The current place of high-dose immunoglobulins in the treatment of neuromuscular disorders

Meché, F. G. A. Van Der; Doorn, Pieter A. van

doi:10.1002/(sici)1097-4598(199702)20:2<136::aid-mus1>3.0.co;2-d

Cited by 45 publications

(17 citation statements)

References 86 publications

(109 reference statements)

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“…Improvement occurred in 150 (69%) [5, 7, 9, 10, 17, 19-21, 23, 24, 26, 28, 29, 33, 38]. In a review by van der Meché and van Doorn [41], considering only studies of ten MG patients or more, 76% improved after onset of IVIg treatment (range 48-92%, median 87%). Recently, Gajdos et al [26] found a treatment response in 61% and 35% of patients with a 3-or 5-day course of IVIg, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…In three reviews of clinical studies [4,17,41], in which IVIg was used for MG patients who were in a bad chronicstatic clinical condition, had an acute onset of MG or had suffered from an acute relapse, improvement after IVIg was reported in about 70-80% of the patients. Recently, Gajdos et al [26] found a treatment response in 61% and 35% of patients with a 3-or 5-day course of IVIg, respectively.…”

Section: Introductionmentioning

confidence: 99%

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High-dose intravenous immunoglobulin therapy for myasthenia gravis

Jongen

Doorn

Meché

1997

Journal of Neurology

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The objective of this open, retrospective study was to investigate whether intravenous immunoglobulin (IVIg) could induce a clinically obvious improvement in patients with generalized myasthenia gravis (MG), as judged by MG functional status. Fourteen patients with generalized MG were treated during at least one episode with 0.4 g IVIg per kilogram body weight per day for 5 consecutive days. Patients with confounding variables were excluded; this left 11 patients (16 episodes) to be further analysed. We defined improvement as at least a one-step improvement in MG functional status (according to the University of Virginia's Modification of Osserman's classification). Of the treatment episodes, 56% were classified as positive responses. If improvement occurred, onset of improvement started after 3 (1-12) days and peak effect was reached after 7 (4-30) days (median and range). All four patients who required artificial ventilation could be weaned from it 8.5 (6-11) days after the start of IVIg (median and range). Of the patients treated on two occasions, only one patient had a positive response during both. In MG functional status 5, improvement was observed during five of seven episodes. None of the patients with MG functional status 3 responded. Patients with an acute relapse of MG seemed to respond equally well to IVIg compared with patients with subacute deterioration/ chronic-static state (50% versus 60%). The MG functional status at the start of IVIg and on the day of maximal improvement was compared for all episodes together, and significant improvement was noted (P = 0.0052). We did not see any serious side-effects after IVIg treatment. This retrospective analysis suggests that high-dose IVIg is an effective therapy in some patients with deterioration of generalized MG. If improvement occurs, it starts within a few days of the onset of IVIg and the effect seems to peak within 2 weeks.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High-dose intravenous immunoglobulin therapy for myasthenia gravis

Jongen

Doorn

Meché

1997

Journal of Neurology

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“…For both disorders, the therapeutic effect of IVIG has been shown in several controlled studies [17,27,33,34].…”

Section: Guillain-barré Syndrome/cidpmentioning

confidence: 97%

“…In patients under age 60, anti-titin antibodies have a relatively high predictive value for an associated tumor, and this information may be used together with the imaging results, but the histological type may not be predicted [7, 39,40]. Beside a symptomatic (pyridostigmine) and surgical treatment (thymectomy), IVIG are equal to plasma exchange in crises, but are not recommended as long-term treatment [8,13,16,28,34,43].…”

Section: Myasthenia Gravis (Mg)mentioning

confidence: 99%

Intravenous immunoglobulin therapy in paraneoplastic neurological syndromes

Voltz¹

2006

J Neurol

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Combining clinical and immunological information, a neurological syndrome can now be diagnosed as a "definite" or "possible" paraneoplastic syndrome according to the newly suggested diagnostic criteria of the PNS Euronetwork. Differentiated diagnosis of a paraneoplastic syndrome is essential for differential therapy in patients. According to the response to IVIG therapy, paraneoplastic disorders may be subgrouped in group A, a clinical response is the rule (prototype Lambert-Eaton myasthenic syndrome), and in group B, IVIG may be helpful in single patients and is indicated in specific clinical settings (prototype anti-Hu associated neurological syndromes). The mode of action of IVIG may range from direct anti-idiotype effect to indirect effects on the cellular part of the pathogenesis of paraneoplastic syndromes. Due to the therapeutic relevance, it is therefore important to diagnose a PND as early as possible, and start immunotherapy including IVIG immediately.

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“…In human patients, expensive short-term therapies, such as IVIg and plasmapheresis (plasma exchange), are used to achieve rapid relief of severe myasthenic symptoms. [84][85][86] Although successful use of combined plasmapheresis and corticosteroid treatment was reported in a myasthenic dog, 87 IVIg and plasmapheresis are unlikely to be widely used in dogs because of the expense and technical difficulty of performing these therapies.…”

Section: Treatment and Prognosismentioning

confidence: 99%

Acute Lower Motor Neuron Tetraparesis

Añor

2014

Veterinary Clinics of North America: Small Animal Practice

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The current place of high-dose immunoglobulins in the treatment of neuromuscular disorders

Cited by 45 publications

References 86 publications

High-dose intravenous immunoglobulin therapy for myasthenia gravis

High-dose intravenous immunoglobulin therapy for myasthenia gravis

Intravenous immunoglobulin therapy in paraneoplastic neurological syndromes

Acute Lower Motor Neuron Tetraparesis

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