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Neuroimmunotherapy: a practical approach to the treatment of immune-mediated neurologic diseases
1Neuromuscular Diseases Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892.
Immunosuppressive drugs and immunomodulating procedures can improve the quality of life in patients with immune-related neurologic diseases, or even be life saving, if properly used to avoid deleterious or irreversible adverse effects. For the successful use of these drugs or procedures, the treating physician must be familiar and comfortable with the drugs' mode of action and consider some important principles: 1. The diagnosis must be secure before starting therapy. 2. It is essential to have a basic understanding of the immunologic dysfunction that is amenable to immunotherapy. 3. The goals and the expectations of therapy must be defined, and the risk/benefit ratio of the drugs or procedures must be well understood. 4. Improvement must be based on objective measurements of muscle strength and a beneficial change in activities of daily living, and not solely on a change in the laboratory test values. 5. The limitations of therapy and the time suitable for starting or stopping a drug should be clear to both the therapist and the patient. 6. The selection of a drug or procedure should be guided on the basis of current knowledge, preferably established in controlled trials. 7. Every effort must be made to prevent the development of adverse effects and to determine the lowest dose of a medication that controls the disease. 8. Drug interactions that can cause adverse effects and conditions that can worsen a disease must be avoided.
Immunosuppressive drugs and immunomodulating procedures can improve the quality of life in patients with immune-related neurologic diseases, or even be life saving, if properly used to avoid deleterious or irreversible adverse effects. For the successful use of these drugs or procedures, the treating physician must be familiar and comfortable with the drugs' mode of action and consider some important principles: 1. The diagnosis must be secure before starting therapy. 2. It is essential to have a basic understanding of the immunologic dysfunction that is amenable to immunotherapy. 3. The goals and the expectations of therapy must be defined, and the risk/benefit ratio of the drugs or procedures must be well understood. 4. Improvement must be based on objective measurements of muscle strength and a beneficial change in activities of daily living, and not solely on a change in the laboratory test values. 5. The limitations of therapy and the time suitable for starting or stopping a drug should be clear to both the therapist and the patient. 6. The selection of a drug or procedure should be guided on the basis of current knowledge, preferably established in controlled trials. 7. Every effort must be made to prevent the development of adverse effects and to determine the lowest dose of a medication that controls the disease. 8. Drug interactions that can cause adverse effects and conditions that can worsen a disease must be avoided.