Intravenous immunoglobulin therapy for neurological disorders.

AIM: To determine the extent to which the use of intravenous human immunoglobulin for neurological conditions complied with the guidelines of the Australian Health Minister's Advisory Council.

METHODS: Patients treated with intravenous immunoglobulin in Otago over a 5.5-year period were identified from the records of the New Zealand Blood Service and the hospital files were reviewed.

RESULTS: 200 patients received immunoglobulin therapy, of whom 57 had neurological conditions: myasthenia gravis, (15.8%), Guillain-Barre syndrome (36.8%), multiple sclerosis (10.5%), chronic inflammatory demyelinating polyneuropathy (17.5%), inclusion body myositis (7%), polymyositis (1.7%), miscellaneous disorders (stiff person syndrome, diabetic amyotrophy, neuropathy associated with paraproteinaemia, and hereditary neuropathy with liability to pressure palsies) (10.5). Thirty-one percent of the immunoglobulin was used in 27% of the patients for disorders lacking convincing evidence of benefit according to the guidelines of the Australian Health Minister's Advisory Council. These were multiple sclerosis, inclusion body myositis, and miscellaneous neuropathies. Good response occurred most often in patients with myasthenia gravis, Guillain-Barre syndrome, multiple sclerosis, and chronic inflammatory demyelinating polyneuropathy.

CONCLUSIONS: Intravenous immunoglobulin was frequently used for indications not recommended by the Australian Health Minister's Advisory Council guidelines. However guidelines vary internationally, and there is a paucity of controlled studies to guide management of some uncommon conditions.