Use of intravenous immunoglobulin and plasma exchange in neurological disease
Use of intravenous immunoglobulin and plasma exchange in neurological disease
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DOI：
10.1097/wco.0b013e3282ff5b8f
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发表时间：
2008-06-01
影响因子：
4.8
通讯作者：
Gold, Ralf
中科院分区：
文献类型：
--
作者：
Linker, Ralf A.;Gold, Ralf
目的reviewThe最相关的适应症使用静脉注射免疫球蛋白和血浆置换在神经系统疾病的描述，特别强调的数据从临床试验和临床routine.Recent findingsMuch方面的具体重要性在神经肌肉和神经免疫疾病的治疗成功来与治疗介绍静脉注射免疫球蛋白和血浆置换。目前，静脉注射免疫球蛋白和血浆置换优先用于治疗急性格林-巴利综合征、肌无力危象、急性或慢性炎性脱髓鞘性多发性神经病或僵硬人综合征。静脉注射免疫球蛋白也被证明对难治性皮肌炎或多灶性运动神经病有价值。由于其通常轻微的副作用，静脉注射免疫球蛋白现在已经在许多适应症中进行了测试，有时在脊髓灰质炎后综合征的情况下具有令人惊讶的临床效果。虽然静脉注射免疫球蛋白是不是在许多免疫介导的中枢神经系统疾病的首选治疗，血浆置换已成为复发缓解型多发性sclerosis.SummaryIn近年来，我们对神经系统疾病机制的认识已经扩大，更具体的治疗方法已经成为一个不可或缺的一部分。然而，已建立的治疗选择，如静脉注射免疫球蛋白和血浆置换仍然是许多神经免疫性疾病的首选。对照试验使两种治疗方法的应用得到了改进，其目标有时是一致的，但在其他情况下也是非常不同的。
Purpose of reviewThe most relevant indications for the use of intravenous immunoglobulins and plasma exchange in neurological disorders are described, with special emphasis on the data from clinical trials and aspects of specific importance for clinical routine.Recent findingsMuch therapeutic success in neuromuscular and neuroimmunological diseases came with the therapeutic introduction of intravenous immunoglobulin and plasma exchange. Today, intravenous immunoglobulins and plasma exchange are preferentially used to treat acute Guillain-Barre syndrome, myasthenic crisis, acute or chronic inflammatory demyelinating polyneuropathy, or stiff person syndrome. Intravenous immunoglobulins also proved valuable for refractory dermatomyositis or multifocal motor neuropathy. Owing to their generally mild side effects, intravenous immunoglobulins have now been tested in many more indications, sometimes with surprising clinical effects as in the case of postpolio syndrome. While intravenous immunoglobulin is not the treatment of first choice in many immune-mediated disorders of the central nervous system, plasma exchange has become an integral part of escalating relapse therapy in relapsing-remitting multiple sclerosis.SummaryIn recent years, our knowledge on neurological disease mechanisms has broadened and more specific treatment alternatives have become available. Yet, established therapeutic options such as intravenous immunoglobulins and plasma exchange are still high on the list for many neuroimmunological disorders. Controlled trials have led to a refinement of the application of both treatment modalities, whose targets can be sometimes congruent, but in other cases also very distinct.