Intravenous immunoglobulin response and evidence for pathogenic antibodies in a case of complex regional pain syndrome 1

Göebel, Andreas; Stöck, Michael; Deacon, Rob M.J.; Sprotte, G.; Vincent, Angela

doi:10.1002/ana.20400

Cited by 48 publications

(33 citation statements)

References 5 publications

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“…These observations have led researchers to investigate the role of IVIg as a potential treatment. In one study, researchers noted a patient response rate to IVIg of 30-40 %, and further trials are now planned, both in regional pain syndrome and in trigeminal neuralgia [12,13].…”

Section: ■ Pain and Fibrosismentioning

confidence: 97%

IVIg in other autoimmune neurological disorders: current status and future prospects

Dalakas¹

2008

J Neurol

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A number of autoimmune disorders have been identified in which IVIg treatment may be beneficial. Evidence for the use of IVIg in inflammatory myopathies comes from controlled trials in dermatomyositis (DM) and sporadic-inclusion body myositis (s-IBM). In DM, muscle strength was increased and neuromuscular scores and skin rashes improved. Results for s-IBM have not been as encouraging as those observed for DM. Subsequently, IVIg should be recommended as a second-line therapy in DM and used for life-threatening dysphagia in s-IBM. Using an animal model of experimental autoimmune myasthenia gravis (MG), studies also indicate that IVIg can significantly improve clinical symptoms and affect pathogenic idiotypic antibodies. In human MG, studies indicate that IVIg exhibited equal efficacy compared to plasmapheresis. IVIg can therefore be recommended for use in an MG crisis or in lieu of plasmapheresis. The role of IVIg in the chronic management of MG has not been studied. IVIg has also been investigated in autoimmune CNS disorders. In a controlled study in patients with stiff person syndrome IVIg was effective, with improvements in the distribution of stiffness index and heightened sensitivity scores. For neurodegenerative diseases such as Alzheimer's disease, post-polio syndrome, pain, fibrosis, and autoimmune sleep disorders, some early promising results for the use of IVIg are emerging, but remain to be fully investigated. In conclusion, IVIg appears to be an effective treatment for a number of autoimmune disorders, however, optimal dosing and pharmacogenetic studies are necessary.

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Section: ■ Pain and Fibrosismentioning

confidence: 97%

IVIg in other autoimmune neurological disorders: current status and future prospects

Dalakas¹

2008

J Neurol

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“…The majority of the responded patients had CRPS or postherpetic neuralgia of recent onset (less than 1 year) suggesting that inflammatory mediators might have triggered the pain from the outset. Of interest, the pain in one patient with CRPS who responded to IVIg was transferred to mice implicating an inflammatory/autoimmune mechanism [33]. Based on these early results, a control treatment trial is now planned in patients with trigeminal neuralgia.…”

Section: V/30mentioning

confidence: 98%

Role of IVIg in autoimmune, neuroinflammatory and neurodegenerative disorders of the central nervous system: present and future prospects

Dalakas

2006

J Neurol

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IVIg is effective in anti-GAD-positive patients with SPS. Whether it is also effective in other GAD-positive CNS disorders such as epilepsies, cerebellar degenerations or Batten's disease need to be studied in control trials. Emerging data suggest that IVIg, by suppressing proinflammatory cytokines, may exert a beneficial effect in patients with Alzheimer's disease, postpolio syndrome, chronic pain syndromes, fibrotic disorders and narcolepsy. Controlled studies are being planned or conducted to substantiate the benefit of IVIg in neurodegenerative disorders.

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“…Alternatives that are being explored include graded imagery, repetitive transcranial magnetic simulation [52], hyperbaric oxygen [53], intravenous infusion of iloprost (a prostacyclin analogue) [54] and immunoglobulin [55], as well as subanesthetic infusion of ketamine [56,57]. Of these options, graded motor imagery has shown benefit in a randomized controlled trial [58] consisting of 13 patients with CRPS who were given 2 weeks each of a hand laterality recognition task, imagined hand movements, and mirror therapy.…”

Section: Miscellaneous Therapeutic Optionsmentioning

confidence: 98%

Advances in treatment of complex regional pain syndrome: recent insights on a perplexing disease

Sharma

Williams

Raja

2006

Current Opinion in Anaesthesiology

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Enhanced insight into the pathophysiology of chronic regional pain syndrome has modified current clinical practice and the focus of research. Certain 'standard' therapeutic options for chronic regional pain syndrome have failed the test of time while others have prevailed. New options have recently been evaluated and have shown promising early results. Knowledge of recent advances in chronic regional pain syndrome will help pain physicians provide optimal care to these patients.

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Intravenous immunoglobulin response and evidence for pathogenic antibodies in a case of complex regional pain syndrome 1

Cited by 48 publications

References 5 publications

IVIg in other autoimmune neurological disorders: current status and future prospects

IVIg in other autoimmune neurological disorders: current status and future prospects

Role of IVIg in autoimmune, neuroinflammatory and neurodegenerative disorders of the central nervous system: present and future prospects

Advances in treatment of complex regional pain syndrome: recent insights on a perplexing disease

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