INMUNOGLOBULINA ENDOVENOSA EN ENFERMEDADES NEUROMUSCULARES GUÍA PARA SU UTILIZACIÓN

Summary Guidelines for the use of IV Immunoglobulin in neuromuscular disorders. IVIG has shown clinical benefit in several immune mediated neuromuscular disorders. Different mechanisms of action have been postulated including: inhibition of antibody production, blocking the antibody action or acceleration of their catabolism, blocking of monocites and T cells, and interference of both: cytokines and complement pathway. The IVIG is obtained from the plasma of normal volunteers through methods including polyethilenglicol, chromatography of ionic interchange and treatment at pH4. IVIG has been used in acute immune mediated neuropathies (Guillain-Barré syndrome and its variants: Miller Fisher syndrome, Acute motor axonal neuropathy, acute motor and sensory axonal neuropathy) and chronic immune mediated neuropathies (chronic idiopathic demyelinating neuropathy, multifocal motor neuropathy with conduction block, multifocal demyelinating motor and sensory neuropathy, neuropathies associated to monoclonal gamopathies, chronic ataxic neuropathies). Disorders associated to neuromuscular transmission failure (myasthenia and Eaton Lambert syndrome). Inflammatory myopathies (dermatomyositis; polymiositis; inclusion body myositis). Neuronopathies and stiff person syndrome. IVIG is easy to infuse and usually well tolerated. Side effects are frequently mild and include headache, shivering, nausea, vomiting, headaches, myalgia, and fatigue and they can be easily controlled with symptomatic treatment. Very rarely IVIG can produce renal failure; anaphylactic reactions aseptic meningitis, cerebrovascular accidents and myocardial infarctions. The use of IVIG is contraindicated in patients with hypersensitivity to immune globulins and patients with congenital IgA deficit. IVIG is infused at a dosage of 2g/kg divided in 2 or 5 consecutive days at a speed of 40 -80 ml/h.