A new AAN guideline provides recommendations for the use of IV immunoglobulin (IVIg) in the treatment of various neuromuscular disorders. "Evidence-based Guideline: IV Immunoglobulin in the Treatment of Neuromuscular Disorders" is published in the March 27, 2012, issue of Neurology®.
Strong evidence shows IVIg effectively treats certain neuromuscular disorders. IVIg works as well as plasma exchange to treat Guillain-Barré syndrome (GBS) in adults, and is effective in the long-term treatment of chronic inflammatory demyelinating polyneuropathy (CIDP).
IVIg also is effective in treating other neuromuscular diseases, including other forms of neuropathy. There is moderate evidence for use of this therapy in treating moderate to severe forms of myasthenia gravis and multifocal motor neuropathy.
IVIg may help treat nonresponsive dermatomyositis and Lambert-Eaton myasthenic syndrome. There is insufficient evidence to show whether IVIg is effective in the treatment of other neuromuscular disorders such as IgM paraprotein-associated neuropathy, inclusion body myositis, polymyositis, diabetic radiculoplexoneuropathy, or Miller Fisher syndrome, or in the routine treatment of postpolio syndrome.
There is insufficient evidence to show whether IVIg is superior or inferior to plasma exchange for treatment of CIDP.
High-quality studies are not available on IVIg use in children with GBS. However, because IVIg is effective in adults with GBS, it is reasonable to assume it is also effective in children with GBS. Many people seem to tolerate IVIg therapy; however, hypercoagulability and renal failure, although rare, are of concern.Read the guideline and access PDF summaries for clinicians and patients, a slide presentation, and a clinical example.
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