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Dimitrios Karussis, MD, PhD; Oded Abramsky, MD, PhD
From the Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.

Arch Neurol. 1999;56:1028-1032.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

DURING the last decade, intravenous immunoglobulin (IVIG) has been used to treat several neurologic conditions.^1-2 However, because of the initial enthusiasm that followed the success of this treatment in some systemic autoimmune diseases, IVIG has been overused in the past few years; sometimes, use is based on only small uncontrolled studies. This review deals with IVIG overuse and emphasizes the precautions to be taken before prescribing treatment.

MECHANISMS OF ACTION OF IVIG

The precise mechanisms by which immunoglobulins induce their beneficial effects in immune-mediated diseases are partially unknown and under investigation. Their immunomodulating effects are nonspecific and pleiotropic at various levels of the immune system, including Fc receptor blockage,³ neutralization of the autoantibodies by anti-idiotypic antibodies and networks, inhibition of T- and B-cell proliferation, down-regulation of adhesion molecules, inhibition of proinflammatory cytokines or shift toward T_H2 cytokines, and blockage of complement activation proteins.^4-11 Each batch of . . . [Full Text of this Article]

SAFETY

CRITICAL EVALUATION OF THE EFFICACY OF IVIG IN VARIOUS NEUROLOGIC DISEASES
Myasthenia Gravis

Guillain-Barré Syndrome

Chronic Inflammatory Demyelinating Polyneuropathy

Multifocal Motor Neuropathy

Paraproteinemic Polyneuropathy

Multiple Sclerosis

Inflammatory Myopathies

Neuromyotonia (Isaac Syndrome)

Paraneoplastic Syndromes

Lambert-Eaton Myasthenic Syndrome.

Other Paraneoplastic Syndromes.

Other Neurologic Diseases

CONCLUSIONS

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