Acute motor response following a single IVIG treatment course in chronic inflammatory demyelinating polyneuropathy

Abstract

In chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), the acute motor response following withdrawal and reestablishment of intravenous immunoglobulin (IVIG) therapy was studied. In a prospectively designed case series 11 CIDP patients in IVIG maintenance therapy were assessed with isokinetic dynamometry, nerve conduction studies, and functional tests. After short-term withdrawal of IVIG, eight treatment-responsive patients had a 14.2% (8.6-20.0) loss of isokinetic strength of 12 muscle groups. Three patients remained stable without treatment and were excluded from further study. On days 5 and 10 after reinitiation of IVIG therapy isokinetic muscle strength increased by 5.5% (1.6-9.6) and 11.9% (7.5-16.5), respectively, but there was no further increase at day 15. Improvement of walking velocity and hand function coincided. The minimal F-wave latency shortened, whereas other electrophysiological parameters remained unchanged. In conclusion, isokinetic dynamometry is a sensitive and clinically relevant method for monitoring the acute response to IVIG treatment in CIDP.

Health-related quality of life in chronic inflammatory neuropathies: A systematic review

“…Both treatments provided significant, but not significantly different, improvements at 2 weeks in the primary outcome measure, the 11-point Inflammatory Neuropathy Cause and More improvement on IVIg than on steroids Merkies et al [2] 2002 CIDP, PDN Cross-sectional 31 Lower than in controls; Improvement with treatment Padua et al [6] 2004 CIDP, MMN Prospective cohort 11 Improvement with IVIg Padua et al [7] 2005 CIDP, MMN Prospective cohort 11 Improvement with IVIg Garssen et al [8] 2004 CIDP Interventional: Physical Training 4 Improvement with training Hughes et al [9] 2008 CIDP Therapeutic 117 Improvement with IVIg Merkies et al [10] 2009 CIDP Therapeutic 117 Improvement with IVIg Merkies et al [11] 2010 CIDP Therapeutic 117 Correlation with strength, grip, disability Harbo et al [12] 2008 CIDP Cross-sectional 14 Impairment; Correlation with isokinetic strength Harbo et al [13] 2009 CIDP Therapeutic 11 Improvement with IVIg Harbo et al [14] 2009 MMN Therapeutic 9 SCIg equivalent to IVIg Eftimov et al [15] 2009 MMN Therapeutic 10 SCIg equivalent to IVIg Misbah et al [16] 2011 MMN Therapeutic 8 Improvement on SCIg Cocito et al [17] 2012 CIDP Therapeutic 5 SCIg equivalent to IVIg Cocito et al [18] 2013 CIDP Therapeutic 10 Improved with 20% SCIg compared to 16% SCIg Braine et al [19] 2012 MMN Therapeutic 16 SCIg equivalent to IVIg Nobile-Orazio et al [20] 2012 CIDP Therapeutic 45 IV Steroids equivalent to IVIg Mahdi-Rogers et al [21] 2014 CIDP, MMN, PDN Economic, HRQoL 106 Impaired compared to average Unrelated to treatment received Maxwell et al [22] 2013 CIDP, PDN HRQoL, Social 39 Impaired compared to normal dos Santos et al [23] 2014 CIDP HRQoL, cognitive 41 Impaired compared to non-matched normal subjects Niermeijer et al [24] 2007 PDN Therapeutic 35 Improved with cyclophosphamide + prednisone Léger et al [25] 2013 PDN (anti-MAG neuropathy only) Therapeutic 54…”

“…In another analysis, Harbo et al evaluated the acute motor response following a single IVIg treatment course in 11 patients with CIDP [13]. Various assessment tools were used, including isokinetic strength, NIS (neuropathy impairment score)-strength score, functional tests such as the nine-hole peg test and 40-metre walk test, and in addition, the SF-36 Questionnaire.…”

“…Although scores for various domains were provided, normative values for the relevant Brazilian population were not available for analysis. Comparisons were made with data from Denmark [13], although, as acknowledged by the authors, these comparisons were likely to be biased cultural differences.…”

New Insights Into the Management of Chronic Inflammatory Demyelinating Polyradiculoneuropathy

“…In a smaller study involving 11 patients on IVIG maintenance therapy, a clear increase in the strength of various muscle groups as measured with isokinetic dynamometry was observed following reinitiation of IVIG therapy after a short-term withdrawal [24]. Response was maximal between days 5 and 10 after the course of IVIG therapy, with no further improvement beyond day 15.…”

Retrospective study of a TTR FAP cohort to modify NIS + 7 for therapeutic trials

“…NIS + 7 has, and is, the primary or co-primary outcome measure in the trials of diabetic sensorimotor polyneuropathy [23,29], TTR FAP [10,11,13] and other generalized sensorimotor polyneuropathies [30][31][32][33][34]. The Kumamoto scale was a secondary outcome measure in the Diflunisal Trial [13].…”