMS, Lambert-Eaton myasthenic syndrome
  • DM, dermatomyositis
  • PM, polymyositis
  • IBM, inclusion body myositis
  • MS, multiple sclerosis
  • EDSS, expanded disability status score
  • WS, West syndrome
  • LGS, Lennox-Gastaut syndrome
  • RE, Rasmussen encephalitis
  • LKS, Landau-Kleffner syndrome
  • PND, paraneoplastic neurological disorders
  • PEM, paraneoplastic encephalomyelitis (anti-Hu)
  • PCD, progressive cerebellar degeneration (anti-Yo)
  • SSM, subacute sensory neuropathy
  • ITP, idiopathic thrombocytopenic purpura
  • PID, primary immune deficiency
  • CJD, Creuzfeldt-Jakob disease
  • QALY, quality adjusted life year

https://doi.org/10.1136/jnnp.72.4.440

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    Footnotes

    • Conflicts of interest

      Octapharma contributed to the travel and subsistence costs for the meeting. RACH has received hospitality and sponsorship from Novartis and Octapharma, and his department has received a research grant from Novartis. JN-D has received funds from Baxter to cover the costs of consumables for a clinical trial of IVIg in LEMS, and has received travel costs from Octapharma to lecture on the use of IVIg in MG. HC has received sponsorship monies from Griffols, Baxter, Novartis, CSL, Octapharma, BPL for clinical trials of immunologlobulin therapy, and educational grants on behalf of ESID and other Societies: also consultancy honoraria. TDM was employed by Octapharma AG at the time of writing this article: ADBW has had sponsorship and grants from Octopharma, Grifols, amd BPL. He is currently a private consultant and President of Genesis Marketing Consultants.