INVITED REVIEW OPTIMIZING IGG THERAPY IN CHRONIC AUTOIMMUNE NEUROPATHIES: A HYPOTHESIS DRIVEN APPROACH

ABSTRACT: Prolonged intravenous immunoglobulin (IVIG) ther-apy is used for the chronic autoimmune neuropathies chronic idiopathic demyelinating polyneuropathy and multifocal motor neuropathy, but the doses and treatment intervals are usually chosen empirically due to a paucity of data from dose–response studies. Recent studies of the electrophysiology and immunol-ogy of these diseases suggest that antibody-induced reversible dysfunction of nodes of Ranvier may play a role in conduction block and disability which responds to immunotherapy more rap-idly than would be expected for demyelination or axonal damage per se. Clinical reports suggest that in some cases, the effects of each dose of IVIG may be transient, wearing-off before the next dose is due. These observations lead us to hypothesize that that therapeutic IgG acts by competing with pathologic auto-antibodies and that individual patients may require different Ig