The value of high-dose intravenous immunoglobulin in the treatment of chronic inflammatory demyelinating polyneuropathy was studied in a double-blind, placebo controlled, crossover investigation at the Department of Neurology, University Hospital Rotterdam-Dijkzigt, the Department of Immunohematology and Bloodbank, University Hospital Leiden, and the Central Laboratory of the Netherlands, Red Cross Blood Transfusion Service, Amsterdam, The Netherlands. Of seven patients treated two were children aged 10 and 7 and five were adults. At initial diagnosis one child was severely disabled and the other moderately disabled (Rankin score 5 and 3, respectively). All patients had weakness of both legs, areflexia, slowed nerve conduction velocities, and elevated CSF protein level. All had responded to treatment with IVIg, 0.4 g/kg bodyweight/2 weeks. All patients showed deterioration after IVIg was discontinued. The patients were then randomized to IVIg or placebo (albumin treatment) in a double-blind crossover study. Those treated with IVIg improved by day eight after the onset of treatment whereas those treated with placebo showed no improvement. The time lapse between discontinuation of the IVIg treatment until deterioration was 6.4 weeks. After placebo the time lapse in weeks until clinical deterioration was 1.3 weeks. [1]

COMMENT. Chronic inflammatory demyelinating polyneuropathy may fluctuate in severity or show deterioration over many months or years and the course and prognosis differs from Guillain-Barre syndrome. Improvement has followed treatment with prednisone, plasmapheresis, and IV gamma globulin [2]. High dose intravenous immunoglobulin is more convenient than plasma exchange and has less long-term side effects than corticosteroids. It was also of value in the treatment of two patients with demyelinating neuropathy associated with monoclonal gammopathy [3]. Dyck PJ in an editorial comments that the processing of Ig is sufficiently rigorous that HIV or hepatitis should not be transmitted by IVIg and there are no other known complications from this treatment. The major drawback was the high cost, $750-1000/treatment.