Use of intravenous immunoglobulin and plasma exchange in neurological disease

The most relevant indications for the use of intravenous immunoglobulins and plasma exchange in neurological disorders are described, with special emphasis on the data from clinical trials and aspects of specific importance for clinical routine.

Much therapeutic success in neuromuscular and neuroimmunological diseases came with the therapeutic introduction of intravenous immunoglobulin and plasma exchange. Today, intravenous immunoglobulins and plasma exchange are preferentially used to treat acute Guillain-Barré syndrome, myasthenic crisis, acute or chronic inflammatory demyelinating polyneuropathy, or stiff person syndrome. Intravenous immunoglobulins also proved valuable for refractory dermatomyositis or multifocal motor neuropathy. Owing to their generally mild side effects, intravenous immunoglobulins have now been tested in many more indications, sometimes with surprising clinical effects as in the case of postpolio syndrome. While intravenous immunoglobulin is not the treatment of first choice in many immune-mediated disorders of the central nervous system, plasma exchange has become an integral part of escalating relapse therapy in relapsing-remitting multiple sclerosis.

In recent years, our knowledge on neurological disease mechanisms has broadened and more specific treatment alternatives have become available. Yet, established therapeutic options such as intravenous immunoglobulins and plasma exchange are still high on the list for many neuroimmunological disorders. Controlled trials have led to a refinement of the application of both treatment modalities, whose targets can be sometimes congruent, but in other cases also very distinct.