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Review
Immunoglobulin use in neurology: a practical approach
  1. Mahima Kapoor1,
  2. Anthony Khoo2,3,
  3. Michael P T Lunn4,5,
  4. Stephen Reddel6,
  5. Aisling S Carr5
  1. 1Neuroscience / FMNHS / School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
  2. 2Flinders University College of Medicine and Public Health, Adelaide, South Australia, Australia
  3. 3Department of Neurology, Flinders Medical Centre, Bedford Park, South Australia, Australia
  4. 4Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
  5. 5UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
  6. 6ANZAC Research Institute, Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Aisling S Carr, MRC Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, London, UK; Aisling.carr{at}nhs.net

Abstract

Human immunoglobulin, delivered either intravenously (IVIg) or subcutaneously, is used to treat a range of immune-mediated neurological disorders. It has a role in acute or subacute inflammatory disease control and as a maintenance therapy in chronic disease management. This review considers mechanisms of IVIg action and the evidence for IVIg in neurological conditions. We use Guillain-Barré syndrome and chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) as frameworks to demonstrate an approach to IVIg use in acute and chronic dysimmune neurological conditions across two different healthcare systems: the UK and Australia. We highlight the benefits and limitations of IVIg and focus on practical considerations such as informed consent, managing risks and adverse effects, optimal dosing and monitoring response. We use these basic clinical practice principles to discuss the judicious use of an expensive and scarce blood product with international relevance.

  • NEUROPATHY
  • NEUROIMMUNOLOGY
  • CLINICAL NEUROLOGY
  • GUILLAIN-BARRE SYNDROME

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

https://doi.org/10.1136/pn-2022-003655

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    Data availability statement

    Data sharing not applicable as no datasets generated and/or analysed for this study.

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    Footnotes

    • X @mike_the_nerve

    • Contributors MK and AK prepared the first draft of the manuscript. SR and ASC developed the topic for the article. All authors contributed to manuscript revisions, and all authors read and approved the submitted version. ASC is the guarantor.

    • Funding MPTL and ASC are supported by UCL Queen Square Biomedical Research Centre (BRC).

    • Competing interests None declared.

    • Provenance and peer review Provenance and peer review. Commissioned. Externally peer reviewed by Tamara Kaplan, Boston, USA, and Karim Kreft, Cardiff, UK.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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