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Review
. 2002 Apr;200(4):331-9.
doi: 10.1046/j.1469-7580.2002.00041.x.

Systematic reviews of treatment for inflammatory demyelinating neuropathy

R A C Hughes  1
Affiliations
Review

Systematic reviews of treatment for inflammatory demyelinating neuropathy

R A C Hughes. J Anat. 2002 Apr.

Abstract

This review describes the progress made in preparing Cochrane systematic reviews of randomized controlled trials for Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), multifocal motor neuropathy (MMN) and the demyelinating neuropathies associated with paraproteins. The discovery of antibodies against myelin and axolemmal glycolipids and proteins has not yet replaced the clinicopathological classification on which treatment trials have been based. Systematic reviews have endorsed the equivalence of plasma exchange (PE) and intravenous immunoglobulin (IVIg) and the lack of efficacy of steroids in GBS. Systematic reviews have also endorsed the value of steroids, PE and IVIg in CIDP but randomized controlled trials have only shown benefit from IVIg in MMN. There is a paucity of evidence concerning the efficacy of treatments in paraproteinaemic demyelinating neuropathy apartment from small trials showing short-term benefit from PE or IVIg. There is a lack of good quality controlled trials of immunosuppressive agents in any of these conditions. As the number of treatment trials increases, Cochrane systematic reviews will be an increasingly valuable resource for summarizing the evidence from randomised controlled trials on which to base clinical practice. They already demonstrate major deficiencies in the existing evidence base.

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Figures

Fig. 1
Fig. 1
Systematic review of steroid treatment for GBS. Improvement in a seven-point disability grade scale 4 weeks after randomization. From Hughes & van der Meché (1999)
Fig. 2
Fig. 2
Systematic review of PE treatment for GBS. Improvement in a seven-point disability grade scale 4 weeks after randomization. From Hughes et al.(2001b)
Fig. 3
Fig. 3
Systematic review of IVIg compared with PE as treatment for GBS. Improvement in a seven-point disability grade scale 4 weeks after randomization. The values for the standard deviation for the Bril 1996 trial, from which the 95% CI has been calculated, were not published and have been imputed. From Hughes et al.(2001b)
See this image and copyright information in PMC

References

    1. Asbury AK, Arnason BG, Adams RD. The inflammatory lesion in idiopathic polyneuritis. Its role in pathogenesis. Medicine. 1969;48:173–215. - PubMed
    1. Austin JH. Recurrent polyneuropathies and their corticosteroid treatment. Brain. 1958;81:157–192. - PubMed
    1. Bleasel AF, Hawke SHB, Pollard JD, McLeod JG. IgG monoclonal paraproteinaemia and peripheral neuropathy. J. Neurol. Neurosurgery Psychiatry. 1993;56:52–57. - PMC - PubMed
    1. Bril V, Ilse WK, Pearce R, Dhanani A, Sutton D, Kong K. Pilot trial of immunoglobulin versus plasma exchange in patients with Guillain– Barré syndrome. Neurology. 1996;46:100–103. - PubMed
    1. Bromberg MB, Feldman EL, Albers JW. Chronic inflammatory demyelinating polyradiculoneuropathy: Comparison of patients with and without an associated monoclonal gammopathy. Neurology. 1992;42:1157–1163. - PubMed

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