title: Systematic review of immunoglobulin use in paediatric neurological and neurodevelopmental disorders.
abstract: OBJECTIVE
  A systematic literature review of intravenous immunoglobulin (IVIG) treatment of paediatric neurological conditions was performed to summarize the evidence, provide recommendations, and suggest future research.
  
  
  METHODS
  A MEDLINE search for articles reporting on IVIG treatment of paediatric neuroinflammatory, neurodevelopmental, and neurodegenerative conditions published before September 2015, excluding single case reports and those not in English. Owing to heterogeneous outcome measures, meta-analysis was not possible. Findings were combined and evidence graded.
  
  
  RESULTS
  Sixty-five studies were analysed. IVIG reduces recovery time in Guillain-Barré syndrome (grade B). IVIG is as effective as corticosteroids in chronic inflammatory demyelinating polyradiculoneuropathy (grade C), and as effective as tacrolimus in Rasmussen syndrome (grade C). IVIG improves recovery in acute disseminated encephalomyelitis (grade C), reduces mortality in acute encephalitis syndrome with myocarditis (grade C), and improves function and stabilizes disease in myasthenia gravis (grade C). IVIG improves outcome in N-methyl-d-aspartate receptor encephalitis (grade C) and opsoclonus-myoclonus syndrome (grade C), reduces cataplexy symptoms in narcolepsy (grade C), speeds recovery in Sydenham chorea (grade C), reduces tics in selected cases of Tourette syndrome (grade D), and improves symptoms in paediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (grade B).
  
  
  CONCLUSIONS
  IVIG is a useful therapy in selected neurological conditions. Well-designed, prospective, multi-centre studies with standardized outcome measures are required to compare treatments.
authors.affiliation: Evelina London Children's Hospital, St Thomas' Hospital, Children's Neurosciences Centre, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gadian
authors.affiliation: Evelina London Children's Hospital, St Thomas' Hospital, Paediatric Pharmacy, London, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Kirk
authors.affiliation: Meridian HealthComms, Plumley, Cheshire, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Holliday
authors.affiliation: Evelina London Children's Hospital, St Thomas' Hospital, Children's Neurosciences Centre, London, UK.
authors.forename: Ming
authors.initials: M
authors.lastname: Lim
authors.affiliation: Evelina London Children's Hospital, St Thomas' Hospital, Children's Neurosciences Centre, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Absoud
mesh_terms: D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D016239:MEDLINE / Q000706:statistics & numerical data; D009422:Nervous System Diseases / Q000628:therapy*; D065886:Neurodevelopmental Disorders / Q000628:therapy*; D010372:Pediatrics
chemical_list: D007136:Immunoglobulins; D007155:Immunologic Factors