PMID- 9139559
OWN - NLM
STAT- MEDLINE
DCOM- 19970508
LR  - 20220409
IS  - 0003-4819 (Print)
IS  - 0003-4819 (Linking)
VI  - 126
IP  - 9
DP  - 1997 May 1
TI  - Intravenous immune globulin therapy for neurologic diseases.
PG  - 721-30
AB  - High-dose intravenous immune globulin (IVIg) has emerged as an important therapy 
      for various neurologic diseases. Different interpretations of clinical trial 
      results; the expected benefit of IVIg compared with that of alternate therapies; 
      and issues about IVIg's safety, cost, and mechanisms of action have raised 
      concern and uncertainty among practitioners. To clarify these areas, this paper 
      examines the clinical, serologic, and immunologic data on more than 110 patients 
      with various autoimmune neurologic diseases who received IVIg during the past 6 
      years at the National Institute of Neurological Disorders and Stroke. It also 
      reviews work by other investigators on the efficacy, risks, benefits, and 
      mechanisms of the action of IVIg in these diseases. In controlled clinical 
      trials, IVIg has been effective in treating the Guillain-Barre syndrome, 
      multifocal motor neuropathy, chronic inflammatory demyelinating polyneuropathy, 
      and dermatomyositis. In other controlled or open-label trials and case reports, 
      IVIg produced improvement in several patients with the Lambert-Eaton myasthenic 
      syndrome and myasthenia gravis but had a variable, mild, or unsubstantiated 
      benefit in some patients with inclusion-body myositis, paraproteinemic IgM 
      demyelinating polyneuropathy, certain intractable childhood epilepsies, 
      polymyositis, multiple sclerosis, optic neuritis, and the stiff-man syndrome. The 
      primary adverse reaction was headache; aseptic meningitis, skin reactions, 
      thromboembolic events, and renal tubular necrosis occurred rarely. The most 
      relevant immunomodulatory actions of IVIg, operating alone or in combination, are 
      inhibition of complement deposition, neutralization of cytokines, modulation of 
      Fc-receptor-mediated phagocytosis, and down-regulation of autoantibody 
      production. Therapy with IVIg is effective for certain autoimmune neurologic 
      diseases, but its spectrum of efficacy has not been fully established. Additional 
      controlled clinical trials are needed.
FAU - Dalakas, M C
AU  - Dalakas MC
AD  - National Institute of Neurological Disorders and Stroke, National Institutes of 
      Health, Bethesda, MD 20892-1382, USA.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - Ann Intern Med
JT  - Annals of internal medicine
JID - 0372351
RN  - 0 (Adjuvants, Immunologic)
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
CIN - Ann Intern Med. 1997 Dec 15;127(12):1130. PMID: 9412321
CIN - Ann Intern Med. 1997 Dec 15;127(12):1130. PMID: 9412322
MH  - Adjuvants, Immunologic/adverse effects/economics/therapeutic use
MH  - Controlled Clinical Trials as Topic
MH  - Cost-Benefit Analysis
MH  - Humans
MH  - Immunoglobulins, Intravenous/adverse effects/economics/*therapeutic use
MH  - Nervous System Diseases/*drug therapy
MH  - Risk Factors
RF  - 97
EDAT- 1997/05/01 00:00
MHDA- 1997/05/01 00:01
CRDT- 1997/05/01 00:00
PHST- 1997/05/01 00:00 [pubmed]
PHST- 1997/05/01 00:01 [medline]
PHST- 1997/05/01 00:00 [entrez]
AID - 10.7326/0003-4819-126-9-199705010-00008 [doi]
PST - ppublish
SO  - Ann Intern Med. 1997 May 1;126(9):721-30. doi: 
      10.7326/0003-4819-126-9-199705010-00008.