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Long-term effects of intravenous immunoglobulin in CIDP.
Clin Neurophysiol. 2007 Jun 27
Vucic S, Black K, Baldassari LE, Tick Chong PS, Dawson KT, Cros D.
Prince of Wales Medical Research Institute and Prince of Wales Clinical School, University of New South Wales, Australia.
OBJECTIVE:
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an
acquired demyelinating disease of the peripheral nervous system
characterized by muscle weakness, areflexia or hyporeflexia, and
sensory disturbances. Although short-term efficacy of intravenous
immunoglobulin (IVIg) has been demonstrated in randomized-controlled
trials, the data pertaining to long-term outcome in CIDP are limited.
Consequently, the aim of the present study was to assess the long-term
effects of IVIg on neurophysiological parameters in CIDP.
METHODS:
Neurophysiological records from 11 CIDP patients, treated with IVIg for
12 months, were reviewed. Nerve conduction studies were assessed at
baseline, 1-year, and last follow-up. RESULTS: There was a significant
reduction in the frequency of conduction blocks (pre-treatment nerve
segments affected 61%; last follow-up 39%, P<0.01) and a reduction
in ongoing axonal loss (pre-treatment regions with spontaneous
activity, 47%; post-treatment 29%, P<0.01) with IVIg treatment.
Further, there was significant improvement in sensory nerve conduction
studies with IVIg treatment (sensory amplitudes reduced pre-treatment,
90% nerves tested; post-treatment, 62%, P<0.01). CONCLUSIONS: The
present study suggests that long-term IVIg maintenance therapy improves
neurophysiological parameters in CIDP. However, CIDP patients remain
IVIg dependent and new conduction blocks may develop. SIGNIFICANCE: The
present study suggests that long-term IVIg maintenance therapy improves
neurophysiological parameters in CIDP, possibly by reducing the immune
response and thereby fostering nerve healing.
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