Changes in axonal and clinical function during intravenous and subcutaneous immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy

Peter N. Hansen; Abdullahi A. Mohammed; Lars K. Markvardsen; Henning Andersen; Hatice Tankisi; Søren H. Sindrup; Thomas Krøigård

doi:10.1111/jns.12563

Changes in axonal and clinical function during intravenous and subcutaneous immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy

Peter N. Hansen, Abdullahi A. Mohammed, Lars K. Markvardsen, Henning Andersen, Hatice Tankisi, Søren H. Sindrup, Thomas Krøigård^*

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

Background and Aims: Intravenous immunoglobulin (IVIg) has a rapid clinical effect which cannot be explained by remyelination during each treatment cycle in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). This study aimed to investigate axonal membrane properties during the IVIg treatment cycle and their potential correlation with clinically relevant functional measurements. Methods: Motor nerve excitability testing (NET) of the median nerve was performed before and 4 and 18 days after initiation of an IVIg treatment cycle in 13 treatment-naïve (early) CIDP patients and 24 CIDP patients with long term (late) IVIg treatment, 12 CIDP patients treated with subcutaneous immunoglobulin (SCIg) and 55 healthy controls. Clinical function was measured extensively using the Six Spot Step test, 10-Meter Walk test, 9-Hole Peg test, grip strength, MRC sum score, Overall Neuropathy Limitations Score and Patient Global Impression of Change. Results: Superexcitability and S2 accommodation decreased significantly in the early treatment group from baseline to day 4 and returned to baseline levels at day 18, suggesting temporary depolarization of the axonal membrane. A similar trend was observed for the late IVIg group. Substantial clinical improvement was observed in both early and late IVIg groups during the entire treatment cycle. No statistically significant correlation was found between clinical and NET changes. No change was found in NET or clinical function in the SCIg group or controls. Interpretation: NET suggested temporary depolarization of the axonal membrane during IVIg treatment in treatment naïve CIDP patients. The relation to clinical improvement, however, remains speculative.

Original language	English
Journal	Journal of the Peripheral Nervous System
Volume	28
Issue	3
Pages (from-to)	425-435
Number of pages	11
ISSN	1085-9489
DOIs	https://doi.org/10.1111/jns.12563
Publication status	Published - Sept 2023

Keywords

axonal function
chronic inflammatory demyelinating polyneuropathy
immunoglobulin treatment
nerve excitability testing

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10.1111/jns.12563Licence: CC BY

J Peripheral Nervous Sys - 2023 - Hansen - Changes in axonal and clinical function during intravenous and subcutaneousFinal published version, 1.06 MBLicence: CC BY

Cite this

@article{0619d08ac2954011bec512140ce17424,

title = "Changes in axonal and clinical function during intravenous and subcutaneous immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy",

abstract = "Background and Aims: Intravenous immunoglobulin (IVIg) has a rapid clinical effect which cannot be explained by remyelination during each treatment cycle in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). This study aimed to investigate axonal membrane properties during the IVIg treatment cycle and their potential correlation with clinically relevant functional measurements. Methods: Motor nerve excitability testing (NET) of the median nerve was performed before and 4 and 18 days after initiation of an IVIg treatment cycle in 13 treatment-na{\"i}ve (early) CIDP patients and 24 CIDP patients with long term (late) IVIg treatment, 12 CIDP patients treated with subcutaneous immunoglobulin (SCIg) and 55 healthy controls. Clinical function was measured extensively using the Six Spot Step test, 10-Meter Walk test, 9-Hole Peg test, grip strength, MRC sum score, Overall Neuropathy Limitations Score and Patient Global Impression of Change. Results: Superexcitability and S2 accommodation decreased significantly in the early treatment group from baseline to day 4 and returned to baseline levels at day 18, suggesting temporary depolarization of the axonal membrane. A similar trend was observed for the late IVIg group. Substantial clinical improvement was observed in both early and late IVIg groups during the entire treatment cycle. No statistically significant correlation was found between clinical and NET changes. No change was found in NET or clinical function in the SCIg group or controls. Interpretation: NET suggested temporary depolarization of the axonal membrane during IVIg treatment in treatment na{\"i}ve CIDP patients. The relation to clinical improvement, however, remains speculative.",

keywords = "axonal function, chronic inflammatory demyelinating polyneuropathy, immunoglobulin treatment, nerve excitability testing",

author = "Hansen, {Peter N.} and Mohammed, {Abdullahi A.} and Markvardsen, {Lars K.} and Henning Andersen and Hatice Tankisi and Sindrup, {S{\o}ren H.} and Thomas Kr{\o}ig{\aa}rd",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. Journal of the Peripheral Nervous System published by Wiley Periodicals LLC on behalf of Peripheral Nerve Society.",

year = "2023",

month = sep,

doi = "10.1111/jns.12563",

language = "English",

volume = "28",

pages = "425--435",

journal = "Journal of the Peripheral Nervous System",

issn = "1085-9489",

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Changes in axonal and clinical function during intravenous and subcutaneous immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy. / Hansen, Peter N.; Mohammed, Abdullahi A.; Markvardsen, Lars K. et al.
In: Journal of the Peripheral Nervous System, Vol. 28, No. 3, 09.2023, p. 425-435.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Changes in axonal and clinical function during intravenous and subcutaneous immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy

AU - Hansen, Peter N.

AU - Mohammed, Abdullahi A.

AU - Markvardsen, Lars K.

AU - Andersen, Henning

AU - Tankisi, Hatice

AU - Sindrup, Søren H.

AU - Krøigård, Thomas

PY - 2023/9

Y1 - 2023/9

N2 - Background and Aims: Intravenous immunoglobulin (IVIg) has a rapid clinical effect which cannot be explained by remyelination during each treatment cycle in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). This study aimed to investigate axonal membrane properties during the IVIg treatment cycle and their potential correlation with clinically relevant functional measurements. Methods: Motor nerve excitability testing (NET) of the median nerve was performed before and 4 and 18 days after initiation of an IVIg treatment cycle in 13 treatment-naïve (early) CIDP patients and 24 CIDP patients with long term (late) IVIg treatment, 12 CIDP patients treated with subcutaneous immunoglobulin (SCIg) and 55 healthy controls. Clinical function was measured extensively using the Six Spot Step test, 10-Meter Walk test, 9-Hole Peg test, grip strength, MRC sum score, Overall Neuropathy Limitations Score and Patient Global Impression of Change. Results: Superexcitability and S2 accommodation decreased significantly in the early treatment group from baseline to day 4 and returned to baseline levels at day 18, suggesting temporary depolarization of the axonal membrane. A similar trend was observed for the late IVIg group. Substantial clinical improvement was observed in both early and late IVIg groups during the entire treatment cycle. No statistically significant correlation was found between clinical and NET changes. No change was found in NET or clinical function in the SCIg group or controls. Interpretation: NET suggested temporary depolarization of the axonal membrane during IVIg treatment in treatment naïve CIDP patients. The relation to clinical improvement, however, remains speculative.

AB - Background and Aims: Intravenous immunoglobulin (IVIg) has a rapid clinical effect which cannot be explained by remyelination during each treatment cycle in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). This study aimed to investigate axonal membrane properties during the IVIg treatment cycle and their potential correlation with clinically relevant functional measurements. Methods: Motor nerve excitability testing (NET) of the median nerve was performed before and 4 and 18 days after initiation of an IVIg treatment cycle in 13 treatment-naïve (early) CIDP patients and 24 CIDP patients with long term (late) IVIg treatment, 12 CIDP patients treated with subcutaneous immunoglobulin (SCIg) and 55 healthy controls. Clinical function was measured extensively using the Six Spot Step test, 10-Meter Walk test, 9-Hole Peg test, grip strength, MRC sum score, Overall Neuropathy Limitations Score and Patient Global Impression of Change. Results: Superexcitability and S2 accommodation decreased significantly in the early treatment group from baseline to day 4 and returned to baseline levels at day 18, suggesting temporary depolarization of the axonal membrane. A similar trend was observed for the late IVIg group. Substantial clinical improvement was observed in both early and late IVIg groups during the entire treatment cycle. No statistically significant correlation was found between clinical and NET changes. No change was found in NET or clinical function in the SCIg group or controls. Interpretation: NET suggested temporary depolarization of the axonal membrane during IVIg treatment in treatment naïve CIDP patients. The relation to clinical improvement, however, remains speculative.

KW - axonal function

KW - chronic inflammatory demyelinating polyneuropathy

KW - immunoglobulin treatment

KW - nerve excitability testing

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U2 - 10.1111/jns.12563

DO - 10.1111/jns.12563

M3 - Journal article

C2 - 37212187

AN - SCOPUS:85161617521

SN - 1085-9489

VL - 28

SP - 425

EP - 435

JO - Journal of the Peripheral Nervous System

JF - Journal of the Peripheral Nervous System

IS - 3

ER -

Changes in axonal and clinical function during intravenous and subcutaneous immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy

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