PracticeUpdate

" Results of the large, randomized, controlled Second IVIg Dose trial in patients with GBS with a poor prognosis (SID-GBS) trial are eagerly awaited and will likely be available in early 2019. "

Inclusion criteria are: ƒ ƒ Diagnosis of Guillain-Barré syndrome according to internationally accepted criteria ƒ ƒ Grade 3, 4, or 5 on the Guillain-Barré syndrome disability scale or other indi- cation for IV immune globulin therapy according to the treating neurology ƒ ƒ <2 weeks since the onset of weakness ƒ ƒ Ability to attend the 6-month follow-up visit Dr. van Doorn mentioned, “An alternative, simple treatment for Guillain-Barré syn- drome, small-volume plasma exchange, was evaluated in an interesting new study. Small-volume plasma exchange may be especially helpful in low-income countries.” Intravenous immunoglobulin and plasma exchange are effective in Guillain-Barré syndrome. An indication now exists that inhibition of complement activation using eculizumab is potentially effective in Guillain-Barré syndrome, though addi- tional studies are needed. Individuals within the CIDP spectrum can be treated with IV immune globulin, plasma exchange, or steroids. If one of

to be determined at least every 6 to 12 months. Multifocal motor neuropathy may mimic motor neuron disease, but is treatable with IV immune globulin. Surprisingly, individu- als withmultifocal motor neuropathy do not improve with steroids or plasma exchange. Other important immune-mediated neu- ropathies are related to the presence of a paraprotein or are caused by, for example, vasculitis. Dr. van Doorn concluded, “Amazing progress has been made in the under- standing of immunobiology, discovery of new antibodies, and evaluation of new diagnostics. These have helped identify (new) subgroups and have opened the way to new treatments for patients with these disorders.” www.practiceupdate.com/c/70779

these proven effective treatments fail, one of these other treatments are still likely to be successful. A recent randomized controlled trial showed that individuals with CIDP can also be treated with subcutaneous immune globulin. The best treatment for CIDP is debated. IV immune globulin works rapidly but is expensive. Steroids are inexpensive but can induce major side effects. Pulse steroid treatment, however, may be more likely to induce disease remission and is under investigation. Under- and overtreatment in individuals with immune-mediated neuropathies are important problems. Whether an individ- ual still requires treatment (response can be either therapeutically induced or be due to the nature of the disease) needs

ICNMD 2018 • PRACTICEUPDATE CONFERENCE SERIES 15