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EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases
Author(s) -
Elovaara I.,
Apostolski S.,
Van Doorn P.,
Gilhus N. E.,
Hietaharju A.,
Honkaniemi J.,
Van Schaik I. N.,
Scolding N.,
Soelberg Sørensen P.,
Udd B.
Publication year - 2008
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2008.02246.x
Subject(s) - medicine , multifocal motor neuropathy , plasmapheresis , prednisone , intravenous immunoglobulins , intravenous immunoglobulin therapy , pediatrics , polyradiculoneuropathy , dermatomyositis , myasthenia gravis , neurology , chronic inflammatory demyelinating polyneuropathy , polymyositis , multiple sclerosis , acute disseminated encephalomyelitis , guillain barre syndrome , intensive care medicine , antibody , immunology , mismatch negativity , electroencephalography , psychiatry
Despite high‐dose intravenous immunoglobulin (IVIG) is widely used in treatment of a number of immune‐mediated neurological diseases, the consensus on its optimal use is insufficient. To define the evidence‐based optimal use of IVIG in neurology, the recent papers of high relevance were reviewed and consensus recommendations are given according to EFNS guidance regulations. The efficacy of IVIG has been proven 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 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 post‐partum 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).