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autoimmune polyneuropathy guidelines

Satoru Oji, Kyoichi Nomura
In recent years, immunoadsorption has been increasingly recognized as an alternative to therapeutic plasma exchange and used for the treatment of neurological disorders such as Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, neuromyelitis optica spectrum disorders, and multiple sclerosis, as well as autoimmune encephalitis. Unlike therapeutic plasma exchange, which requires fluid replacement with a blood solution such as fresh frozen plasma or albumin, immunoadsorption is a blood purification technique that enables the selective removal of humoral factors from separated plasma through a high-affinity adsorbent with tryptophan or phenylalanine...
August 26, 2017: Transfusion and Apheresis Science
Margherita Nosadini, Shekeeb S Mohammad, Agnese Suppiej, Stefano Sartori, Russell C Dale
AIM: Intravenous immunoglobulin (IVIG) is an expensive therapy used in immunodeficiency and autoimmune disorders. Increasing demands and consequent shortages result in a need for usage to conform to guidelines. METHOD: We retrospectively evaluated IVIG use for neuroimmunological indications and adherence to existing guidelines in a major Australian paediatric hospital between 2000 and 2014. RESULTS: One-hundred and ninety-six children (96 male, 100 female; mean age at disease onset 6y 5mo [range 3mo-15y 10mo], mean age at first IVIG dose 7y 2mo [range 3mo-16y 5mo]) received IVIG for neuroimmunological indications during the study period (28...
November 2016: Developmental Medicine and Child Neurology
Susumu Kusunoki
Guillain-Barré syndrome (GBS) is an acute self-limited polyneuropathy named after Guillain, Barré, and Strohl, who first reported it in 1916. GBS was considered a demyelinating disease until the 1980s, when the acute axonal type of GBS was first reported. Since then, acute inflammatory demyelinating polyneuropathy and acute motor axonal neuropathy have been considered the two main subtypes of GBS. Autoimmunity underlies the pathogenesis of GBS. The presence of antibodies against various glycolipids in the acute-phase sera from patients with GBS has frequently been reported since the late 1980s...
November 2015: Brain and Nerve, Shinkei Kenkyū No Shinpo
S Živković
Intravenous immunoglobulins (IVIGs) are often used in the treatment of autoimmune disorders and immunodeficiencies, and it has been estimated that neurologic indications can account for up to 43% of IVIG used in clinical practice. In neurologic clinical practice, IVIG is used for acute therapy of newly diagnosed autoimmune disorders or exacerbations of pre-existing conditions, or as long-term maintenance treatment for chronic disorders. IVIG exerts its effects on humoral and cell-based immunity through multiple pathways, without a single dominant mechanism...
May 21, 2015: Acta Neurologica Scandinavica
José M Láinez-Andrés, Francisco Gascón-Giménez, Francisco Coret-Ferrer, Bonaventura Casanova-Estruch, José M Santonja
INTRODUCTION: Plasma exchange is a technique used in the treatment of some neurological autoimmune disorders since the 80s, especially in acute conditions. In recent years new data about it use has been published in many diseases with autoimmune basis, expanding the range of use of this technique. AIM: To update the current indications of this technique in the treatment of neurological diseases. DEVELOPMENT: We conducted a thorough review of all articles about the efficacy of plasma exchange in the treatment of different neurological diseases published since the 80s...
February 1, 2015: Revista de Neurologia
Irene Cortese, David R Cornblath
In treating neuroimmunological diseases, neurologists have a number of different drugs to choose from ranging from corticosteroids to IVIg to more specific cell based therapies, the latter most frequently from the world of oncology. In some diseases, therapeutic plasma exchange, a procedure rather than a drug, is used. The most obvious advantage of therapeutic plasma exchange is the usually rapid onset of action presumably due to removal of pathogenic auto-antibodies. In some diseases, a single course of therapeutic plasma exchange is used while in others prolonged treatment with therapeutic plasma exchange is used...
February 2013: Journal of Clinical Apheresis
Robert P Navarro, Mark Ballow, Beckie Fenrick, Edmund J Pezalla
Immunoglobulins are large Y-shaped proteins produced by B-cells and plasma cells that are used by the immune system to identify and neutralize foreign objects such as bacteria and viruses. Immunoglobulin G (IgG) preparations are approved by the US Food and Drug Administration for the treatment of primary immunodeficiency disease, idiopathic thrombocytopenic purpura, Kawasaki disease, chronic lymphocytic leukemia with frequent infections, bone marrow transplantation, to prevent infection in pediatric human immunodeficiency virus, and chronic inflammatory demyelinating polyneuropathy...
June 2012: American Journal of Managed Care
Masami Ueda, Susumu Kusunoki
Here, we have reviewed the clinical patterns, diagnostic paradigms, etiopathogenesis, and therapeutic strategies of autoimmune neuropathies such as Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), multifocal motor neuropathy (MMN), and IgM paraproteinemic neuropathy. Antiganglioside antibodies are frequently present in the serum samples obtained during the acutephase of GBS and Miller Fisher syndrome (MFS), a subtype of GBS. Recently, we found that some patients with GBS and MFS have serum antibodies against antigenic epitopes formed by 2 different gangliosides (ganglioside complex)...
June 2011: Brain and Nerve, Shinkei Kenkyū No Shinpo
I Cortese, V Chaudhry, Y T So, F Cantor, D R Cornblath, A Rae-Grant
OBJECTIVE: To reassess the role of plasmapheresis in the treatment of neurologic disorders. METHODS: We evaluated the available evidence based on a structured literature review for relevant articles from 1995 through September 2009. In addition, due to revision of the definitions of classification of evidence since the publication of the previous American Academy of Neurology assessment in 1996, the evidence cited in that manuscript was reviewed and reclassified...
January 18, 2011: Neurology
I Elovaara, S Apostolski, P van Doorn, N E Gilhus, A Hietaharju, J Honkaniemi, I N van Schaik, N Scolding, P Soelberg Sørensen, B Udd
Despite high-dose intravenous immunoglobulin (IVIG) is widely used in treatment of a number of immune-mediated neurological diseases, the consensus on its optimal use is insufficient. To define the evidence-based optimal use of IVIG in neurology, the recent papers of high relevance were reviewed and consensus recommendations are given according to EFNS guidance regulations. The efficacy of IVIG has been proven in Guillain-Barré syndrome (level A), chronic inflammatory demyelinating polyradiculoneuropathy (level A), multifocal mononeuropathy (level A), acute exacerbations of myasthenia gravis (MG) and short-term treatment of severe MG (level A recommendation), and some paraneoplastic neuropathies (level B)...
September 2008: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
P Petiot
Electrodiagnostic study is very important in the diagnosis of inflammatory neuropathies with clinical, biological or histopathological criterias. It initially affirms the existence of a neuropathy and then to define if the pathological process is demyelinating, axonal or more rarely mixed. It also specifies if it concerns only sensory fibers, motor fibers or both. This exploration thus will make it possible to define different sub-groups with, for each one, a possible etiological guidelines. In the subgroup of demyelinating neuropathies, except congenital neuropathies, the inflammatory neuropathies represent the main étiology with chronic infammatory demyelinating polyneuropathy as a model...
September 2007: Revue Neurologique
Tom Feasby, Brenda Banwell, Timothy Benstead, Vera Bril, Melissa Brouwers, Mark Freedman, Angelika Hahn, Heather Hume, John Freedman, David Pi, Louis Wadsworth
Canada's per capita use of intravenous immune globulin (IVIG) grew by approximately 115% between 1998 and 2006, making Canada one of the world's highest per capita users of IVIG. It is believed that most of this growth is attributable to off-label usage. To help ensure IVIG use is in keeping with an evidence-based approach to the practice of medicine, the National Advisory Committee on Blood and Blood Products (NAC) and Canadian Blood Services convened a panel of national experts to develop an evidence-based practice guideline on the use of IVIG for neurologic conditions...
April 2007: Transfusion Medicine Reviews
Kamran Darabi, Omar Abdel-Wahab, Walter H Dzik
BACKGROUND: Intravenous immune globulin (IVIG) has been approved by the Food and Drug Administration (FDA) for use in 6 conditions: immune thrombocytopenic purpura (ITP), primary immunodeficiency, secondary immunodeficiency, pediatric HIV infection, Kawasaki disease, prevention of graft versus host disease (GVHD) and infection in bone marrow transplant recipients. However, most usage is for off-label indications, and for some of these comprehensive guidelines have been published. STUDY DESIGN AND METHODS: We retrospectively reviewed all approved IVIG transfusions at Massachusetts General Hospital in 2004 to identify the current usage pattern and completed a literature review...
May 2006: Transfusion
R Gold, A Bayas, K V Toyka
The group of autoimmune neuropathies includes the Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuritis, multifocal motor neuropathy, neuropathies associated with monoclonal gammopathies, and vasculitic neuropathies. This educational review first addresses diagnostic pathways that facilitate more rational diagnostic decisions. Many therapies are effective for treating immune neuropathies. Unfortunately, none of the available therapies are specific. In the acute phase, glucocorticosteroids, plasmapheresis, and intravenous immunoglobulins play key roles...
August 2005: Der Nervenarzt
Carmen T Narciso
This is a retrospective study of 131 patients who underwent 479 therapeutic apheresis (TA) procedures at St. Luke's Medical Center, in the Philippines, from 1994 to 2003. Diseases were classified according to indication categories using the American Society for Apheresis (ASFA) guidelines. Seventy-eight percent of the patients belonged to ASFA Category I, 14% to Category II, 8% to Category III, and none in Category IV. The most common indication was for neurological disorders (62%), mainly acute inflammatory demyelinating polyneuropathy (49%) and myasthenia gravis (40%)...
July 2005: Journal of Clinical Apheresis
Marinos C Dalakas
Intravenous immunoglobulin (i.v.Ig) has multiple actions on the immunoregulatory network that operate in concert with each other. For each autoimmune neuromuscular disease, however, there is a predominant mechanism of action that relates to the underlying immunopathogenetic cause of the respective disorder. The best understood actions of i.v.Ig include the following: (a) modulation of pathogenic autoantibodies, an effect relevant in myasthenia gravis (MG), Lambert-Eaton myasthenic syndrome (LEMS), Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and stiff-person syndrome (SPS); (b) inhibition of complement activation and interception of membranolytic attack complex (MAC) formation, an action relevant to the complement-mediated mechanisms involved in GBS, CIDP, MG, and dermatomyositis (DM); (c) modulation of the inhibitory or activation Fc receptors on macrophages invading targeted tissues in nerve and muscle, as seen in CIDP, GBS, and inflammatory myopathies; (d) down-regulation of pathogenic cytokines and adhesion molecules; (e) suppression of T-cell functions; and (f) interference with antigen recognition...
June 2004: Pharmacology & Therapeutics
M C Dalakas
This review summarizes the current status of intravenous immunoglobulin (IVIg) in the treatment of autoimmune neuromuscular disorders and the possible mechanisms of action of the drug based on work in vivo, in vitro, and in animal models. Supply of idiotypic antibodies, suppression of antibody production, or acceleration of catabolism of immunoglobulin G (IgG) are relevant in explaining the efficacy of IVIg in myasthenia gravis (MG), Lambert-Eaton myasthenic syndrome (LEMS), and antibody-mediated neuropathies...
November 1999: Muscle & Nerve
M S Sternbach, S Fawcett, M Wolsley, R Giammarco
Chronic Inflammatory Demyelinating Polyneuropathies (CIDP) are characterized by demyelination of peripheral nerves with mononuclear cell infiltrates, electrical conduction slowing or block and elevated cerebrospinal fluid protein with no cells. An immune mediated pathogenesis has been suggested. Immune suppressive therapy, as well as plasmapheresis and intravenous immunoglobulins have been used with variable success. Our objective was to review our results of plasma exchange in this disease in 20 patients with very different underlying diseases, none of them eligible for the Canadian CIDP plasmapheresis study, and define certain guidelines of predictability for the effectiveness of plasma exchange...
September 1996: Transfusion Science
A J Steck, J Früh
We discuss current approaches in the treatment of immune mediated neuropathies and review recent progress in management. Intensive evaluation has led to improved diagnosis of the cause of neuropathies. Because immunosuppressive drugs are potentially hazardous, strict guidelines for their clinical use, including clinical immunological, neurophysiological and histological investigations, should be followed.
June 17, 1995: Schweizerische Medizinische Wochenschrift
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