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Thread: Ivig Treatment

  1. #1
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    Exclamation Ivig Treatment

    I was wondering if anyone here has tried IVIG treatment for TM.. I'm trying to get it now. I just have to wait and see if my insurance will cover it.. If anyone has has it please let me know if it was of any help.. I've had TM for 7mths and I know physical theropy is the best thing for me right now but if there's something eles I can do to help myself Please let me know...

    Thank you..
    It is not how we fall that defines us..
    It is how we rise.

  2. #2
    hi Shana, I only know that Brian received IVIG in the hosp when they thought that he had Guillian Barre syndrome. We were considering plasmapheresis for him when he was diagnosed with TM. Since seeing Dr Kerrr and the change in diagnosis there would have been no benefit to him. Have you looked into plasmapheresis?

  3. #3
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    I have concidered plasmapheresis but my doctor wants to try IVIG first... If that shows no improvement then I'm going to push for plasmapheresis.
    It is not how we fall that defines us..
    It is how we rise.

  4. #4
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    I have concidered plasmapheresis but my doctor wants to try IVIG first... If that shows no improvement then I'm going to push for plasmapheresis.
    It is not how we fall that defines us..
    It is how we rise.

  5. #5
    Shana,

    IVIG (intravenous immunoglobulin) is a treatment that has been used to treat multiple sclerosis. IVIG has been used to treat a patient who had TM and mixed connective tissue disease (Bhinder, et al. 2007), a seven-year old boy with recurrent TM and antiphospholipid syndrome (Shaharao, et al. 2004), a young woman with idiopathic acute transverse myelitis (Finsterer & Voigtlander, 2002), and two cases of transverse myelitis associated with Sjogren's syndrome (Mochizuki, et al. 2002), and a case of viral-associated transverse myelitis (Humbertclaude, 2001). Generally, IVIG is used during the acute stage after onset and in combination with high-dose methylprednisolone (Fonseca, et al., 2003; Nakamura, et al., 2003).

    Wise.

    References
    1. Bhinder S, Harbour K and Majithia V (2007). Transverse myelitis, a rare neurological manifestation of mixed connective tissue disease-a case report and a review of literature. Clin Rheumatol 26: 445-7. Although neurological involvement occurs in about 10% of patients with mixed connective tissue disease (MCTD), acute transverse myelitis (TM) has only been described in seven cases of MCTD. We hereby report a case of 70-year-old white female with transverse myelitis complicating her underlying MCTD. Our patient presented with lower extremity weakness, loss of sensation and incontinence one year after her diagnosis of MCTD. Her work-up revealed an abnormal MRI, with findings consistent with TM. She had an excellent response to initial therapy with six cycles of monthly intravenous immunoglobulins and steroids, with subsequent maintenance on azathioprine. She had a good neurological recovery with mild residual sequelae only. On basis of this case report and review of literature, we recommend ongoing surveillance and reporting of this rare neurological presentation in MCTD. University of Mississippi Medical Center, 2500 N State St/ L-525, Jackson, MS, 39216, USA, skbhinder@medicine.umsmed.edu. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16391892
    2. Shaharao V, Bartakke S, Muranjan MN, Bavdekar MS, Bavdekar SB and Udani VP (2004). Recurrent acute transverse myelopathy: association with antiphospholipid antibody syndrome. Indian J Pediatr 71: 559-61. A seven-year-old boy presented with a second episode of acute transverse myelopathy. The first episode had responded dramatically to methylprednisolone. The manifestations of the second episode did not respond to methylprednisolone or IVIG. He showed persistently raised levels of antiphospholipid antibodies in the serum. Primary conditions like collagen vascular diseases, malignancy, exposure to drugs and HIV infection, which are known to be associated with the raised titers of these antibodies were ruled out clinically and by investigations. Recurrent transverse myelopathy is a rare event in childhood and reports of its association with Antiphospholipid Antibody Syndrome (APLAS) are scanty. The etiological role for these antibodies remains to be established. However, once the diagnosis is established, it may be prudent to treat the condition with agents and procedures to bring about a decrease in their titers. Long-term therapy to prevent thromboembolic complications of APLAS may also be instituted. Department of Pediatrics, Seth G.S. Medical College & KEM Hospital, Mumbai, India. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15226572
    3. Finsterer J and Voigtlander T (2002). Elevated 14-3-3 protein and axonal loss in immunoglobulin-responsive, idiopathic acute transverse myelitis. Clin Neurol Neurosurg 105: 18-22. OBJECTIVES: To report the elevation of the 14-3-3 protein and the complete denervation of hand muscles in idiopathic acute transverse myelitis (IATM) of the cervical cord. CASE DESCRIPTION: In a 29-year-old woman with a 2-week history of neck pain and repeated attenuated flus, subacute quadriplegia, hypaesthesia of both arms, a T3 sensory level, and urinary dysfunction occurred. Based upon the clinical findings, the cervical MRIs, and an elevated 14-3-3 protein in the CSF, IATM C4-C7 was diagnosed. Ten, 17, 28 and 61 days after onset, nerve conduction studies revealed complete denervation of the right abductor pollicis brevis and abductor digiti minimi muscles but gradual improvement of the compound muscle action potential of the left abductor pollicis brevis muscle. F-waves of the right median nerve were absent. Tibial somatosensory evoked potentials showed a prolonged central conduction time. Transcranial magnetic stimulation evoked a response in the left but not the right abductor digiti minimi muscle. CONCLUSION: IATM may cause elevation of the 14-3-3 protein and loss of motor axons originating from affected anterior horn cells. Neurological Hospital, Rosenhugel, Vienna, Austria. duarte@jet2web.cc http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12445918
    4. Mochizuki H, Kamakura K, Masaki T, Hirata A, Nakamura R and Motoyoshi K (2002). Motor dominant neuropathy in Sjogren's syndrome: report of two cases. Intern Med 41: 142-6. Most of the peripheral neuropathies in Sjogren's syndrome (SS) are sensory- or autonomic-dominant. In this report, we present two cases of a rare type of neuropathy, motor dominant neuropathy, in SS. One showed signs similar to those of Guillain-Barre syndrome, and the other showed signs characteristic of chronic inflammatory demyelinating polyradiculoneuropathy. These patients received i.v. immunoglobulin therapy. To our knowledge, this is the first report indicating that i.v. immunoglobulin has beneficial effects on motor dominant neuropathy in SS. Third Department of Internal Medicine, National Defense Medical College, Tokorozawa, Saitama. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11868603
    5. Fonseca LF, Noce TR, Teixeira ML, Teixeira AL, Jr. and Lana-Peixoto MA (2003). Early-onset acute transverse myelitis following hepatitis B vaccination and respiratory infection: case report. Arq Neuropsiquiatr 61: 265-8. Acute transverse myelitis is an acute inflammatory process of the spinal cord and it is a rare clinical syndrome in childhood. In this paper, we report a case of 3 years-old boy who developed acute onset tetraparesia following a viral respiratory infecction and hepatitis B vaccination. Magnetic resonance imaging of the spinal cord disclosed signal-intensity abnormalities from C4 to C3. A diagnosis of acute transverse myelitis was made and the patient was treated with IV methylprednisolone and IV immunoglobulin. The child had a fair outcome despite of the very acute course of the disease and the presence of a cervical sensory level which usually harbor a poor prognosis. Centro Geral de Pediatria, FHEMIG, Belo Horizonte, MG, Brasil. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12806509
    6. Nakamura N, Nokura K, Zettsu T, Koga H, Tachi M, Terada M, Katoh H, Itoh Y, Osawa H, Ozeki T and Yamamoto H (2003). Neurologic complications associated with influenza vaccination: two adult cases. Intern Med 42: 191-4. We describe two adult cases of neurologic complications occurring after influenza vaccination. The first case was a 62-year-old man who experienced convulsions 5 days after vaccination, and the second case was a 70-year-old man who exhibited paraplegia 7 days after vaccination. Diagnoses of acute disseminated encephalomyelitis and transverse myelitis with acute motor axonal neuropathy were made, respectively, and steroid pulse therapy and intravenous gamma globulin therapy alleviated the patients' symptoms. Although the efficacy and cost benefit of influenza vaccination have been widely accepted, such neurologic complications might occur in the elderly or even in adults. Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12636241
    7. Humbertclaude V, Tourtet S, Semprino M, Roubertie A, Rivier F, Leboucq N, Astruc J and Echenne B (2001). [Acute myelitis of an unusual cause in a child: the lymphocytic choriomeningitis virus]. Arch Pediatr 8: 282-5. Acute transverse myelitis is a rare disorder in childhood. It usually occurs as a post-infectious disease, but a precise infectious agent is identified in only 20% of cases. OBSERVATION: The diagnosis of acute transverse myelitis was made in a 5.5-year-old girl who initially presented with left Claude-Bernard-Horner syndrome and meningitis. A few days later, motor and sensory tetraparesia with bladder dysfunction was observed. Magnetic resonance imaging showed a diffuse lesion in the medulla, with a hypersignal in the T2 and a hyposignal in the T1 sequences. Serum analysis showed the presence of a viral infection due to the lymphocytic choriomeningitis (LCM) virus. The outcome was marked by complete recovery of the sensorimotor deficit, but a persistence of the left Claude-Bernard-Horner syndrome. CONCLUSION: In rare cases, the LCM virus is responsible for myelitis. In the present case, the Claude-Bernard-Horner syndrome was secondary to the cervico-medullary lesion. Recent reports in the literature have been discussed, in particular as regards the use of immunomodulatory therapy, which clearly improves patient prognosis. Service de neuropediatrie, centre hospitalier universitaire Saint-Eloi, avenue Bertin-Sans, 34295 Montpellier, France. http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11270252

  6. #6

    Dr. Kerr mentioned below

    Hello! I just posted my first message to this forum and started reading other messages. Is this Dr. Kerr from John Hopkins/Baltimore you speak of? I was told he was the expert on Transverse Myelitis. Has he been helpful to you and what can you tell me about him? Thank you, Jeff


    Quote Originally Posted by Nancy E
    hi Shana, I only know that Brian received IVIG in the hosp when they thought that he had Guillian Barre syndrome. We were considering plasmapheresis for him when he was diagnosed with TM. Since seeing Dr Kerrr and the change in diagnosis there would have been no benefit to him. Have you looked into plasmapheresis?

  7. #7
    Super Moderator Sue Pendleton's Avatar
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    Quote Originally Posted by jeff@wagnerlee.com
    Hello! I just posted my first message to this forum and started reading other messages. Is this Dr. Kerr from John Hopkins/Baltimore you speak of? I was told he was the expert on Transverse Myelitis. Has he been helpful to you and what can you tell me about him? Thank you, Jeff
    Yes that Douglas Kerr, MD, PhD. Great doc, researcher and lousy at answering emails. His schedule normally requires a 6 month wait for non-acute appointments.

    Shana I don't hear much about IVIG either unless there is a dual diagnosis. Plasmaphresis is the normal course now if methylprednisolone doesn't work. This was developed by another member of the TMA medical board at the Mayo Clinic. Check more out at www.myelitis.org.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  8. #8
    HI Jeff,
    Dr. Kerr was extremely helpful to us. He is at john hopkins in Baltimore. Check out the john hopkins site, transverse myelitis center. Ultimately he was the one who diagnosed my son. ( not with TM)
    I'm sorry that this happened to you. it sounds like you've been through alot. We learned a ton from this site.
    If you have any questions I can help you with let me know.
    Nancy

  9. #9
    Oh my, Dr. Kerr is wonderful! He has always answered everyone of our emails within a very timely manner. He has been my son's doctor since his occurrence of TM in November, 2005.

    Ben has had 2 separate treatments of IVIG. It did help in some return. I do know other folks that have had plasma exchange and IVIG, which has been quite successful for them. As Dr. Kerr has told us, everyone's case is different. My son has nerve root involvement, too, which makes it a bit more complicated.

    I wish you the best. Please consult Dr. Kerr. He is truly an amazing doctor and absolutely wonderful to work with. Dr. Kerr, along with Dr. John McDonald at KKI and Dr. Ewa Brandys at Children's Institute in Pittsburgh have been a tremendous help in my son's wellness. They are truly amazing and caring doctors!

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