EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases |
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| Authors: | I. Elovaara,S. Apostolski,P. van Doorn,N. E. Gilhus,A. Hietaharju,J. Honkaniemi,I. N. van Schaik,N. Scolding,P. Soelberg Sø rensen, B. Udd |
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| Affiliation: | Department of Neurology and Rehabilitation, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland;;Institute of Neurology, School of Medicine, University of Belgrade, Belgrade, Serbia;;Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands;;Department of Neurology, Haukeland University Hospital, Bergen, Norway;;Department of Neurology and Rehabilitation, Tampere University Hospital, Tampere, Finland;;Department of Neurology, Vaasa Central Hospital, Vaasa, Finland;;Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands;;University of Bristol Institute Of Clinical Neuroscience, Frenchary Hospital UK Bristol, UK;;Department of Neurology, National University Hospital, Rigshospitalet, Copenhagen, Denmark;;and Department of Neurology and Rehabilitation, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland |
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| Abstract: | 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). |
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| Keywords: | acute disseminated encephalomyelitis Balo's concentric sclerosis childhood refractory epilepsy chronic inflammatory demyelinating polyradiculoneuropathy dermatomyositis Guillain-Barré syndrome intravenous immunoglobulin multifocal motor neuropathy multiple sclerosis myastenia gravis neuromyelitis optica Rasmussen's encephalitis stiff-person syndrome and post-polio syndrome |
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