INTRAVENOUS IMMUNOGLOBULIN THERAPY IN AMYOTROPHIC-LATERAL-SCLEROSIS

Seven consecutive patients with amyotrophic lateral sclerosis (ALS) we re treated with intravenous immunoglobulins (IVIg; 0.4 g/kg per day fo r 5 consecutive days followed by monthly 2-day infusions at the same d aily dosage) continued with oral cyclophosphamide (1-2 mg/kg per day), for 4-13 months (mean 8.1). Response to treatment was assessed by mea ns of the Medical Research Council (MRC) rating scale for muscle stren gth on 40 muscles (10 per Limb), a clinical scale for bulbar function and a modified Rankin disability scale. All patients continued to dete riorate during treatment on as regards both their MRC score and either their bulbar or Rankin score or both. The progression of the disease during treatment, expressed as the monthly variation in MRC score (mea n = - 2.71; SD = 1.36), was no slower than that estimated before thera py (mean = 1.81; SD = 0.93). Even if the results of this small, uncont rolled study do not permit the exclusion of an effect of IVIg on the p rogression of ALS, they also do not provide any evidence that this exp ensive form of therapy consistently slows the course of the disease.