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In controlled clinical trials,IVIg has been effective in treating the Guillain-Barre syndrome,multifocal motor neuropathy,chronic inflammatory demyelinating polyneuropathy,and dermatomyositis.In other controlled or open-label trials and cast reports,IVIg produced improvement in several patients with the Lambert-Eaton myasthenic syndrome and myasthenia gravis but had a variable,mild,or unsubstantiated benefit in some patients with inclusion-body myositis,paraproteinemic IgM demyelinating polyneuropathy, certain intractable childhood epilepsies,polymyositis,multiple sclerosis, optic neuritis,and the stiff-man syndrome.The primary adverse reaction was headache;aseptic meningitis,skin reactions,thromboembolic events,and renal tubular necrosis occurred rarely.The most relevant immunomodulatory actions of IVIg,operating alone or in combination,are inhibition of complement deposition,neutralization of cytokines,modulation of Fc- receptor-mediated phagocytosis,and down-regulation of autoantibody production.Therapy with IVIg is effective for certain autoimmune neurologic diseases,but its spectrum of efficacy has not been fully established.Additional controlled clinical trials are needed. |
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