IVIg dose increase in multifocal motor neuropathy: A prospective six month follow-up

In this prospective, non-randomized 6-month observational study we evaluated the efficacy of intravenous immunoglobulin (IVIg) dose increase in patients with multifocal motor neuropathy (MMN). Diagnosis according to AAEM criteria, repetitive IVIg treatment for at least one year, persistent paresis a...

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Bibliographic Details
Published in:Journal of neurology 2009-04, Vol.256 (4), p.608-614
Main Authors: Baumann, Andreas, Hess, Christian W., Sturzenegger, Matthias
Format: Article
Language:English
Subjects:
Age of Onset
Aged
Aged, 80 and over
Biological and medical sciences
Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction
Disability Evaluation
Dose-Response Relationship, Drug
Electromyography
Female
Follow-Up Studies
Humans
Immunoglobulins, Intravenous - administration & dosage
Immunologic Factors - administration & dosage
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Motor Activity - drug effects
Motor Neuron Disease - drug therapy
Muscular Atrophy - drug therapy
Nervous system (semeiology, syndromes)
Neural Conduction
Neurology
Neuropsychological Tests
Neuroradiology
Neurosciences
Original Communication
Prospective Studies
Treatment Outcome
Citations: Items that this one cites
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Summary:In this prospective, non-randomized 6-month observational study we evaluated the efficacy of intravenous immunoglobulin (IVIg) dose increase in patients with multifocal motor neuropathy (MMN). Diagnosis according to AAEM criteria, repetitive IVIg treatment for at least one year, persistent paresis and conduction block, stable symptoms and findings for at least six months were inclusion criteria. Nine patients (7 men) were identified and approved to standardized increase of IVIg dose. Patients were monitored using clinical scores and electrophysiological studies. Dose was increased from a baseline of 0.5 g/kg per month [mean, range: 0.1–1.1], given at variable intervals [4–12 weeks] to 1.2 g/kg per month given over 3 consecutive days planned for 6 cycles. If the patients’ motor function did not improve after two cycles they entered step two: Dose was increased to 2 g/kg per month given over 5 consecutive days. The increased dose was maintained for 6 months. Assessments were performed by the same investigator, not involved in the patient’s management, at baseline, after 2 and after 6 months. Following dose increase, motor function significantly improved in 6 patients (p = 0.014), 2 patients entered step two, 1 patient withdrew due to absent efficacy. Higher doses of IVIg caused more side effects, however, transient and rarely severe (p = 0.014). IVIg dose increase may improve motor functions in patients with stable MMN on long-term IVIg therapy independent of baseline dose. Improvement of motor function was associated with shorter disease duration (p = 0.008), but not with degree of muscle atrophy (p = 0.483). The treatment strategy to try to find the lowest effective dose and the longest tolerated interval might lead to underdosing in the long-term in many patients.
ISSN:0340-5354
1432-1459
DOI:10.1007/s00415-009-0130-0