Friday, October 12, 2012

IVIG (Immunoglobulin) THERAPY IN NEUROLOGY

IVIG THERAPY IN NEUROLOGY

Introduction

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- drsudhirkumar@yahoo.com

Dr Sudhir Kumar MD (Internal Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Health City, Jubilee Hills, Hyderabad
Phone- 0091-40-23607777/60601066
email: drsudhirkumar@yahoo.com

13 comments:

Anonymous said...

Great information for the layman - atleast it gives them an idea of whether to undergo IVIG or not. More such info would be great on everything neuro-related.

Anonymous said...

Thank you sir, your blog has so much of information. My F-Inlaw is hospitalsed and affected by myasthenia Gravis. His age is 68 years. First symptom is eyelid drop and within a span of 5 months we have got to know that he is affected by myasthenia gravis. Now its been a year, and he could not able to lift his hands and legs, have problems in chewing and swallowing.Doctor has now adviced to put IVIG and informed it is expensive.
My question is if we put IVIG, how long the drugs improve the life expectancy? Please shed some lights on the same.

SHINU said...

Thank you sir.

Unknown said...

Dear sir,

Your blog has providing very useful information thanks for sharing all the information my cousin brother suffering from same problem doctor has suggested us for IVIG treatment but hear is a problem that they cannot offerd that much of amount so can you please suggest us on this and what will be the approximate cost for complete treatment

SaraNya said...

My grandfather(age 70) has also treated with the same injection at Coimbatore pvt hospital. He was not able to move leg's and continuous cough due to nerve system. Its been 3 months ,now he can able to walk with someone's help and cough has been stopped completely.

jasbeer singh said...

Thanks for the information you provided here. My 5 years son got cidp desease and getting treatment in australia....thx

Unknown said...

thanks for dr sudheer sir this is very good information sharing insite thorugh medicine and More such info would be great on everything this medicine.

Anonymous said...

my 3yr & 8 mnths old daughter diagnosed atypical kawasaki disease, the only treatment is the IVIG.We payed 98,240 philippine peso in dollar it cost 2000 USdollar for the IVIG alone, we dont care the cost what important now is the Life of our precious duaghter,Thank You

Dr. Sudhir Kumar said...

I hope and pray your daughter recovers well!

Anonymous said...

My father after stroke 1month later was diagnosed by SJ syndrome the reason dr. told was medicinal allergy. After suffering through stroke with tracheostomy performed body his eyes became red full of water and cough problem started mouth full of ulcer and blood flows with cough. Do IVIG cure SJ syndrome? Is it safe?

Dr. Sudhir Kumar said...

IVIG Has indications across various specialities in treating immune-mediated inflammatory diseases. Regarding usefulness of IVIG in SJ syndrome, please contact an internist/dermatologist/rheumatologist.

shashikant said...

MY RELATIVE HAS PROBLEM IN LEG DR. DIAGNOSIS CIDP . STEROID USE LAST 2 MONTH. FIRST TWO WEEK 80 MG ,SECOND TWO WEEK 60 MG, THIRD TWO WEEK 40 MG. FOLLOWUP DR. NOT SATISFIED FOR IMPROVEMENT REDOSE SUGGESTED 60 MG FOR TWO WEEK AFTER TWO WEEK 40 MG. AND AFTER THIS COURSE NOT SATISFIED GIVEN IV/IG THIS TREATMENT IS RIGHT FOR 20 YEARS OUR RELATIVE. PL SUGGESTED SIR. THANKS SHASHI AGRAWAL CHHATTISGARH

Dr. Sudhir Kumar said...

Shashikant, we need to actually examine the patient, and go through all the reports to decide the best treatment.