Skip to main content
NCBI home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1996 Apr;60(4):388–392. doi: 10.1136/jnnp.60.4.388

Intravenous immunoglobulin treatment in paraneoplastic neurological syndromes with antineuronal autoantibodies.

M Uchuya 1, F Graus 1, F Vega 1, R Reñé 1, J Y Delattre 1
PMCID: PMC1073889  PMID: 8774401

Abstract

OBJECTIVE: To evaluate the effect of intravenous high dose human immunoglobulin (IVIg) therapy on the clinical course and autoantibody titres of patients with neurological paraneoplastic syndromes. METHODS: Twenty two patients with paraneoplastic encephalomyelitis and sensory neuronopathy syndrome associated with anti-Hu antibodies (18) or paraneoplastic cerebellar degeneration (PCD) with anti-Yo antibodies (four), were treated with 1-26 (mean 5.8) cycles of IVIg. The Rankin scale was used to evaluate the response. RESULTS: The only serious toxicity was one case of haemolytic anaemia. Twenty one patients were evaluable for therapeutic response. One patient, with subacute sensory neuronopathy (SSN), improved for at least 15 months, 10 remained stable (eight with anti-Hu and two with anti-Yo antibodies), and 10 deteriorated (eight with anti-Hu and two with anti-Yo antibodies). In seven of the 10 patients who stabilised, the syndrome had already made a plateau when the treatment was started but three patients (one with anti-Hu and two with anti-Yo antibodies) who had still been progressing stabilised for six, eight, and more than 48 months, including one patient with SSN who achieved stabilisation when the neurological dysfunction was only moderate (Rankin scale = 3). Another patient with SSN and initial stable response worsened when IVIg was reduced and improved when it was increased. No significant predictive factors of outcome could be identified but improvement or stabilisation was more frequent in patients with isolated involvement of the peripheral nervous system (62%) than in patients with evidence of CNS damage (37%) at the onset of treatment. Stabilisation in patients with CNS involvement was only achieved when the neurological dysfunction was already severe (Rankin scale > 3). The titres of autoantibodies did not change significantly. CONCLUSION: Treatment with IVIg at the doses given in the present protocol was not effective in paraneoplastic CNS syndromes associated with antineuronal antibodies. The role of this regime in the treatment of SSN should be further evaluated.

Full text

PDF
388

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amato A. A., Cornman E. W., Kissel J. T. Treatment of stiff-man syndrome with intravenous immunoglobulin. Neurology. 1994 Sep;44(9):1652–1654. doi: 10.1212/wnl.44.9.1652. [DOI] [PubMed] [Google Scholar]
  2. Anderson N. E., Rosenblum M. K., Graus F., Wiley R. G., Posner J. B. Autoantibodies in paraneoplastic syndromes associated with small-cell lung cancer. Neurology. 1988 Sep;38(9):1391–1398. doi: 10.1212/wnl.38.9.1391. [DOI] [PubMed] [Google Scholar]
  3. Chabriat H., Chen Q. M., Poisson M., Delattre J. Y. Dégénérescence cérébelleuse paranéoplasique. Rev Neurol (Paris) 1994;150(2):105–114. [PubMed] [Google Scholar]
  4. Cook D., Dalakas M., Galdi A., Biondi D., Porter H. High-dose intravenous immunoglobulin in the treatment of demyelinating neuropathy associated with monoclonal gammopathy. Neurology. 1990 Feb;40(2):212–214. doi: 10.1212/wnl.40.2.212. [DOI] [PubMed] [Google Scholar]
  5. Cornblath D. R., Chaudhry V., Griffin J. W. Treatment of chronic inflammatory demyelinating polyneuropathy with intravenous immunoglobulin. Ann Neurol. 1991 Jul;30(1):104–106. doi: 10.1002/ana.410300119. [DOI] [PubMed] [Google Scholar]
  6. Counsell C. E., McLeod M., Grant R. Reversal of subacute paraneoplastic cerebellar syndrome with intravenous immunoglobulin. Neurology. 1994 Jun;44(6):1184–1185. doi: 10.1212/wnl.44.6.1184. [DOI] [PubMed] [Google Scholar]
  7. Dalmau J., Graus F., Rosenblum M. K., Posner J. B. Anti-Hu--associated paraneoplastic encephalomyelitis/sensory neuronopathy. A clinical study of 71 patients. Medicine (Baltimore) 1992 Mar;71(2):59–72. doi: 10.1097/00005792-199203000-00001. [DOI] [PubMed] [Google Scholar]
  8. Dalmau J., Posner J. B. Neurologic paraneoplastic antibodies (anti-Yo; anti-Hu; anti-Ri): the case for a nomenclature based on antibody and antigen specificity. Neurology. 1994 Dec;44(12):2241–2246. doi: 10.1212/wnl.44.12.2241. [DOI] [PubMed] [Google Scholar]
  9. Delattre J. Y., Davila L., Vega F., Poisson M. Auto-immunité et syndromes neurologiques paranéoplasiques. Rev Neurol (Paris) 1991;147(8-9):549–556. [PubMed] [Google Scholar]
  10. Dietrich G., Kaveri S. V., Kazatchkine M. D. Modulation of autoimmunity by intravenous immune globulin through interaction with the function of the immune/idiotypic network. Clin Immunol Immunopathol. 1992 Jan;62(1 Pt 2):S73–S81. doi: 10.1016/0090-1229(92)90044-o. [DOI] [PubMed] [Google Scholar]
  11. Faed J. M., Day B., Pollock M., Taylor P. K., Nukada H., Hammond-Tooke G. D. High-dose intravenous human immunoglobulin in chronic inflammatory demyelinating polyneuropathy. Neurology. 1989 Mar;39(3):422–425. doi: 10.1212/wnl.39.3.422. [DOI] [PubMed] [Google Scholar]
  12. Gajdos P. Intravenous immune globulin in myasthenia gravis. Clin Exp Immunol. 1994 Jul;97 (Suppl 1):49–51. [PMC free article] [PubMed] [Google Scholar]
  13. Graus F., Bonaventura I., Uchuya M., Valls-Solé J., Reñ R., Leger J. M., Tolosa E., Delattre J. Y. Indolent anti-Hu-associated paraneoplastic sensory neuropathy. Neurology. 1994 Dec;44(12):2258–2261. doi: 10.1212/wnl.44.12.2258. [DOI] [PubMed] [Google Scholar]
  14. Moll J. W., Henzen-Logmans S. C., Van der Meché F. G., Vecht C. H. Early diagnosis and intravenous immune globulin therapy in paraneoplastic cerebellar degeneration. J Neurol Neurosurg Psychiatry. 1993 Jan;56(1):112–112. doi: 10.1136/jnnp.56.1.112. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Peterson K., Rosenblum M. K., Kotanides H., Posner J. B. Paraneoplastic cerebellar degeneration. I. A clinical analysis of 55 anti-Yo antibody-positive patients. Neurology. 1992 Oct;42(10):1931–1937. doi: 10.1212/wnl.42.10.1931. [DOI] [PubMed] [Google Scholar]
  16. Roifman C. M., Schaffer F. M., Wachsmuth S. E., Murphy G., Gelfand E. W. Reversal of chronic polymyositis following intravenous immune serum globulin therapy. JAMA. 1987 Jul 24;258(4):513–515. doi: 10.1001/jama.1987.03400040111034. [DOI] [PubMed] [Google Scholar]
  17. Soueidan S. A., Dalakas M. C. Treatment of autoimmune neuromuscular diseases with high-dose intravenous immune globulin. Pediatr Res. 1993 Jan;33(1 Suppl):S95–100. doi: 10.1203/00006450-199333011-00017. [DOI] [PubMed] [Google Scholar]
  18. Takano H., Tanaka M., Koike R., Nagai H., Arakawa M., Tsuji S. Effect of intravenous immunoglobulin in Lambert-Eaton myasthenic syndrome with small-cell lung cancer: correlation with the titer of anti-voltage-gated calcium channel antibody. Muscle Nerve. 1994 Sep;17(9):1073–1075. doi: 10.1002/mus.880170919. [DOI] [PubMed] [Google Scholar]
  19. Vega F., Graus F., Chen Q. M., Poisson M., Schuller E., Delattre J. Y. Intrathecal synthesis of the anti-Hu antibody in patients with paraneoplastic encephalomyelitis or sensory neuronopathy: clinical-immunologic correlation. Neurology. 1994 Nov;44(11):2145–2147. doi: 10.1212/wnl.44.11.2145. [DOI] [PubMed] [Google Scholar]
  20. Vermeulen M., van Doorn P. A., Brand A., Strengers P. F., Jennekens F. G., Busch H. F. Intravenous immunoglobulin treatment in patients with chronic inflammatory demyelinating polyneuropathy: a double blind, placebo controlled study. J Neurol Neurosurg Psychiatry. 1993 Jan;56(1):36–39. doi: 10.1136/jnnp.56.1.36. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Vermeulen M., van der Meché F. G., Speelman J. D., Weber A., Busch H. F. Plasma and gamma-globulin infusion in chronic inflammatory polyneuropathy. J Neurol Sci. 1985 Oct;70(3):317–326. doi: 10.1016/0022-510x(85)90173-x. [DOI] [PubMed] [Google Scholar]
  22. van Doorn P. A., Brand A., Strengers P. F., Meulstee J., Vermeulen M. High-dose intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyneuropathy: a double-blind, placebo-controlled, crossover study. Neurology. 1990 Feb;40(2):209–212. doi: 10.1212/wnl.40.2.209. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES