EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases: EFNS task force on the use of intravenous immunoglobulin in treatment of neurological diseases.
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 (good practice point) [corrected],stiff-person syndrome (level A), some acute-demyelinating diseases and childhood refractory epilepsy (good practice point).
Elovaara
I
I
Department of Neurology and Rehabilitation, Tampere University Hospital and Medical School, University of Tampere, Tampere, Finland. irina.elovaara@uta.fi
Apostolski
S
S
van Doorn
P
P
Gilhus
N E
NE
Hietaharju
A
A
Honkaniemi
J
J
van Schaik
I N
IN
Scolding
N
N
Soelberg Sørensen
P
P
Udd
B
B
D020274:Autoimmune Diseases of the Nervous System / Q000276:immunology / Q000628:therapy; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003711:Demyelinating Diseases / Q000276:immunology / Q000628:therapy; D004827:Epilepsy / Q000628:therapy; D019317:Evidence-Based Medicine; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009422:Nervous System Diseases / Q000628:therapy*; D020364:Paraneoplastic Polyneuropathy / Q000276:immunology / Q000628:therapy; D010265:Paraproteinemias / Q000276:immunology / Q000628:therapy; D010951:Plasma Exchange
D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents