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IGIV in neurology--evidence and recommendations
Summary
Intravenous immunoglobulin (IGIV) is recommended for various neurologic conditions, with strong support for Guillain-Barré syndrome. Evidence quality and impact determine its use, ranging from strongly recommended to a last resort.
Area of Science:
- Neurology
- Immunology
Background:
- Neurologic disorders often have poorly understood mechanisms.
- Clinical decisions for these conditions may rely on limited evidence.
- Intravenous immunoglobulin (IGIV) is increasingly used in neurological practice.
Purpose of the Study:
- To review the evidence supporting neurologic applications of IGIV.
- To guide the development of practice recommendations for IGIV use in neurology.
- To ensure effective and efficient clinical application of IGIV.
Main Methods:
- A comprehensive MEDLINE search identified 231 English-language reviews and reports on IGIV in neurology (pre-March 1998).
- Evidence quality was graded based on study design and expert clinical experience.
- Recommendations were synthesized from synthesized data and expert consensus.
Main Results:
- IGIV's utility in neurology was assessed using a combined score of evidence quality and impact.
- Scores ranged from A+ (strongly recommended) to C (last resort).
- Specific recommendations were formulated for various neurological conditions.
Conclusions:
- IGIV is strongly recommended (A+) for Guillain-Barré syndrome.
- Favorable recommendations (A) include chronic inflammatory demyelinating polyradiculoneuropathy, dermatomyositis, and multifocal motor neuropathy.
- Recommended as a second resort (B) for multiple sclerosis and myasthenia gravis; as a last resort (C) for polymyositis, inclusion-body myositis, intractable epilepsies, and stiff-man syndrome.