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Efficacy of Intravenous Immunoglobulin in Patients With IgG Monoclonal Gammopathy and Polyneuropathy
Kenneth C. Gorson, MD;
Allan H. Ropper, MD;
David H. Weinberg, MD;
Robert Weinstein, MD
Arch Neurol. 2002;59:766-772.
Context The optimal treatment of patients with neuropathy associated with IgG
monoclonal gammopathy of undetermined significance is unknown. Plasma exchange
has been shown to be effective but alternative therapies have not been systematically
evaluated.
Objective To report our experience with intravenous immunoglobulin (IVIG) in patients
with IgG monoclonal gammopathy of undetermined significance polyneuropathy.
Design Retrospective review of clinical and electrodiagnostic features of 20
consecutive patients treated with IVIG over an 8-year period.
Setting Academic medical center.
Main Outcome Measures Medical Research Council strength (maximum, 40 points) and sensory (maximum,
26 points) scores, modified Rankin Disability Scale score.
Results There were 14 men and 6 women (mean age, 65 years; age range, 36-82
years). The mean strength score was 35.6 points and the mean sensory score
was 15.8 points prior to therapy. After IVIG therapy, the mean strength score
increased by 1.1 points (P = .22) and the sensory
score increased by 1.7 points (P = .11). Eight patients
(40%) improved by 2 points or more in their motor or sensory score and 1 point
or more in the modified Rankin Disability Scale score and were considered
IVIG therapy responders. They had a shorter duration of symptoms (P = .03), numb hands (P = .02), and falling
episodes (P = .02), and had greater proximal leg
weakness (P = .02) compared with nonresponders. In
IVIG therapy responders, the ulnar motor conduction velocity was slower, ulnar
and peroneal distal motor latencies were prolonged, and the frequency of conduction
block was higher (13 of 36 motor nerves in responders vs 6 of 53 in nonresponders, P = .008).
Conclusions Intravenous immunoglobulin therapy was beneficial in 8 (40%) of our
20 patients with polyneuropathy and IgG monoclonal gammopathy of undetermined
significance. Proximal leg weakness, short duration of symptoms, and demyelinating
features on electrodiagnostic studies were associated with a response to IVIG
therapy.
From the Divisions of Neurology (Drs Gorson, Ropper, and Weinberg)
and Hematology (Dr Weinstein), St Elizabeth's Medical Center, Tufts University
School of Medicine, Boston, Mass.
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