Background Intravenous immunoglobulins (IVIG) indications are replacement therapy and as immunomodulatory therapy for several autoimmune disorders. It has been estimated that neurologic indications can account for up to 43% of IVIG used in clinical practice.1
Purpose To evaluate the use of IVIG in paediatric patients from the neurology service of a children’s care reference hospital.
Material and methods Based on medical history records, we collected and analysed retrospective data from January 2013 to December 2017 of all children who received IVIG patients followed by our neurology department.
We classified the patients according to their diagnosis and we contrasted the results with the recent published review about the IVIG use in paediatric neurological and neurodevelopmental disorders.2
Patients diagnosed during an enterovirus encephalitis spread during 2016 in our region were excluded because the patients were assigned to other paediatric departments.
Results A total of 60 patients met the inclusion criteria.
Their diagnostics were: twenty-nine peripheral nervous system indications: Guillain–Barré syndrome (22), peripheral nervous system indications (six) and myasthenia gravis (1).
Fourteen central nervous system indications: acute encephalomyelitis disseminata (four), refractory epilepsy (four), ataxia-telangiectasia (two), acute-cerebellitis (two) and anti-NMDA encephalitis (two).
Seventeen non-neurologycal specific indications: post-rituximab hipogammaglobulinaemia (four), opsoclonus myoclonus (four), infectious encephalitis (four) and other diagnostics (five).
All patients were treated with a correct dose as per immunomodulatory (1–2 g/kg/dose) or immune-replacement (0.3–0.5 g/kg/dose) therapy. Most of them tolerated well the IGIV administration (three mild-adverse events reported).
Conclusion IVIG are used in a large number of indications not labelled in Spain, although substantiated, in a high percentage, in solid evidence according to the reviews. Other diagnostics not associated with neurological disorders were classified and we need to ensure that other specialists validated the utilisation. Given the significant economic impact of using this therapy, it is necessary to protocolise and adapt its use to the recommendations of the CPG, in order to carry out a rational use of health resources.
References and/or acknowledgements 1. Zivkovic S. Intravenous immunoglobulin in the treatment of neurologic disorders. Acta Neurol Scand 2016;133:84–96. © 2015 John Wiley & Sons A/S.
2. Gadian, J, et al. Systematic review of immunoglobulin use in paediatric neurological and neurodevelopmental disorders. Dev Med Child Neurol2017;59:136–44.
No conflict of interest.