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Tavee J, Brannagan TH, Lenihan MW, Muppidi S, Kellermeyer L, D Donofrio P. Updated consensus statement: Intravenous immunoglobulin in the treatment of neuromuscular disorders report of the AANEM ad hoc committee. Muscle Nerve 2023; 68:356-374. [PMID: 37432872 DOI: 10.1002/mus.27922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023]
Abstract
Intravenous immune globulin (IVIG) is an immune-modulating biologic therapy that is increasingly being used in neuromuscular disorders despite the paucity of high-quality evidence for various specific diseases. To address this, the AANEM created the 2009 consensus statement to provide guidance on the use of IVIG in neuromuscular disorders. Since then, there have been several randomized controlled trials for IVIG, a new FDA-approved indication for dermatomyositis and a revised classification system for myositis, prompting the AANEM to convene an ad hoc panel to update the existing guidelines.New recommendations based on an updated systemic review of the literature were categorized as Class I-IV. Based on Class I evidence, IVIG is recommended in the treatment of chronic inflammatory demyelinating polyneuropathy, Guillain-Barré Syndrome (GBS) in adults, multifocal motor neuropathy, dermatomyositis, stiff-person syndrome and myasthenia gravis exacerbations but not stable disease. Based on Class II evidence, IVIG is also recommended for Lambert-Eaton myasthenic syndrome and pediatric GBS. In contrast, based on Class I evidence, IVIG is not recommended for inclusion body myositis, post-polio syndrome, IgM paraproteinemic neuropathy and small fiber neuropathy that is idiopathic or associated with tri-sulfated heparin disaccharide or fibroblast growth factor receptor-3 autoantibodies. Although only Class IV evidence exists for IVIG use in necrotizing autoimmune myopathy, it should be considered for anti-hydroxy-3-methyl-glutaryl-coenzyme A reductase myositis given the risk of long-term disability. Insufficient evidence exists for the use of IVIG in Miller-Fisher syndrome, IgG and IgA paraproteinemic neuropathy, autonomic neuropathy, chronic autoimmune neuropathy, polymyositis, idiopathic brachial plexopathy and diabetic lumbosacral radiculoplexopathy.
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Affiliation(s)
- Jinny Tavee
- National Jewish Health, Division of Neurology, Denver, Colorado, USA
| | - Thomas H Brannagan
- Vagelos College of Physicians and Surgeons, Neurological Institute, Columbia University, New York, New York, USA
| | | | - Sri Muppidi
- Stanford Neuroscience Health Center, Palo Alto, California, USA
| | | | - Peter D Donofrio
- Neurology Clinic, Vanderbilt University, Nashville, Tennessee, USA
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Kim JG, Kim SY, Oh HS, Jo DH. Parsonage-Turner Syndrome Following Typhoid Vaccination. Yonsei Med J 2021; 62:868-871. [PMID: 34427074 PMCID: PMC8382727 DOI: 10.3349/ymj.2021.62.9.868] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 06/15/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
Parsonage-Turner syndrome is a rare neurological disease of varying etiology characterized by severe shoulder pain, muscle weakness, and atrophy. Mechanisms are unclear, but are thought to be genetic and immune-mediated reactions. Rarely, Parsonage-Turner syndrome occurs as a side effect of vaccination. A 20-year-old male who worked as a soldier visited the military hospital because of shoulder pain after vaccination against typhoid and was diagnosed with Parsonage-Turner syndrome based on electromyography and joint magnetic resonance imaging. Pain was controlled with a nerve block. Intravenous immunoglobulin was administered for improvement of neurologic symptoms. This case suggests that Parsonage-Turner syndrome should be considered as a side effect of vaccination. To the best of our knowledge, this is the first report of Parsonage-Turner syndrome following vaccination in Korea.
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Affiliation(s)
- Jeong Gil Kim
- Department of Rehabilitation Medicine, Armed Forces Yangju Hospital, Yangju, Korea
| | - Se Yong Kim
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Armed Forces Daejeon Hospital, Daejeon, Korea
| | - Hong Sang Oh
- Division of Infectious Disease, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Dong Ho Jo
- Division of Infectious Disease, Department of Internal Medicine, Myongji Hospital, Goyang, Korea.
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Affiliation(s)
- Alex C Tselis
- Department of Neurology, School of Medicine, Wayne State University, Detroit, MI, USA.
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Khadilkar SV, Khade SS. Brachial plexopathy. Ann Indian Acad Neurol 2013; 16:12-8. [PMID: 23661957 PMCID: PMC3644772 DOI: 10.4103/0972-2327.107675] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 11/09/2012] [Accepted: 10/24/2012] [Indexed: 11/04/2022] Open
Abstract
Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN), often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles. Idiopathic hypertrophic brachial neuritis, a rare condition, is usually painless to begin with, unlike IBN. Hereditary neuralgic amyotrophy is an autosomal-dominant disorder characterized by repeated episodes of paralysis and sensory disturbances in an affected limb, which is preceded by severe pain. While the frequency of the episodes tends to decrease with age, affected individuals suffer from residual deficits. Neurogenic thoracic outlet syndrome affects the lower trunk of the brachial plexus. It is diagnosed on the basis of electrophysiology and is amenable to surgical intervention. Cancer-related brachial plexopathy may occur secondary to metastatic infiltration or radiation therapy. Traumatic brachial plexus injury is commonly encountered in neurology, orthopedic, and plastic surgery set-ups. Trauma may be a direct blow or traction or stretch injury. The prognosis depends on the extent and site of injury as well as the surgical expertise.
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Affiliation(s)
- Satish V Khadilkar
- Department of Neurology, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India
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Naito KS, Fukushima K, Suzuki S, Kuwahara M, Morita H, Kusunoki S, Ikeda SI. Intravenous immunoglobulin (IVIg) with methylprednisolone pulse therapy for motor impairment of neuralgic amyotrophy: clinical observations in 10 cases. Intern Med 2012; 51:1493-500. [PMID: 22728480 DOI: 10.2169/internalmedicine.51.7049] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Neuralgic amyotrophy (NA) is a distinct peripheral nervous system disorder characterized by attacks of acute neuropathic pain and rapid multifocal weakness and atrophy unilaterally in the upper limb. The current hypothesis is that the episodes are caused by an immune-mediated response to the brachial plexus, however, therapeutic strategies for NA have not been well established. METHODS AND RESULTS We retrospectively reviewed 15 case series of NA; 10 of the 15 patients received intravenous immunoglobulin (IVIg) with methylprednisolone pulse therapy (MPPT) and 9 of these 0 patients showed clinical improvement of motor impairment. CONCLUSION Our clinical observations do not contradict the possibility that IVIg with MPPT may be one of the potential therapeutics for NA, however the efficacy remains to be established. Further confirmatory trials are needed in patients with various clinical severities and phases of NA. Further basic research and confirmatory trials should be performed to survey the efficacy of such immunomodulation therapy for NA.
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Affiliation(s)
- Ko-suke Naito
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
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Moriguchi K, Miyamoto K, Takada K, Kusunoki S. Four cases of anti-ganglioside antibody-positive neuralgic amyotrophy with good response to intravenous immunoglobulin infusion therapy. J Neuroimmunol 2011; 238:107-9. [PMID: 21872943 DOI: 10.1016/j.jneuroim.2011.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 07/08/2011] [Accepted: 08/09/2011] [Indexed: 11/19/2022]
Abstract
Neuralgic amyotrophy (NA), which is an idiopathic disorder in the peripheral nerves, is characterized by an acute onset of unilateral pain in the proximal limbs followed by muscular weakness and wasting. Some cases of NA are thought to be related to immune pathogenic disorders such as Guillain-Barré syndrome (GBS). We report the case of four patients with NA who were positive for anti-N-acetylgalactosaminyl GD1a (anti-GalNAc-GD1a) antibodies, had a preceding infection, and showed a good response to intravenous immunoglobulin infusion therapy. Anti-ganglioside antibodies, especially the anti-GalNAc-GD1a antibody, may be a useful marker for predicting response to immune therapy.
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Affiliation(s)
- Kota Moriguchi
- Division of Neurology, Department of Internal Medicine 3, National Defense Medical College, Tokorozawa, Japan
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Brown JM, Yee A, Ivens RA, Dribben W, Mackinnon SE. Post-Cervical Decompression Parsonage-Turner Syndrome Represents a Subset of C5 Palsy: Six Cases and a Review of the Literature: Case Report. Neurosurgery 2010; 67:E1831-43; discussion E1843-4. [PMID: 21107152 DOI: 10.1227/neu.0b013e3181f8254b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Approximately 5% of cervical decompression cases are complicated by postoperative weakness. Parsonage-Turner syndrome (PTS) or neuralgic amyotrophy is known to be precipitated by surgery and unrelated to technical or structural issues. Our practice has seen a number of cases of PTS after cervical decompression surgery. In this case report, we discuss a series of such patients, highlighting the commonalities with the more frequently diagnosed C5 palsy. We conclude with our management algorithm.
CLINICAL PRESENTATION:
Six patients with post-cervical decompression PTS were referred to our institution during a 32-month period. All patients were examined physically, radiographically, and electromyographically and were followed for up to 2 years or until symptoms resolved. Conservative management was the rule, and surgical intervention, including nerve releases and nerve reconstruction, was undertaken in select circumstances. In the majority of patients (4 of 6 patients), pain management and physical therapy alone were used and achieved eventual resolution of pain and recovery of motor strength. The other 2 patients required adjunctive surgical procedures to maximize their outcomes.
CONCLUSION:
PTS accounts for a subset of patients experiencing postoperative weakness after cervical decompression operations. Although it is at times difficult to arrive at this diagnosis, an understanding of the history of PTS, among other causes of postoperative weakness, allows a structured approach to these patients. An evidence-based approach to management helps provide the best outcome for a given patient.
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Affiliation(s)
- Justin M Brown
- Department of Neurological Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew Yee
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Renee A Ivens
- Program in Physical Therapy, Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - William Dribben
- Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
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Donofrio PD, Berger A, Brannagan TH, Bromberg MB, Howard JF, Latov N, Quick A, Tandan R. Consensus statement: The use of intravenous immunoglobulin in the treatment of neuromuscular conditions report of the aanem AD HOC committee. Muscle Nerve 2009; 40:890-900. [DOI: 10.1002/mus.21433] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Wendling D, Sevrin P, Bouchaud-Chabot A, Chabroux A, Toussirot E, Bardin T, Michel F. Parsonage–Turner syndrome revealing Lyme borreliosis. Joint Bone Spine 2009; 76:202-4. [DOI: 10.1016/j.jbspin.2008.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2008] [Indexed: 11/26/2022]
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