Skip to main content
SpringerLink
Log in

A novel trial design to study the effect of intravenous immunoglobulin in chronic inflammatory demyelinating polyradiculoneuropathy

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Using a novel trial design, we prospectively examined the effect of intravenous immunoglobulin in seven patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in a doubleblind, placebo-controlled cross-over study. We suggest that the commonly used manual muscle testing and Rankin scale are not sufficiently sensitive to measure changes in CIDP and should not be used as isolated outcome measures. We propose a timed 10-m walk, the Nine-Hole Peg Test, the Hammersmith Motor Ability Score, and myometry as alternative measures which are valid, reliable and sensitive. Our trial design permitted the measurement of a treatment response in three responders despite different patterns of disability typical of the broad clinical picture seen in CIDP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ad Hoc Subcommittee of the American Academy of Neurology AIDS Task Force (1991) Research criteria for the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Neurology 41:617–618

    Google Scholar 

  2. Bohannon RW (1986) Test-retest reliability of hand-held dynamometry during a single session of strength assessment. Phys Ther 66:206–209

    PubMed  Google Scholar 

  3. Bohannon RW (1989) Correlation of lower limb strengths and other variables with standing performance in stroke patients. Physiother Can 41:198–202

    Google Scholar 

  4. Comblath DR, Chaudhry V, Griffin JW (1991) Treatment of chronic inflammatory demyelinating polyradiculoneuropathy with intravenous immunoglobulin. Ann Neurol 30:104–106

    PubMed  Google Scholar 

  5. Dyck PJ, O'Brien PC, Oviatt KF, Dinapoli RP, Daube JR, Bardeson JD, Mokri B, Swift T, Low PA, Windebank AJ (1982) Prednisolone improves chronic inflammatory demyelinating polyradiculoneuropathy more than no treatment. Ann Neurol 11:136–141

    PubMed  Google Scholar 

  6. Dyck PJ, Daube J, O'Brien P, Pineda A, Low PA, Windebank AJ, Swanson C (1986) Plasma exchange in chronic inflammatory demyelinating poly radiculoneuropathy. N Engl J Med 314:461–465

    PubMed  Google Scholar 

  7. Dyck PJ, Litchy WJ, Kratz KM, Suarez GA, Low PA, Pineda AA, Windebank AJ, Karnes JL, O'Brien PC (1994) A plasma exchange versus immune globulin infusion trial in chronic inflammatory demyelinating polyradiculoneuropathy. Ann Neurol 36:838–845

    PubMed  Google Scholar 

  8. Faed JM, Day B, Pollock M, Taylor PK, Nukada H, Hammond-Tooke GD (1989) High-dose intravenous human immunoglobulin in chronic inflammatory demyelinating polyneuropathy. Neurology 39:422–425

    PubMed  Google Scholar 

  9. Fisher NM, Pendergast DR, Calkins EC (1990) Maximal isometric torque of knee extension as a function of muscle length in subjects of advancing age. Arch Phys Med Rehabil 71:729–734

    PubMed  Google Scholar 

  10. Goodkin DE, Herstgaard D, Seminary J (1988) Upper extremity function in multiple sclerosis: improving assessment sensitivity with box and ninehole peg test. Arch Phys Med Rehabil 69:850–854

    PubMed  Google Scholar 

  11. Hahn AF, Bolton CF, Vandervoort P, Feasby TE, Zochodne D (1994) Intravenous immunoglobulin treatment in chronic demyelinating polyneuropathy (CIDP): a double blind placebo-controlled cross-over study. Proceedings of the Peripheral Nerve Study Group Meeting, St. Paul's, Minneapolis, USA. Peripheral Nerve Study Group, Rochester, Minn

    Google Scholar 

  12. Hartung HP, Stoll G, Toyka KV (1993) Immune reactions in the peripheral nervous system. In: Dyck PJ, Thomas PK (eds) Peripheral neuropathy. Saunders, Philadelphia, pp 418–444

    Google Scholar 

  13. Hauser SL, Dawson DM, Lehrich JR, Beal FM, Kevy SU, Proper RD, Mills JA, Weiner HL (1983) Intensive immunosuppression in progressive multiple sclerosis: a randomised three arm study of high dose intravenous cyclophosphomide, plasma exchange and ACTH. N Engl J Med 308:173–180

    PubMed  Google Scholar 

  14. Hodgkinson SJ, Pollard JD, McLeod JG (1990) Cyclosporin A in the treatment of chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol Neurosurg Psychiatry 53:327–330

    PubMed  Google Scholar 

  15. Hughes RAC (1990) Chronic idiopathic demyelinating polyradiculoneuropathy. In: Guillain-Barré syndrome. Springer, Berlin Heidelberg New York, pp 205–246

    Google Scholar 

  16. Iddings DM, Smith KL, Spencer WA (1961) Muscle testing, part 2. Reliability in clinical use. Phys Ther 41:249–256

    Google Scholar 

  17. Kaveri SV, Mouthon L, Kazatchkine MD (1994) Immunomodulating effects of intravenous imunoglobulin in autoimmune and inflammatory diseases. J Neurol Neurosurg Psychiatry 57:S6-S8

    Google Scholar 

  18. Kleyweg RP, Meché FGA van der, Schmitz PIM (1991) Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barré syndrome. Muscle Nerve 14:1103–1109

    PubMed  Google Scholar 

  19. Lennon SM, Ashburn A (1993) Use of myometry in the assessment of neuropathic weakness: testing for reliability in clinical practice. Clin Rehabil 7:125–133

    Google Scholar 

  20. Lewis RA, Sumner AJ, Brown MJ, Astbury MK (1982) Multifocal demyelinating neuropathy with persistent conduction block. Neurology 32:1127–1132

    PubMed  Google Scholar 

  21. Lilienfield AM, Jacobs M, Willis M (1954) A study of the reproducibility of muscle testing and certain other aspects of muscle scoring. Phys Ther Rev 34:279–289

    PubMed  Google Scholar 

  22. Medical Research Council (1943) Aids to investigation of peripheral nerve injuries. War memorandum, revised 2nd edn. HMSO, London

    Google Scholar 

  23. Oh SJ, Joy JL, Kurnoglu R (1992) “Chronic sensory demyelinating neuropathy”: chronic demyelinating polyradiculaoneuropathy presenting as a pure sensory neuropathy. J Neurol Neurosurg Psychiatry 55:677–680

    PubMed  Google Scholar 

  24. Parry GJ, Clarke S (1988) Multifocal acquired demyelinating neuropathy masquerading as motor neuron disease. Muscle Nerve 11:103–107

    PubMed  Google Scholar 

  25. Pentland B, Adams GGW, Mawdsley G (1982) Chronic idiopathic polyneuropathy treated with azathioprine. J Neurol Neurosurg Psychiatry 45:866–869

    PubMed  Google Scholar 

  26. Rankin J (1957) Cerebral vascular accidents in patients over the age of 60. 2. Prognosis. Scott Med J 2:200–215

    PubMed  Google Scholar 

  27. Scott OM, Hyde SA, Goddard C, Dubowitz V (1982) Quantitation of muscle function in children: a prospective study in Duchenne muscular dystrophy. Muscle Nerve 5:291–301

    PubMed  Google Scholar 

  28. Stuberg WA, Metcalf WK (1988) Reliability of quantitative muscle testing in healthy children and in children with Duchenne muscular dystrophy using a hand-held dynamometer. Phys Ther 68:977–982

    PubMed  Google Scholar 

  29. Van der Ploeg RJO, Oosterhuis HJGH, Reuvekamp J (1984) Measuring muscle strength. J Neurol 231:200–203

    Google Scholar 

  30. Van Doorn PA, Vermeulen M, Brand A, Mulder PGH, Busch HFM (1991) Intravenous immunoglobulin treatment in patients with chronic inflammatory demyelinating polyneuropathy: clinical and laboratory characteristics associated with improvement. Arch Neurol 48:217–220

    PubMed  Google Scholar 

  31. Van Doorn PA, Brand A, Strengers PFW, Meulstee J, Vermeulen M (1990) High dose intravenous immunoglobulin treatment in chronic inflammatory demyelinating polyneuropathy: a double-blind, placebo-controlled, crossover study. Neurology 40:209–212

    PubMed  Google Scholar 

  32. Vermeulen M, Doorn PA van, Brand A, Strengers PFW, Jennekens FGI, Busch HFM (1993) Intravenous immunoglobulin with chronic inflammatory demyelinating polyneuropathy: a double blind, placebo controlled study. J Neurol Neurosurg Psychiatry 56:36–39

    PubMed  Google Scholar 

  33. Wiles CM, Kami Y, Nicklin J (1990) Laboratory testing of muscle function in the management of neuromuscular disease. J Neurol Neurosurg Psychiatry 53:384–387

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, UMDS, Guy's Hospital, SE1 9RT, London, UK

    N. Thomson, P. Choudhary, R. A. C. Hughes & R. M. Quinlivan

  2. Division of Paediatrics, UMDS, Guy's Hospital, London, UK

    N. Thomson & R. M. Quinlivan

Authors
  1. N. Thomson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Choudhary
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. A. C. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. M. Quinlivan
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thomson, N., Choudhary, P., Hughes, R.A.C. et al. A novel trial design to study the effect of intravenous immunoglobulin in chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol 243, 280–285 (1996). https://doi.org/10.1007/BF00868527

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00868527

Key words

Search

Navigation