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Modulatory effects on axonal function after intravenous immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy.
MedLine Citation:
PMID:  21747028     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: To investigate the immediate and longitudinal mechanisms of action of intravenous immunoglobulin (IVIg) on axonal function in chronic inflammatory demyelinating polyneuropathy (CIDP).
DESIGN: Prospective single-center study.
SETTING: Hospitals and outpatient clinics.
PARTICIPANTS: Clinical and functional assessment, nerve conduction studies, and 526 motor excitability studies were undertaken in 27 patients, matched before and immediately after infusion and followed up longitudinally.
MAIN OUTCOME MEASURES: Axonal excitability variables were measured before and immediately after infusion and compared with matched studies and findings in healthy controls.
RESULTS: Immediately after infusion, patients demonstrated decreased threshold, with significant reduction in strength-duration time constant (P = .003), reduction in accommodation to depolarization (P = .04), and reduced threshold change during hyperpolarization (P = .003), accompanied by significant decreases in superexcitability (P = .03) and subexcitability (P = .02). In contrast, changes were absent in disease controls, confirming a specific IVIg action in CIDP patients. Longitudinally, changes correlated with clinical improvement (mean [SE] increase in the Medical Research Council sum score, 2.7 [0.7]; P = .005). Increased compound muscle action potential amplitude was associated with reduction in terminal latency (correlation coefficient, -0.65; P = .02). In addition, these changes translated into improvement in functional assessment with the adjusted Inflammatory Neuropathy Cause and Treatment score, which demonstrated a significant correlation with nerve excitability variables longitudinally (P = .01).
CONCLUSIONS: Findings from the present series establish a modulatory effect of IVIg on axonal function in CIDP patients, suggesting that IVIg stabilizes axonal membrane potential and promotes axonal recovery.
Authors:
Cindy Shin-Yi Lin; Arun V Krishnan; Susanna B Park; Matthew C Kiernan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of neurology     Volume:  68     ISSN:  1538-3687     ISO Abbreviation:  Arch. Neurol.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372436     Medline TA:  Arch Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  862-9     Citation Subset:  AIM; IM    
Affiliation:
Faculty of Medicine, School of Medical Science, Wallace Wurth Building, University of New South Wales, Sydney, New South Wales, Australia 2051. c.lin@unsw.edu.au.
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