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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