Electrophysiology in chronic inflammatory demyelinating polyneuropathy with IGIV

Abstract

Patients with chronic inflammatory demyelinating polyneuropathy (CIDP) received immune globulin intravenous, 10% caprylate/chromatography purified (IGIV-C, Gamunex; n=59) or placebo (n=58) every 3 weeks for up to 24 weeks (first period) in a randomized, double-blind, parallel-group, response-conditional, crossover study. Motor and sensory nerves were assessed at baseline and endpoint/week 24. A nonsignificant trend toward improvement in the proximal amplitude of the most severely affected motor nerve was observed with IGIV-C (0.69+/-1.86 mV) versus placebo (0.47+/-2.29 mV), and a greater improvement of 1.08+/-2.15 mV with IGIV-C versus 0.46+/-2.03 mV with placebo (P=0.089) was observed with exclusion of data from Erb's point stimulation. Greater improvements from baseline favoring IGIV-C were observed for 127/142 electrophysiologic parameters. The averaged motor amplitudes from all motor nerves significantly improved with IGIV-C versus placebo [treatment difference, 0.62 mV; 95% confidence interval (CI), 0.05, 1.20; P=0.035], and conduction block decreased significantly (treatment difference, -5.54%; 95% CI, -10.43, -0.64; P=0.027), particularly in the lower limbs. Overall, the data suggest that IGIV-C improves electrophysiologic parameters in CIDP.

Confirming the efficacy of intravenous immunoglobulin in CIDP through minimum clinically important differences: shifting from statistical significance to clinical relevance

“…Baseline values for the impairment measures—electromyographic parameters, Medical Research Council (MRC) sum score, grip strength, INCAT sensory sum score, activity and participation scale scores (INCAT disability scale and Rotterdam handicap scale (RHS)), and quality-of-life component measures (physical component score (PCS) and mental component score (MCS))—were similar between the two treatment groups 3 4 27…”

New Insights Into the Management of Chronic Inflammatory Demyelinating Polyradiculoneuropathy

“…A subanalysis of the ICE study found significantly greater improvement from baseline in favor of IVIG over placebo for averaged motor amplitudes from all motor nerves (treatment difference 0.62 mV; 95% CI: 0.05-1.20; p = 0.035) and conduction block (treatment difference -5.54%; 95% CI: -10.43 to -0.64; p = 0.027) [27]. These investigators also examined correlations between the changes observed in nerve conduction studies and response to treatment [28].…”

Characteristics and correlates of sensory function in chronic inflammatory demyelinating polyneuropathy

“…Although precise and regular monitoring of sensory scores is seldom performed in routine clinical practice, sensory scales are commonly utilized in research settings [4,5]. The relation of clinical function with sensory electrophysiology is also uncertain, non-significant improvement of the amplitudes of sensory electrophysiological responses having been demonstrated in a recent therapeutic study [6]. We proposed to evaluate the clinical and electrophysiological sensory functions in a cohort of patients with clinically-stabilized CIDP, as well as establish the relationship with motor strength and function, and with the degree of motor axonal involvement.…”