9. Intravenous Immunoglobulin in the Treatment of Neurological Diseases

  1. Nils Erik Gilhus MD, PHD10,11,
  2. Michael P. Barnes MD, FRCP12,13 and
  3. Michael Brainin MD14,15,16
  1. I. Elovaara1,
  2. S. Apostolski2,
  3. P. van Doorn3,
  4. N. E. Gilhus4,
  5. A. Hietaharju5,
  6. J. Honkaniemi6,
  7. I. N. van Schaik7,
  8. N. Scolding8,
  9. P. Soelberg Sørensen9 and
  10. B. Udd1

Published Online: 21 SEP 2011

DOI: 10.1002/9781444346268.ch9

European Handbook of Neurological Management, Volume 2, Second Edition

European Handbook of Neurological Management, Volume 2, Second Edition

How to Cite

Elovaara, I., Apostolski, S., van Doorn, P., Gilhus, N. E., Hietaharju, A., Honkaniemi, J., van Schaik, I. N., Scolding, N., Sørensen, P. S. and Udd, B. (2011) Intravenous Immunoglobulin in the Treatment of Neurological Diseases, in European Handbook of Neurological Management, Volume 2, Second Edition (eds N. E. Gilhus, M. P. Barnes and M. Brainin), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444346268.ch9

Editor Information

  1. 10

    Department of Clinical Medicine, University of Bergen, Norway

  2. 11

    Department of Neurology, Haukeland University Hospital, Bergen, Norway

  3. 12

    University of Newcastle, Newcastle upon Tyne, UK

  4. 13

    Hunters Moor Neurorehabilitation Ltd, Newcastle upon Tyne, UK

  5. 14

    Department of Clinical Medicine and Prevention, Austria

  6. 15

    Center for Clinical Neurosciences, Donau-Universität Krems, Austria

  7. 16

    Department of Neurology, Landesklinikum Donauregion Tulln, Tulln, Austria

Author Information

  1. 1

    Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland

  2. 2

    School of Medicine, University of Belgrade, Belgrade, Serbia

  3. 3

    Erasmus Medical Centre, Rotterdam, The Netherlands

  4. 4

    Haukeland University Hospital, Bergen, Norway

  5. 5

    Tampere University Hospital, Tampere, Finland

  6. 6

    Vaasa Central Hospital, Vaasa, Finland

  7. 7

    Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

  8. 8

    University of Bristol Institute of Clinical Neuroscience, Frenchary Hospital UK, Bristol, UK

  9. 9

    National University Hospital, Rigshospitalet, Copenhagen, Denmark

Publication History

  1. Published Online: 21 SEP 2011
  2. Published Print: 30 SEP 2011

ISBN Information

Print ISBN: 9781405185349

Online ISBN: 9781444346268

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Keywords:

  • acute disseminated encephalomyelitis;
  • Balo's concentric sclerosis;
  • childhood refractory epilepsy;
  • chronic inflammatory demyelinating polyradiculoneuropathy;
  • dermatomyositis;
  • Guillain-Barré's syndrome;
  • intravenous immunoglobulin;
  • multifocal motor neuropathy;
  • multiple sclerosis;
  • myastenia gravis;
  • neuromyelitis optica;
  • Rasmussen's encephalitis;
  • stiffperson syndrome and post-polio syndrome

Summary

High-dose intravenous immunoglobulin (IVIG) is widely used in the treatment of a number of immune-mediated neurological diseases, yet consensus on its optimal use is lacking. To define the evidence-based optimal use of IVIG in neurology, recent papers of high relevance were reviewed and consensus recommendations are given according to EFNS guidance regulations. The efficacy of IVIG has been proved in Guillain-Barré syndrome (Level A), chronic inflammatory demyelinating polyradiculoneuropathy (Level A), multifocal mononeuropathy (Level A), acute exacerbations of myasthenia gravis (MG) and short-term treatment of severe MG (Level A recommendation), and some paraneoplastic neuropathies (Level B). IVIG is recommended as a second-line treatment in combination with prednisone in dermatomyositis (Level B) and as a treatment option in polymyositis (Level C). IVIG should be considered as a second- or third-line therapy in relapsing–remitting multiple sclerosis, if conventional immunomodulatory therapies are not tolerated (Level B), and in relapses during pregnancy or the postpartum period (good clinical practice point). IVIG seems to have a favourable effect also in paraneoplastic neurological diseases (Level A), stiff-person syndrome (Level A), some acute-demyelinating diseases and childhood refractory epilepsy (good practice point).