Treatment of immune-mediated inflammatory neuropathies.
Experimental models have suggested potential new treatments for human inflammatory neuropathy, but current practice is largely based on empirical trials. Evidence from randomized trials supports the use of intravenous immunoglobulin in Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy with conduction block (MMNCB). In Guillain-Barré syndrome and CIDP intravenous immunoglobulin is equivalent to but more convenient than plasma exchange. In MMNCB adequate comparative studies of intravenous immunoglobulin and plasma exchange have not been performed. Corticosteroid treatment is beneficial in CIDP, but not in Guillain-Barré syndrome and may worsen MMNCB. More randomized trials and systematic reviews are needed to improve the evidence base for clinical practice.
Hadden
R D
RD
Department of Clinical Neurosciences, Guy's School of Medicine, Guy's Hospital, London, UK. robert.hadden@kcl.ac.uk
Hughes
R A
RA
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000818:Animals; D020275:Guillain-Barre Syndrome / Q000628:therapy; D006801:Humans; D007154:Immune System Diseases / Q000628:therapy*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D016472:Motor Neuron Disease / Q000503:physiopathology / Q000628:therapy; D009431:Neural Conduction; D009443:Neuritis / Q000628:therapy*; D010951:Plasma Exchange; D020277:Polyradiculoneuropathy, Chronic Inflammatory Demyelinating / Q000628:therapy
D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous