Neurology is one area, where we see patients who are critically ill, and require emergent and aggressive medical care for better outcomes. This branch of Neurology is also called NEURO CRITICAL CARE. I have a lot of passion for neuro critical care. Here, time is crucial. One has to make the diagnostic and treatment plans as fast as possible, so as to start the best treatment at the earliest, and I love that.
IVIG (INTRAVENOUS IMMUNOGLOBULINS)
IVIG belongs to the group of medicines, called as immunotherapy. This is used in illnesses, which are due to involvement of immune system. In many conditions, antibodies are produced in the body, which can harm, leading to diseases. In these diseases, IVIG treatment can be life-saving.
IVIG Treatment in Neurology
IVIG is required in the following neurological diseases:
1. Guillain Barre syndrome (GBS)- In this illness, patients have paralysis of both hands and legs and may get difficulty in breathnig also.
2. Myasthenia Gravis- In this condition, patients have drooping of eyelids, difficulty in speaking and swallowing, weakness of hands and legs and breathing problem.
3. Multiple sclerosis (MS)- In severe cases of MS, IVIG is useful.
4. CIDP- Chronic inflammatory demyelinating Polyradiculoneuropathy- In this condition, there is weakness of both legs and hands. When steroids do not work, IVIG may be required.
5. Epilepsy- In certain cases of epilepsy, such as West syndrome (seen in children), refractory status epilepticus (where fits do not respond to usual treatment), etc, IVIG therapy can be life-saving.
My Experience with IVIG Therapy
I have been using IVIG since 1995 (about 17 years now). I have given IVIG in all the above-mentioned indications and my experience with this medicine has been very good.
I remember several patients who came in states of severe disability and they recovered well.
One case, I would like to share with you. There was a young 25-year-old software professional Ms Reena (name changed) from Chennai, who had developed severe GBS. She rapidly worsened, became totally paralysed in whole body, and could not breathe. She was put on ventilatory support for the same. As she was not responding to the treatment, their family consulted me. I advised them to shift her to Apollo Hyderabad under my care. She was treated with a course of IVIG, ably supported by our excellent ICU doctors and nurses. She showed gradual improvement and was discharged from hospital after one month. She had little movements of hands and legs at discharge, could not speak, and required feeding through a nasal tube. I advised them to continue physiotherapy. She came back after two months to my OPD for a review. I was pleasantly surprised to see her totally normal. When I asked her if she had any problem, she replied- "yes- my nails have become dark, what to do to make them better?" I could not stop smiling to see the extent of recovery.
There are several similar cases that come to mind, when I look back at more than 500 patients during the past 17 years, who were treated with IVIG under my care and showed excellent recovery.
Dose of IVIG
The standard dose of IVIG is 0.4 grams per kg body weight per day for five days (a total of 2 grams per kg body weight). For ex- a person with body weight of 75 kg would require 150 gms total dose of IVIG (30 grams per day for five days).
It is given as drip (infusion) in the hand veins, slowly over 4-6 hours (just how we give glucose or saline drip).
Cost of IVIG
IVIG is costly, as it is prepared from the plasma (a part of blood) of healthy volunteers. As the source of healthy plasma is scarce, IVIG also is scarce product. A typical vial of 5 gm would cost Rs 15000-20,000/ (USD 300-400). So, a person requiring 150 grams may need to spend Rs 4,50,000-Rs 6,00,000 (USD 9000-12000).
Side effects of IVIG
IVIG is fairly safe product. In some cases, minor allergic reactions may occur. This can include fever, chills, etc. This can be well managed with simple medicines and decreasing the rate of IVIG infusion.
If you require any further information about IVIG treatment, please send an email to me- firstname.lastname@example.org
Dr Sudhir Kumar MD (Internal Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Health City, Jubilee Hills, Hyderabad