Monday, June 17, 2013

IVIG for Peripheral Neuropathy

I saw this note on the California Lyme listserv today:
A listserv member brought this to the attention of the group today. 
Intravenous immunoglobulin therapy helped all of the lyme patients with neuropathy 
after 6 months of one treatment per month. You may be put off by the 
starting premise of the study -- that their symptoms were part of post-lyme 
treatment syndrome -- but the conclusion seemed to be that they still had Lyme or 
would not have benefited from the IVIG therapy. 

Source: DGNews 
Immunoglobulin Therapy Effective for Neuropathy in Patients With 
Post-Treatment Lyme Syndrome
Presented at AAN

By Andrew Wilner, MD

SEATTLE, Wash -- May 2, 2009 -- Intravenous immunoglobulin (IVIG) therapy 
may improve neuropathic symptoms in patients with post-treatment Lyme 
syndrome, researchers stated here on April 28 at the American Academy of 
Neurology (AAN) 61st Annual Meeting.

A significant number of patients who had Lyme disease will continue to 
have lingering symptoms referred to as post-treatment Lyme syndrome, 
according to presenter Amiram Katz, MD, Lambert Professional Center, Orange, 
Connecticut. Similar symptoms are seen in patients who have received the Lymerix 

The study included 30 patients seen by Dr. Katz (13 females, 17 males; 
mean age 48.2 years) who complained of neuropathic pain.

Of the patients, 22 had a history of Lyme disease and 8 patients had 
received the Lymerix vaccine. All patients had antibodies to outer surface 
protein A (anti-OspA) and persistent symptoms despite at least 1 course of 

Twenty-four patients had electrodiagnostic studies, but there was a poor 
correlation between electrodiagnostic and nerve biopsy results.

Four patients with abnormal electrodiagnostic studies had normal epidermal 
nerve fibre density on nerve biopsy, while 10 patients with normal 
electrodiagnostic studies had abnormal epidermal nerve fibre density on nerve 
biopsy. Three patients had inflammatory changes around the nerve endings on 
skin biopsy.

All patients were treated with IVIG 2 g/kg per month for at least 6 months.

After IVIG treatment, all patients had improvement of their neurological 
examination with respect to their sensation, Achilles reflex, and Romberg 
test. Several patients also showed improvement in the number of nerve fibres 
on repeat nerve biopsy after treatment. There was no placebo group.

"The diagnosis of chronic Lyme disease is not widely accepted, yet these 
patients have symptoms and nerve biopsies that respond to IVIG treatment, 
legitimising their complaints," concluded Dr. Katz.

[Presentation title: Diminished Epidermal Nerve Fiber Density in Patients 
With Antibodies to Outer Surface Protein A (OspA) of B. burgdorferi 
Improves with Intravenous Immunoglobulin Therapy. Abstract P02.021]

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