RESUMO
During recent years, an increasing number of neuromuscular diseases have been recognized either to be caused primarily by autoimmune mechanisms, or to have important autoimmune components. The involved pathophysiological mechanisms and clinical manifestations have been better recognized and many of these disorders are potentially treatable by immunosuppression or by immunomodulation with intravenous immunoglobulin (IVIg). IVIg has been tried in a variety of immune-mediated neurological diseases, being target of widespread use in central and peripheral nervous systems diseases. Objective To give an overview of the main topics regarding the mechanism of action and different therapeutic uses of IVIg in neurological practice, mainly in neuromuscular diseases. .
Nos últimos anos, um número progressivo de doenças neuromusculares passaram a ser reconhecidas tanto por ser causadas por mecanismos autoimunes ou por envolver importantes componentes autoimunes. Os mecanismos fisiopatológicos e as manifestações clínicas envolvidos têm sido mais bem reconhecidos e muitas de tais doenças são potencialmente tratáveis por imunossupressão ou imunomodulação com imunoglobulina intravenosa (IVIg). IVIg vem sendo utilizada em uma variedade de doenças neurológicas imunomediadas, sendo alvo de amplo uso em doenças dos sistemas nervosos central e periférico. Objetivo Oferecer uma visão global sobre os principais tópicos relacionados aos mecanismos de ação e aos diferentes usos terapêuticos da IVIg na prática neurológica, principalmente em doenças neuromusculares. .
Assuntos
Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Miosite/tratamento farmacológico , Doenças Neuromusculares/tratamento farmacológico , Ensaios Clínicos como AssuntoRESUMO
Twelve patients of elapid ophitoxaemia presented with neuromuscular paralytic features were given anticholinesterase (Neostigmine) in recommended dosage. In four of these patients, despite neuromuscular paralysis, no ASV was used. All these four patients survived. In eight patients, ASV was used; in three of whom it used in doses less than 50 units, yet patients survived. Of the remaining five, despite use of ASV in higher doses (more than 50 units), two succumbed to death. Eight patients required ventilatory support. Hence, in absence of any definite role of ASV in management of elapid ophitoxaemia (snake bite), use of anticholinesterase drugs alone, with good supportive care and prevention of likely complications, can result in satisfactory outcome.