Aa
IVIG PROTOCOL
When IVIG is given for the first time because they are suspected of having Multi Focal Motor Neuropathy, how is the increase in strength monitored? I have read that the average benefit lasts for about two weeks, thus I assume the specialist will check muscle strength before the IVIG infusion and about two weeks after the infusion. Is this the normal way to proceed? Thanking you very much, in advance, for your answer.
Hello Esteban Cheng-Ching, MD,
Over the past 3 weeks my son has been sick lately with the common cold sypmtoms, fevers and diarhea. So finally, we took him in on Halloween day to our family physician and he said that my son's ear was a little red. So he was given Amoxocillian and Prednosoline (by the way is 11 months old). He was suppose to take Prednosoline for 5 days and the Amoxocillian for 10 days. He finished the Prednosoline of day 5 and then on day 8 we noticed a rash (Sunday). So we took him in to the ER. They looked at him and got on the phone with the infectious disease doctor and right away with out the infectious disease doctor even having a look at him, she said that it might be the Kawasaki disease and and so they treated him with the IVIG. So after the IVIG infusion we were sent home that night. The day after he started up a fever again and was sent to the ER again. The infectious disease doctor suggested a second dose of IVIG. So he was given a second dose, but now he is still getting a fever. He is playing, full of energy, eating well and seems perfectly normal except for the little fevers coming and going about once or twice a day. Is this normal for getting an infusion of IVIG to get fevers for a while? How long can I expect fevers for afterwards?
Over the past 3 weeks my son has been sick lately with the common cold sypmtoms, fevers and diarhea. So finally, we took him in on Halloween day to our family physician and he said that my son's ear was a little red. So he was given Amoxocillian and Prednosoline (by the way is 11 months old). He was suppose to take Prednosoline for 5 days and the Amoxocillian for 10 days. He finished the Prednosoline of day 5 and then on day 8 we noticed a rash (Sunday). So we took him in to the ER. They looked at him and got on the phone with the infectious disease doctor and right away with out the infectious disease doctor even having a look at him, she said that it might be the Kawasaki disease and and so they treated him with the IVIG. So after the IVIG infusion we were sent home that night. The day after he started up a fever again and was sent to the ER again. The infectious disease doctor suggested a second dose of IVIG. So he was given a second dose, but now he is still getting a fever. He is playing, full of energy, eating well and seems perfectly normal except for the little fevers coming and going about once or twice a day. Is this normal for getting an infusion of IVIG to get fevers for a while? How long can I expect fevers for afterwards?
MEDICAL PROFESSIONAL
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.
Multifocal Motor Neuropathy is a condition of the motor nerves. The nerves are conformed by a group of fibers where electrical impulses travel, and these fibers are covered by something called myelin, which is a compound that surrounds the fibers forming a sheath around them, and allowing for the rapid spread of the electrical responses. It is thought that in multifocal motor neuropathy, there is demyelination, this is a destruction of this myelin sheath. It is also thought that the cause for this is associated with a disturbance in the immunologic system with the abnormal production of antibodies that attack this sheath. There is a specific antibody that has been described in motor neuropathy, and it is the Anti-GM1.
The treatment for this condition is with IVIG, which acts as an immunomodulatory agent. IVIG has been shown to be effective in study trials. The response produces improvement in the symptoms and in the electrodiagnostic changes in the EMG-NCV. The therapeutic effect is usually transient, and sometimes patients need a prolonged treatment. However there are cases in which there is remission. The exact mechanism of action of IVIG in motor neuropathy is not well known, and is thought to have effects by targeting the antibodies attacking the myelin, or the inflammatory cells involved. As with every treatment option, there are potential side effects such as allergic reactions, headaches, thrombotic events, infections, renal problems, and something called “aseptic meningitis”, in which the patient experiences fever, headache, nuchal rigidity, nausea and vomiting.
Regarding follow up, it is important that you have a baseline neurologic exam with detailed motor exam performed by your neurologist, and subsequent exams after the treatment. Probably a week or two into the treatment. The follow up exams are more objective if performed by the same physician. According to this, and to what the patient experiences, the duration of treatment can be decided. Also some neurologist follow this condition using electrodiagnostic studies, however the neurologic exam is the most important aspect to follow.
I think you should discuss with your neurologist about what the treatment with IVIG implies and what you should expect from this treatment, as I am not exactly sure how severe or mild your condition is.
I hope you find this information useful. Good luck.
Multifocal Motor Neuropathy is a condition of the motor nerves. The nerves are conformed by a group of fibers where electrical impulses travel, and these fibers are covered by something called myelin, which is a compound that surrounds the fibers forming a sheath around them, and allowing for the rapid spread of the electrical responses. It is thought that in multifocal motor neuropathy, there is demyelination, this is a destruction of this myelin sheath. It is also thought that the cause for this is associated with a disturbance in the immunologic system with the abnormal production of antibodies that attack this sheath. There is a specific antibody that has been described in motor neuropathy, and it is the Anti-GM1.
The treatment for this condition is with IVIG, which acts as an immunomodulatory agent. IVIG has been shown to be effective in study trials. The response produces improvement in the symptoms and in the electrodiagnostic changes in the EMG-NCV. The therapeutic effect is usually transient, and sometimes patients need a prolonged treatment. However there are cases in which there is remission. The exact mechanism of action of IVIG in motor neuropathy is not well known, and is thought to have effects by targeting the antibodies attacking the myelin, or the inflammatory cells involved. As with every treatment option, there are potential side effects such as allergic reactions, headaches, thrombotic events, infections, renal problems, and something called “aseptic meningitis”, in which the patient experiences fever, headache, nuchal rigidity, nausea and vomiting.
Regarding follow up, it is important that you have a baseline neurologic exam with detailed motor exam performed by your neurologist, and subsequent exams after the treatment. Probably a week or two into the treatment. The follow up exams are more objective if performed by the same physician. According to this, and to what the patient experiences, the duration of treatment can be decided. Also some neurologist follow this condition using electrodiagnostic studies, however the neurologic exam is the most important aspect to follow.
I think you should discuss with your neurologist about what the treatment with IVIG implies and what you should expect from this treatment, as I am not exactly sure how severe or mild your condition is.
I hope you find this information useful. Good luck.
You are reading content posted in the Neurology Forum
Find out how beta-blocker eye drops show promising results for acute migraine relief.
In this special Missouri Medicine report, doctors examine advances in diagnosis and treatment of this devastating and costly neurodegenerative disease.
Here are 12 simple – and fun! – ways to boost your brainpower.
Discover some of the causes of dizziness and how to treat it.
Discover the common causes of headaches and how to treat headache pain.
Two of the largest studies on Alzheimer’s have yielded new clues about the disease
