Evidence-based guideline: Intravenous
immunoglobulin in the treatment of
Report of the Therapeutics and Technology Assessment Subcommittee of the
American Academy of Neurology
H.S. Patwa, MD
V. Chaudhry, MD
H. Katzberg, MD
A.D. Rae-Grant, MD
Y.T. So, MD, PhD
Objective: To assess the evidence for the efficacy of IV immunoglobulin (IVIg) to treat neuromus-
Methods: The MEDLINE, Web of Science, and EMBASE databases were searched (1966–2009).
Selected articles were rated according to the American Academy of Neurology’s therapeutic clas-
sification of evidence scheme; recommendations were based on the evidence level.
Results and Recommendations: IVIg is as efficacious as plasmapheresis and should be offered for
treating Guillain-Barre ´ syndrome (GBS) in adults (Level A). IVIg is effective and should be offered
probably effective and should be considered for treating moderate to severe myasthenia gravis
and multifocal motor neuropathy (Level B). IVIg is possibly effective and may be considered for
treating nonresponsive dermatomyositis in adults and Lambert-Eaton myasthenic syndrome
(Level C). Evidence is insufficient to support or refute use of IVIg in the treatment of immunoglob-
ulin M paraprotein–associated neuropathy, inclusion body myositis, polymyositis, diabetic radicu-
loplexoneuropathy, or Miller Fisher syndrome, or in the routine treatment of postpolio syndrome
or in children with GBS (Level U). IVIg combined with plasmapheresis should not be considered for
treating GBS (Level B). More data are needed regarding IVIg efficacy as compared with other
treatments/treatment combinations. Most studies concluded IVIg-related serious adverse ef-
fects were rare. Given the variable nature of these diseases, individualized treatments depending
on patient need and physician judgment are important. Neurology®2012;78:1009–1015
AAN ? American Academy of Neurology; AE ? adverse effect; CI ? confidence interval; CIDP ? chronic inflammatory
demyelinating polyneuropathy; FDA ? Food and Drug Administration; GBS ? Guillain-Barre ´ syndrome; IBM ? inclusion body
myositis; IgM ? immunoglobulin M; INCAT ? Inflammatory Neuropathy Cause and Treatment Score; IVIg ? IV immunoglobulin;
LEMS ? Lambert-Eaton myasthenic syndrome; MG ? myasthenia gravis; MMN ? multifocal motor neuropathy; MP ? methyl-
prednisolone; MRC ? Medical Research Council; NDS ? neurologic disability scale; QMG ? Quantitative Myasthenia Gravis
score; RCT ? randomized controlled trial.
IV immunoglobulin (IVIg) is used to treat a range of
immune-mediated neurologic diseases. The US Food
and Drug Administration (FDA) approved IVIg for
use in Guillain-Barre ´ syndrome (GBS) and chronic
inflammatory demyelinating polyneuropathy (CIDP),
but IVIg use for non–FDA-approved indications is
common. Although IVIg appears to be well tolerated
in many patients, hypercoagulability and renal fail-
ure are of concern.
This American Academy of Neurology (AAN)
evidence-based guideline summarizes the evidence
and makes recommendations regarding IVIg use in
treating patients with neuromuscular disorders.
DESCRIPTION OF THE ANALYTIC PROCESS
The Therapeutics and Technology Assessment sub-
committee (appendix e-1 on the Neurology®Web
site at www.neurology.org) selected panelists on the
basis of expertise in IVIg use or familiarity with the
guideline process, or both. A literature search of
MEDLINE, Web of Science, and EMBASE data-
bases from 1966 to 2009 was conducted, using the
Correspondence & reprint
requests to American Academy
From the Yale University/VA Connecticut Healthcare System (H.S.P.), New Haven, CT; Johns Hopkins Medical Institute (V.C.), Baltimore, MD;
University of Toronto (H.K.), Toronto, Canada; Cleveland Clinic (A.D.R.-G.), Cleveland, OH; and Stanford University (Y.T.S.), Palo Alto, CA.
Approved by the Therapeutics and Technology Assessment Subcommittee on January 3, 2011; by the Practice Committee on February 7, 2011; and
by the AAN Board of Directors on December 12, 2011.
Disclosure: Author disclosures are provided at the end of the article.
Copyright © 2012 by AAN Enterprises, Inc.
search term “immunoglobulin” and one of the fol-
lowing: myasthenia gravis, GBS, neuropathy, CIDP,
multifocal motor neuropathy, polymyositis, dermato-
myositis, diabetic neuropathy, diabetic radiculoplexo-
neuropathy, postpolio syndrome, paraproteinemic
neuropathy, Lambert-Eaton myasthenic syndrome,
Miller Fisher syndrome, inclusion body myositis.
cles were included if they were therapeutic studies rele-
vant to the efficacy, safety, tolerability, or IVIg mode of
use in humans. Reviews and meta-analyses were re-
viewed to ensure inclusion of all relevant published
peutic classification of evidence scheme (appendix e-2);
recommendations were linked to the strength of the ev-
idence (appendix e-3). Disagreements on article classifi-
presented in tables e-1 to e-14.
ANALYSIS OF EVIDENCE Guillain-Barre ´ syn-
drome. Is IVIg effective in GBS in children? Data com-
paring IVIg with placebo in GBS treatment are
limited. This may be due to the well-accepted use of
plasmapheresis as treatment.1One Class II study exam-
ined 21 children with mild GBS able to walk 5 meters
unassisted.2Fourteen children received treatment of 1
g/kg over 2 days; the remaining patients received no
treatment (no blinding or sham treatment was used).
There was no difference between groups in the primary
outcome measure of disability at the disease nadir.
to improvement p ? 0.001, disability duration p ?
0.05, disability at 4 weeks p ? 0.25).
In another study (Class III),318 children were
assigned to either IVIg 1 g/kg/day for 2 days or no
treatment. Although the primary outcome was not
well-defined, the interval from onset to maximum
weakness (IVIg mean 9.3 days vs placebo mean 12.5
days, p ? 0.05), the interval from maximum weak-
ness to improvement (IVIg 7.5 days vs placebo 11.8
days, p ? 0.05), and hospitalization length (IVIg
mean 16.5 days vs placebo 23.8 days, p ? 0.05) all
Due to differing outcome measures and small
sample size in Class III studies, the benefit of IVIg in
children with GBS is uncertain.
Clinical context. There is a lack of randomized, con-
trolled studies of IVIg in children with GBS to show
efficacy; however, most experts consider it a reason-
able treatment option in children on the basis of its
effectiveness in adults with GBS.
Is IVIg as effective as plasmapheresis in GBS in adults?
Two Class I studies compared IVIg with plas-
mapheresis in GBS in adults.4,5The first Class I
study4enrolled 150 patients with GBS and random-
ized patients to 5-day treatment with either 5 vol-
umes of plasma exchange or 0.4 g/kg/day of IVIg.
Patients were randomized within 14 days of symp-
tom onset. Primary outcome measure was a 1-grade
improvement on a 7-point disability scale at 4 weeks
(functional scale based on ability to walk and breathe
independently, with 0 ? normal and 6 ? death).
Fifty-three percent of patients given IVIg achieved a
1-grade improvement at week 4 vs 34% given plas-
mapheresis (p ? 0.024). Additionally, plasmaphere-
sis patients took 41 days to reach 1 grade of
improvement, and IVIg patients took 27 days (p ?
0.05). Although the examiner was unblinded, the
outcome criteria were judged to be objective.
A Class I study5enrolled 379 patients in a ran-
domized, single-blind trial comparing IVIg, plas-
mapheresis, and plasmapheresis followed by IVIg
within 14 days of GBS onset. The study found no
significant difference among the 3 groups. The study
was powered to demonstrate a 0.5-point difference in
a disability grade with a 95% confidence level.
Three Class III studies did not change the above
All trials comparing IVIg with plasmapheresis
used a standard of 5 exchanges, with 250 mL/kg total
volume exchanged in the control arm. Older studies
varied widely in the number of exchanges (2 to 8)
used. In our view, these comparison trials involved a
satisfactory plasmapheresis regimen to test IVIg ef-
fectiveness and satisfy the AAN criteria for Class I
noninferiority or equivalence trials (appendix e-2).
Is steroid an effective adjunctive treatment in patients
with GBS treated with IVIg? One Class I study com-
pared IVIg with IVIg plus methylprednisolone
(MP).9A total of 233 patients were randomized to
receive IVIg 0.4 g/kg/day for 5 days plus either MP
(500 mg/day for adults or 8 mg/kg/day for children)
or placebo. Primary outcome measure was disability
improvement by 1 grade or more at 4 weeks. No
significant difference was found (56% of patients in
IVIg and 68% in IVIg/MP groups, odds ratio 1.68,
95% confidence interval [CI] 0.97 to 2.88, p ?
0.06). This study was not adequately powered to ex-
clude a meaningful benefit (risk difference 12.1%,
CI ?0.6% to 24.3%).
What is the optimal IVIg dosing for GBS? One Class I
study examined the role of 2 IVIg regimens for treat-
ing GBS.10In this study, 39 patients were random-
ized to receive IVIg 0.4 g/kg/day for 3 days or 6 days.
Primary outcome was time to walk 5 meters. There
was no significant difference in primary outcome (84
days vs 131 days in favor of 6-day treatment); how-
ever, the study lacked the statistical precision to ex-
clude a clinically important difference. Subgroup
analysis of patients who were ventilator dependent
Neurology 78 March 27, 2012
showed a better outcome with the longer IVIg regi-
men (86 days vs 152 days in favor of 6-day, p ?
1. Based on conflicting primary outcome measures,
IVIg benefit is uncertain in children with GBS.
2. Based on 2 Class I studies, IVIg is as efficacious as
plasmapheresis for treating GBS in adults. Be-
cause plasmapheresis is established as effective
GBS treatment,1we conclude that IVIg also has
3. Based on one adequately powered Class I study,
the combination of plasmapheresis and IVIg is
probably not better than either treatment alone.
4. Based on one underpowered Class I study, evi-
dence is insufficient to support or exclude a bene-
fit of adding MP to IVIg in GBS.
5. Data are insufficient to make a recommendation
on optimal IVIg dosing.
Recommendations. There is insufficient evidence to
support or refute the effectiveness of IVIg in children
with GBS (Level U). IVIg should be offered to treat
GBS in adults (Level A). IVIg combined with plas-
mapheresis should not be considered for treating
GBS (Level B). Evidence is insufficient to recom-
mend MP in combination with IVIg (Level U).
Clinical context. Many experts consider it reason-
able treatment to use IVIg for GBS in children given
its effectiveness in the same disease in adults.
Chronic inflammatory demyelinating polyneuropathy.
Two Class I and 2 Class II studies compared IVIg
with placebo in treating CIDP.11–14In a Class I cross-
over study,11117 patients received a loading dose of
2 g/kg and then 1 g/kg of IVIg or placebo (albumin)
every 3 weeks. Patients were switched to the alternate
treatment for worsening or no improvement. Pa-
tients completing 24 weeks of the first period were
rerandomized to a single dose of IVIg or placebo.
Primary endpoint was the percentage of patients who
improved 1 or more points on the Inflammatory
Neuropathy Cause and Treatment Score (INCAT).
More patients improved in the IVIg group (54%
IVIg vs 21% placebo, p ? 0.0002). Four patients
dropped out of the study. Adverse effects (AEs) oc-
curred at a higher rate in the IVIg group (55% vs
17%), but the number of serious AEs was low and
similar in the 2 groups.
Another Class I study12randomized 53 untreated
patients with CIDP to IVIg or placebo. IVIg 1 g/kg
was administered on days 1, 2, and 21. Primary out-
come was change from baseline of the average muscle
score (based on a modified Medical Research Coun-
cil [MRC] scale expanded to 10 points) at day 42.
This increased by 0.63 in the IVIg group and de-
creased by ?0.1 in the placebo group (p ? 0.006).
Two Class II studies13,14comparing IVIg with pla-
cebo demonstrated IVIg benefits comparable with
those shown in the Class I studies.
One Class II double-blind study compared oral
prednisolone with IVIg for CIDP.15Thirty-two pa-
tients were randomized to receive either IVIg fol-
lowed by prednisolone or prednisolone followed by
IVIg. Patients were treated with prednisolone 60 mg
tapered to 10 mg over 6 weeks or IVIg 2 g/kg given
over 1 or 2 days. Analysis of 24/32 patients complet-
ing both treatment phases showed that both groups
improved when compared with baseline, although
there was no significant difference between the 2
treatment groups. The study, however, was not de-
signed and powered to demonstrate equivalence of
the 2 treatments.
1. Based on 2 Class I studies, IVIg is effective for the
long-term treatment of CIDP.
2. Data are insufficient to address the comparative
efficacy of prednisolone and IVIg in treating
Recommendation. IVIg should be offered for the
long-term treatment of CIDP (Level A).
Clinical context. Dosing, frequency, and duration of
IVIg for CIDP may vary depending on the clinical as-
sessment. Data are insufficient to address the compara-
tive efficacy of other CIDP treatments (e.g., steroids,
plasmapheresis, immunosuppressants). Experts have
identified that there may be overuse of IVIg in long-
term care of CIDP. We were unable to evaluate this
question using available randomized trial data.
Myasthenia gravis. One Class I study16examined 24
patients with myasthenia gravis (MG) with worsen-
ing weakness treated with IVIg 2 g/kg vs 27 patients
on placebo. The Quantitative Myasthenia Gravis
score (QMG) was better at 14 days in the IVIg group
(?2.54 vs ?0.89 in placebo, p ? 0.047). In a sub-
group analysis stratified for severity, IVIg was effec-
tive in patients with moderate or severe MG (QMG
difference of ?3.39 over placebo, 95% CI ?5.88 to
?0.90, p ? 0.01) but produced no discernable dif-
ference in patients with mild MG.
One Class III study17showed no difference in pri-
mary measures between IVIg and placebo, but assess-
ment time (42 days) was unlikely to show benefit.
Two comparative Class III studies randomized
patients with MG to treatment with either IVIg or
plasmapheresis.18,19One study18compared the 2
treatments in 12 patients, using a single-blind, cross-
over design, and found no difference between the 2
groups, but the study is likely underpowered. A
Neurology 78 March 27, 2012
larger study randomized 46 patients to IVIg and 41
to plasmapheresis19and was powered to detect a 50%
difference in myasthenic muscular score (scale
0–100 [normal]). The primary outcome assessment
was unblinded. There was no difference in treatment
efficacy at 15 days.
1. Based on one Class I study, IVIg is probably effec-
tive in treating patients with MG.
2. Evidence is insufficient to compare the efficacy of
IVIg and plasmapheresis in treating MG.
Recommendation. IVIg should be considered in the
treatment of MG (Level B).
Clinical context. This recommendation was based
on studies involving primarily moderately or severely
affected patients. The benefits and risks of this med-
ication should be weighed carefully in patients with
mild MG. Further studies of IVIg efficacy in MG are
warranted due to the few randomized trials and small
study size to date.
Multifocal motor neuropathy. In one Class II ran-
domized controlled trial (RCT),2019 patients with
multifocal motor neuropathy (MMN) were random-
ized to receive either IVIg 0.5 g/kg/day for 5 days or
placebo monthly for 3 consecutive months. Patients
who did not respond in one treatment arm were
switched to the alternate treatment for an additional
3 months, with final evaluation after the treatment
period. Primary endpoint was improvement in MRC
sumscore at month 4. Seven of 9 patients who re-
ceived IVIg responded to treatment as compared
with 2 of 9 who received placebo (p ? 0.03). Most
AEs were mild and occurred in the IVIg group. Sub-
group analysis indicated a higher response rate in pa-
tients who had been treated with IVIg in the past vs
those who had never received IVIg before the study
(8 of 9 patients with prior IVIg treatment responded
vs 5 of 9 without; there was one dropout from the
previously untreated group).
A Class II crossover study21enrolled 16 patients
to receive either IVIg 0.4 g/kg for 5 days or placebo.
Patients were assessed at 28 days using a modified
neurologic disability scale (NDS; summed score of
26 muscles, each rated 0–4) as the primary outcome
measure, with grip strength, change in conduction
All patients completed the study; 13/16 had mild AEs.
NDS scores improved 6.7 ? 3.3 in the patients treated
with IVIg and worsened 2.1 ? 3.0 in the placebo pa-
tients (p ? 0.038). All secondary outcome measures
improved in the IVIg group. Eleven of 16 patients re-
ported improvement on IVIg; none reported improve-
ment on placebo. A small Class II study22treated 5
a crossover design. Primary outcome measure was
quantitative muscle strength in 2 muscles. Strength im-
proved 28 days after treatment (p ? 0.05).
Conclusion. Based on consistent results from 3
Class II studies, IVIg is probably effective for MMN
Recommendation. IVIg should be considered for the
treatment of MMN (Level B).
Clinical context. MMN is a chronic disease requiring
ongoing treatment. No data are available to address op-
timal treatment dosing, interval, and duration.
Neuropathy associated with IgM paraprotein. In a
Class I study, 22 patients with paraproteinemic neu-
ropathy associated with immunoglobulin M (IgM)
were randomized to receive either IVIg 2 g/kg or pla-
cebo in a double-blind crossover trial.23There was no
significant difference in the primary endpoint, the
INCAT disability scale, at 2 weeks. A Class II study
evaluated 11 patients with IgM paraprotein.24All
were treated with IVIg 2 g/kg or placebo monthly for
3 consecutive months. No significant difference was
detected in the MRC sumscore and other outcome
measures over the treatment period.
Conclusion. Based on 1 Class I study and 1 Class II
study, IVIg is possibly ineffective for the treatment of
IgM paraprotein–associated neuropathy. A modest
benefit cannot be excluded due to each study’s small
Recommendation. Evidence is insufficient to assess
the role of IVIg in treating neuropathy associated
with IgM paraprotein (Level U).
Dermatomyositis. One Class II crossover study25evalu-
ated 15 adults with biopsy-confirmed dermatomyositis
who did not respond to prior treatments. Five outcome
measures were used, none designated as primary.
Summed MRC scores of 18 muscles (maximum nor-
mal score 90) improved by 8.0 after 3 months of treat-
ment (p ? 0.018); the neuromuscular symptom score
(maximum normal score 60) improved by 7.3 (p ?
0.035). Repeat muscle biopsies showed improved cyto-
architecture and reduced muscle inflammation. Activi-
ties of daily living scores based on Barthel Index
improved to 100 from a low of 65; rash as assessed by
photography improved “markedly.”
Conclusion. Based on 1 Class II study, IVIg is pos-
sibly effective for the treatment of nonresponsive der-
matomyositis in adults.
Recommendation. IVIg may be considered for the
treatment of nonresponsive dermatomyositis in
adults (Level C).
Inclusion body myositis. In one Class I study2619
patients with inclusion body myositis (IBM) were
randomized and completed treatment with either
IVIg or placebo. The primary outcome measure was
Neurology 78 March 27, 2012
a summed modified MRC score of 20 muscles (0–10
for each muscle; maximum normal score ? 200).
The score improved by a mean of 4.2 after 3 months
of IVIg, whereas that of the placebo group declined
by 2.7. The difference was nonsignificant. A second-
ary outcome measure, quantitative strength testing,
did not show a significant effect. Another secondary
outcome measure, duration of swallowing, showed
significant difference favoring IVIg in some cases
(p ? 0.05), but no correction was made for multiple
A Class I crossover study27assessed the addition of
high-dose prednisone to IVIg. All 37 patients were
pretreated with a tapering regimen of oral prednisone
and then randomized to receive either IVIg with con-
tinuing prednisone or placebo with prednisone. The
primary outcome measures were the summed modi-
fied MRC score of 13 muscles and quantitative
strength testing 2 and 3 months after beginning infu-
sion treatments. There was no difference between
treatment and placebo groups in either measure. Re-
garding secondary measures, the number of necrotic
muscle fibers declined (p ? 0.01), and the number
of endomysial inflammation foci decreased (p ?
0.005) in the IVIg/prednisone group when com-
pared with controls.
In a Class II study28of 22 patients, each patient
received either IVIg or placebo for 6 months, fol-
lowed by crossover to the other arm. Multiple out-
come measures were used without a designated
primary outcome. There was no difference in the
summed modified MRC score, but improvement
was seen in the neuromuscular symptom score (IVIg
6.2 vs placebo 1.2 during the first 6 months, IVIg 2.6
vs placebo ?0.6 during the second 6 months, p ?
0.05). Other outcome measures were not signifi-
cantly different between treatment groups.
Conclusion. Two Class I studies and 1 Class II
study failed to demonstrate a consistent or significant
clinical benefit of IVIg in treating IBM.
Recommendation. Evidence is insufficient to sup-
port or refute the use of IVIg in treating IBM
Clinical context. There is presently no effective
treatment for IBM.
Postpolio syndrome. Two Class I studies evaluated
IVIg efficacy in patients with postpolio syn-
drome.29,30The first study, a double-blind RCT,
evaluated 142 patients with postpolio syndrome,
most with severe weakness (Class IV or V based on
the National Rehabilitation Postpolio Limb Classifi-
cation).29The 2 primary outcome measures were im-
proved strength of a muscle believed to be
significantly affected by postpolio (25%–75% of
normal for age and sex) and improved quality of life
as measured by the Short Form–36. The study found
a significant improvement of 8.6% in the strength
of the most affected muscle, but this did not reach
a predetermined target of 15% for clinical signifi-
cance. There was no significant effect on quality of
Another Class I, double-blind, randomized pilot
study of 20 patients with postpolio syndrome was
performed.30There were 3 concurrent primary out-
come measures: muscle strength as measured by fixed
dynamometer on selected muscles, Fatigue Severity
Scale, and pain as measured by visual analog scale
and pain drawing instrument change at 3 months.
The study showed that patients receiving IVIg had
significantly improved pain levels at 3 months as
compared with baseline; however, there were no ef-
fects on muscle strength or fatigue.
Conclusion. One Class I study showed a significant
difference, but the difference was not clinically im-
portant for IVIg use on the most affected muscle in
postpolio syndrome. One underpowered Class I
study showed an effect of IVIg for pain in postpolio
syndrome but no effect on strength or fatigue.
Recommendation. Evidence is insufficient to sup-
port or refute IVIg use in the routine treatment of
postpolio syndrome (Level U).
Clinical context. There is presently no effective
treatment for postpolio syndrome.
Other neuromuscular disorders. One Class II placebo-
controlled crossover study evaluated IVIg efficacy in
10 patients with Lambert-Eaton myasthenic syn-
drome (LEMS).31As compared with placebo, IVIg
showed a modest benefit on vital capacity, limb
strength, drinking time, and antibody titer. There are
no controlled studies evaluating the effects of IVIg
on polymyositis, diabetic polyradiculoplexoneuropa-
thy, or Miller Fisher syndrome.
Conclusion. Based on 1 Class II study, IVIg is pos-
sibly effective in LEMS.
Recommendation. IVIg may be considered in the
treatment of LEMS (Level C).
Adverse effects of IVIg. Eighteen of the 22 prospec-
tive studies reviewed recorded the number of serious
and minor AEs from 632 patients receiving IVIg (to-
tal dose 2.0–2.5 g/kg). There were no IVIg-related
deaths in these studies. Most studies concluded that
IVIg was well-tolerated and AEs were either transient
or manageable. Serious AEs related to IVIg were rare
and included aseptic meningitis (n ? 3), urticaria
(n ? 2), heart failure (n ? 1), myocardial infarction
(n ? 1), and renal failure (n ? 1). These findings do
not exclude the possibility of rare AEs such as stroke
and thrombotic events, which have been previously
reported with IVIg. It is important to screen for vas-
Neurology 78 March 27, 2012
cular risk factors before infusion and to monitor care-
fully during and after infusion.32–34The most
common IVIg-related AEs included headache
(16.1%), fever (6.6%), mild hypertension (4.6%),
chills (3.3%), nausea (3.2%), asthenia (1.4%), ar-
thralgia (1.3%), anorexia (1.1%), dizziness (1.1%),
malaise (1.1%), and transient hyperglycemia (1.1%).
Clinical context. It is important to assess individual
patient risk for AEs when considering IVIg therapy.
1. For most of the diseases examined here, alterna-
tive treatment modalities are available. Compara-
tive studies may be helpful.
2. IVIg benefit is generally short lived; further, long-
term studies might be useful.
3. Studies are needed to explore possible synergistic
effects of adjunctive treatments such as immuno-
suppressants or plasmapheresis.
4. Few data are available on the optimal IVIg infu-
sion frequency and cumulative dose.
5. A larger study of IVIg in patients with mild MG
may be useful.
6. The issue of overtreatment of CIDP with IVIg,
which may be a clinically significant issue, could
be assessed with further observational studies.
Dr. Patwa: drafting/revising the manuscript, analysis or interpretation of
data, contribution of vital reagents/tools/patients, acquisition of data. Dr.
Chaudhry: drafting/revising the manuscript, study concept or design. Dr.
Katzberg: drafting/revising the manuscript, analysis or interpretation of
data, acquisition of data. Dr. Rae-Grant: drafting/revising the manuscript,
analysis or interpretation of data. Dr. So: drafting/revising the manu-
script, study concept or design, analysis or interpretation of data, acquisi-
tion of data, study supervision.
Dr. Patwa was an investigator in the ICE trial comparing IVIg with placebo
for CIDP. Dr. Chaudhry serves on the editorial board of Neurologist; is an
inventor on patent(s) re: Total Neuropathy Score (TNS)—a score for evalu-
Abbott, Johnson & Johnson, and sanofi-aventis; receives publishing royalties
for Harrison’s Principles of Internal Medicine, 17th ed. (McGraw Hill Compa-
nies, Inc., 2008); estimates that 40% of his clinical effort is spent on nerve
conduction studies; has given expert testimony for the Department of Health
and Human Services Vaccine Injury Compensation program; and receives
Dr. Katzberg has received funding for travel from the Muscular Dystrophy
Association. Dr. Rae-Grant has received speaker honoraria from Biogen Idec,
Teva Pharmaceutical Industries Ltd., and EMD Serono, Inc.; receives pub-
lishing royalties for Handbook of Multiple Sclerosis (Springer Healthcare,
Lange, 2007), Occupational & Environmental Medicine (Appleton & Lange,
2007), and contributions to UpToDate; receives research support from the
NIH (NIEHS, NINDS); and holds stock in Sartoris, Inc.
This statement is provided as an educational service of the American
Academy of Neurology. It is based on an assessment of current scientific
and clinical information. It is not intended to include all possible proper
methods of care for a particular neurologic problem or all legitimate crite-
ria for choosing to use a specific procedure. Neither is it intended to
exclude any reasonable alternative methodologies. The AAN recognizes
that specific patient care decisions are the prerogative of the patient and
the physician caring for the patient, based on all of the circumstances
involved. The clinical context section is made available in order to place
the evidence-based guidelines into perspective with current practice habits
and challenges. No formal practice recommendations should be inferred.
CONFLICT OF INTEREST
The American Academy of Neurology is committed to producing inde-
pendent, critical and truthful clinical practice guidelines (CPGs). Signifi-
cant efforts are made to minimize the potential for conflicts of interest to
influence the recommendations of this CPG. To the extent possible, the
AAN keeps separate those who have a financial stake in the success or
failure of the products appraised in the CPGs and the developers of the
guidelines. Conflict of interest forms were obtained from all authors and
reviewed by an oversight committee prior to project initiation. AAN lim-
its the participation of authors with substantial conflicts of interest. The
AAN forbids commercial participation in, or funding of, guideline proj-
ects. Drafts of the guideline have been reviewed by at least three AAN
committees, a network of neurologists, Neurology®peer reviewers and
representatives from related fields. The AAN Guideline Author Conflict
of Interest Policy can be viewed at www.aan.com.
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Endorsed by the American Association of Neuromuscular and Electrodiagnostic Medicine on February 20, 2012.
Neurology 78 March 27, 2012
H.S. Patwa, V. Chaudhry, H. Katzberg, et al.
Subcommittee of the American Academy of Neurology
neuromuscular disorders: Report of the Therapeutics and Technology Assessment
Evidence-based guideline: Intravenous immunoglobulin in the treatment of
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