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High-dose intravenous immunoglobulins in neurocritical care

High-dose intravenous immunoglobulins in neurocritical care

Intensivmedizin und Notfallmedizin 32(8): 642-650

High-dose intravenous human immunoglobulin G (IVIG) is a well-tolerated, rapidly acting immunodepressant, effective in neuroimmunological diseases. Side effects appear rare. A Dutch controlled study showed that in Guillain-Barre syndrome IVIG is at least as effective as plasma exchange (PE). Three controlled and randomized studies are being performed comparing IVIG with PE, with immunoadsorption, with a combination of PE followed by IVIG, and with IVIG given together with methylprednisolone. In dermatomyositis and in polymyositis IVIG is beneficial, especially in cases resistant to conventional treatment. In inclusion body myositis IVIG is the only treatment promising to work, and in multifocal motor neuropathy IVIG is an alternative to conventional cyclophosphamide. Mild to severe deterioration in myasthenia gravis is treated effectively with IVIG, which may act more rapidly than corticosteroids and may cause less worsening of pareses. A controlled randomized trial is being carried out. In life-threatening myasthenic crisis conventional PE should be the therapy of first choice until the results of a study comparing IVIG and PE are published. An unknown risk of human plasma preparations cannot be completely excluded, especially regarding spongioform encephalopathies such as Creutzfeld-Jacobs's disease. Therefore the administration of IVIG should be restricted to severely affected patients.

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