Neurocritical Care

, Volume 12, Issue 1, pp 132–143 | Cite as

Immunomodulatory Therapies in Neurologic Critical Care

  • Logan M. McDaneld
  • Jeremy D. Fields
  • Dennis N. Bourdette
  • Anish BhardwajEmail author



Neurologic disorders with autoimmune dysregulation are commonly encountered in the critical care setting. Frequently encountered diseases include Guillain–Barré syndrome (GBS), myasthenia gravis, multiple sclerosis, acute demyelinating encephalomyelitis, and encephalitides. Immunomodulatory therapies, including high-dose corticosteroids, plasmapheresis, and intravenous immunoglobulins, are the cornerstone of the treatment of these diseases. Here we review the efficacy and side effects of immunomodulatory therapies commonly utilized in critically ill neurologic patients in the intensive care setting.


Search of Medline, Cochrane databases, and manual review of article bibliographies.


The efficacy of high-dose corticosteroids, plasmapheresis, and intravenous immunoglobulins have been studied extensively in GBS, myasthenia gravis, and demyelinating disorders such as multiple sclerosis and acute demyelinating encephalomyelitis. For these diseases, however, the duration of treatment, dosing regimens, and choices among different therapeutic modalities remain controversial. For many of the other diseases (e.g., encephalitis and status epilepticus of autoimmune etiology) discussed in this review, evidence is limited to small case series.


There is good evidence for the efficacy and tolerability of immunomodulatory therapies in GBS, myasthenia gravis, and acute central nervous system demyelination, though data to establish superiority of one therapeutic regimen over another remains lacking. For most other conditions, the data for immunomodulatory therapies are limited, and further research is required.


Immunomodulation Corticosteroids Plasmapheresis Immunoglobulin Cyclophosphamide 



Dr. Bhardwaj is supported in part by the U.S. Public Health Service National Institutes of Health Grant NS046379.


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Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Logan M. McDaneld
    • 1
  • Jeremy D. Fields
    • 1
    • 2
  • Dennis N. Bourdette
    • 1
  • Anish Bhardwaj
    • 1
    • 2
    • 3
    Email author
  1. 1.Departments of NeurologyOregon Health & Science UniversityPortlandUSA
  2. 2.Neurosciences Critical Care Program, Departments of Neurology, Neurological Surgery and Anesthesiology/Peri-Operative MedicineOregon Health & Science UniversityPortlandUSA
  3. 3.Department of Neurology, Tufts Medical CenterTufts University School of MedicineBostonUSA

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