scholarly journals Immunoglobulins in neurological practice: a review of the literature

2019 ◽  
Vol 9 (1) ◽  
pp. 32-51
Author(s):  
S. S. Nikitin ◽  
L. M. Boriskina
Keyword(s):  
Neurological Disorders ◽  
Multifocal Motor Neuropathy ◽  
Intravenous Immunoglobulins ◽  
High Dose ◽  
Motor Neuropathy ◽  
Review Of The Literature ◽  
Second Line Therapy ◽  
Randomized Controlled ◽  
Line Therapy ◽  
Neurological Conditions

Today intravenous immunoglobulins are used increasingly in the management of patients with neurological conditions. The efficacy and safety of intravenous immunoglobulins treatment in chronic inflammatory demyelinating polyradiculoneuropathy, Guillain–Barre syndrome and multifocal motor neuropathy have been established in randomized controlled trials and declared in systematic reviews. There are discussions about the dose, timing, duration and necessity of repeated infusions in these disorders. The intravenous immunoglobulins treatment is an option in myasthenia gravis crisis and exacerbations the disease, stiff-person syndrome, a second-line therapy in dermatomyositis and some patients with polymyositis. The use of intravenous immunoglobulins in patients with multiple sclerosis, inclusion body myositis, resistant epilepsy is not finally proved. The review discussed the data of immunoglobulins efficacy in neurological disorders based on informative studies with an emphasis on the main criteria for choosing a drug for effective high-dose intravenous immunotherapy.

scholarly journals PEGINTERFERON-ALPHA 2A RELATED PERIPHERAL NEUROPATHY: A CASE REPORT AND REVIEW OF THE LITERATURE

2017 ◽  
Vol 16 (3) ◽  
pp. 119-122
Author(s):  
Amalia Ghergu ◽  
◽  
Alexandra Oprisan ◽  
Cristina Mitu ◽  
Sorana Popescu ◽  
...  
Keyword(s):  
Multifocal Motor Neuropathy ◽  
Intravenous Immunoglobulins ◽  
Nerve Conduction Studies ◽  
Drug Discontinuation ◽  
Motor Neuropathy ◽  
Hepatitis C Virus Infection ◽  
Review Of The Literature ◽  
Early Management ◽  
Rare Association ◽  
Upper And Lower Extremities

We report the case of a 46-year old female with chronic hepatitis C virus infection who developed paresthesia and weakness of face and upper and lower extremities nine months after administration of peginterferon-alpha 2a. Considering her clinical evolution, neurological examination and nerve conduction studies, she was diagnosed with multifocal motor neuropathy related to peginterferon-alpha treatment. The patient recovered after use of intravenous immunoglobulins. From our knowledge there is no data in the literature about multifocal motor neuropathy related to peginterferon-alpha treatment. Doctors should be aware of this rare association, which requires immediate drug discontinuation and early management.

Relapse After Early-Stage, Favorable Hodgkin Lymphoma: Disease Characteristics and Outcomes With Conventional or High-Dose Chemotherapy

2021 ◽  
Vol 39 (2) ◽  
pp. 107-115
Author(s):  
Paul J. Bröckelmann ◽  
Horst Müller ◽  
Teresa Guhl ◽  
Karolin Behringer ◽  
Michael Fuchs ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Early Stage ◽  
High Dose Chemotherapy ◽  
Sensitivity Analyses ◽  
High Dose ◽  
Second Line ◽  
Second Line Therapy ◽  
Line Therapy ◽  
Significant Difference ◽  
First Diagnosis

PURPOSE We evaluated disease and treatment characteristics of patients with relapse after risk-adapted first-line treatment of early-stage, favorable, classic Hodgkin lymphoma (ES-HL). We compared second-line therapy with high-dose chemotherapy and autologous stem cell transplantation (ASCT) or conventional chemotherapy (CTx). METHODS We analyzed patients with relapse after ES-HL treated within the German Hodgkin Study Group HD10+HD13 trials. We compared, by Cox proportional hazards regression, progression-free survival (PFS) after relapse (second PFS) treated with either ASCT or CTx and performed sensitivity analyses with overall survival (OS) from relapse and Kaplan-Meier statistics. RESULTS A total of 174 patients’ disease relapsed after treatment in the HD10 (n = 53) and HD13 (n = 121) trials. Relapse mostly occurred > 12 months after first diagnosis, predominantly with stage I-II disease. Of 172 patients with known second-line therapy, 85 received CTx (49%); 70, ASCT (41%); 11, radiotherapy only (6%); and 4, palliative single agent therapies (2%). CTx was predominantly bleomycin, etoposide, doxorubicin cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [68%]), followed by the combination regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (19%), or other regimens (13%). Patients aged > 60 years at relapse had shorter second PFS (hazard ratio [HR], 3.0; P = .0029) and were mostly treated with CTx (n = 33 of 49; 67%) and rarely with ASCT (n = 8; 16%). After adjustment for age and a disadvantage of ASCT after the more historic HD10 trial, we did not observe a significant difference in the efficacy of CTx versus ASCT for second PFS (HR, 0.7; 95% CI, 0.3 to 1.6; P = .39). In patients in the HD13 trial who were aged ≤ 60 years, the 2-year, second PFS rate was 94.0% with CTx (95% CI, 85.7% to 100%) versus 83.3% with ASCT (95% CI, 71.8% to 94.8%). Additional sensitivity analyses including OS confirmed these observations. CONCLUSION After contemporary treatment of ES-HL, relapse mostly occurred > 12 months after first diagnosis. Polychemotherapy regimens such as BEACOPP are frequently administered and may constitute a reasonable treatment option for selected patients with relapse after ES-HL.

scholarly journals Early anti IL-1 treatment replaces steroids in refractory Kawasaki disease: clinical experience from two case reports

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110025
Author(s):  
Maria Vincenza Mastrolia ◽  
Giulia Abbati ◽  
Claudia Signorino ◽  
Ilaria Maccora ◽  
Edoardo Marrani ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Evidence ◽  
Case Reports ◽  
Therapeutic Option ◽  
Intravenous Immunoglobulins ◽  
Second Line Therapy ◽  
Coronary Artery Aneurysms ◽  
Coronary Arteritis ◽  
Line Therapy ◽  
Prior Use

Refractory Kawasaki disease (KD) is related to a major risk of coronary arteries abnormalities and its treatment is not standardized. In this regard, anakinra (ANA), an interleukin (IL)-1 receptor antagonist, represents an emerging therapeutic option. We report two cases of children, diagnosed with KD, nonresponsive to two doses of intravenous immunoglobulins, successfully treated with ANA, without a prior use of steroids. Patient 2 developed a coronary dilatation, that improved significantly after ANA therapy. Our experience highlights IL-1 blockade effectiveness in reducing KD inflammation and suggests ANA adoption as second-line therapy, with a timesaving and steroid-sparing strategy. Our results, combined with the evidence of the IL-1 key role in KD and coronary arteritis pathogenesis and to the recent clinical evidence reported by the KAWAKINRA trial, encourage an earlier recourse to ANA in patients with refractory KD, in order to fight inflammation, and to treat and prevent the development of coronary artery aneurysms. Further studies are needed to better define the place of IL-1 blockade in KD step-up treatment.

The Korsakov Syndrome in Spontaneous Subarachnoid Haemorrhage

1953 ◽  
Vol 99 (416) ◽  
pp. 521-530 ◽  
Author(s):  
John N. Walton
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Neurological Disorders ◽  
Review Of The Literature ◽  
Case Histories ◽  
Actual Case ◽  
Mental Symptoms ◽  
Symptom Complex ◽  
Excellent Description ◽  
The Subject ◽  
Neurological Conditions

The amnestic-confabulatory symptom-complex to which the eponymous title of Korsakov's syndrome is usually given was probably first described by the Swedish physician Magnus Huss (1807–90), who spent the greater part of his lifetime in the study of alcoholism. There is, however, no doubt that Korsakov's (1890) paper on the subject gave an excellent description of the syndrome, and stressed the fact that whereas it often developed in patients with alcoholism and polyneuritis, numerous other metabolic and neurological disorders could be complicated by the characteristic mental changes. Indeed, in Korsakov's (1890) own series of cases alcoholics were in the minority. One of the neurological conditions in which the syndrome has been described significantly often is spontaneous subarachnoid haemorrhage. The first reports of the association were probably those of Flatau (1918 and 1921), and it was discussed in some detail by Goldflam (1923) and Herman (1925 and 1926). Each of these authors described the mental symptoms exhaustively but gave no actual case-histories; the first fully documented cases in the literature were the two reported by Hall (1929). Single cases have since been described by Cubitt (1930), Popow (1930) and Kulkow (1935), and in 1939 Tarachow gave an extensive review of the literature and reported an additional 3 cases. It is remarkable that since 1939 the association has received little attention, although it has been mentioned by Sands (1941) and Meadows (1951).

Focal peripheral neuropathy

2011 ◽  
Author(s):  
Michael Donaghy
Keyword(s):  
Peripheral Nerve ◽  
Immunosuppressive Treatment ◽  
Conduction Block ◽  
Multifocal Motor Neuropathy ◽  
Nerve Damage ◽  
High Dose ◽  
Motor Neuropathy ◽  
Peripheral Nerve Damage ◽  
Entrapment Neuropathies ◽  
Focal Neuropathy

Some causes of focal peripheral nerve damage are self-evident, such as involvement at sites of trauma, tissue necrosis, infiltration by tumour, or damage by radiotherapy. Focal compressive and entrapment neuropathies are particularly valuable to identify in civilian practice, since recovery may follow relief of the compression. Leprosy is a common global cause of focal neuropathy, which involves prominent loss of pain sensation with secondary acromutilation, and requires early antibiotic treatment. Mononeuritis multiplex due to vasculitis requires prompt diagnosis and immunosuppressive treatment to limit the severity and extent of peripheral nerve damage. Various other medical conditions, both inherited and acquired, can present with focal neuropathy rather than polyneuropathy, the most common of which are diabetes mellitus and hereditary liability to pressure palsies. A purely motor focal presentation should raise the question of multifocal motor neuropathy with conduction block, which usually responds well to high-dose intravenous immunoglobulin infusions.

scholarly journals Utility of Botulinum Injections in Stiff-Person Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
L. M. Conners ◽  
A. Betcher ◽  
A. Shahinian ◽  
P. Janda
Keyword(s):  
Case Report ◽  
Adverse Reactions ◽  
Intravenous Immunoglobulins ◽  
Initial Therapy ◽  
High Dose ◽  
B Cell Depletion ◽  
Stiff Person Syndrome ◽  
Review Of The Literature ◽  
Systemic Treatments ◽  
Muscle Spasms

Stiff-person syndrome (SPS) is an uncommon neurological disorder characterized by significant rigidity and muscle spasms primarily affecting the truncal and proximal musculature. Furthermore, a wide-based gait with functional impairment is generally seen. High-dose benzodiazepines or baclofen are widely considered the optimal initial therapy; however, major adverse effects often preclude adequate dosing. Refractory cases may be treated with intravenous immunoglobulins (IVIG), plasma exchange, or B-cell depletion with rituximab, although these are also associated with major, sometimes fatal, adverse reactions. Several reports have validated the safety and utility of botulinum injections in this setting, yet botulinum remains markedly underutilized in this cohort. Below, a case report and review of the literature show botulinum can decrease pain and stiffness, improve gait and balance, and decrease dependence on powerful systemic treatments in this group.

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