Immunomodulatory therapies in neurologic critical care

Logan M. McDaneld, Jeremy D. Fields, Dennis N. Bourdette, Anish Bhardwaj

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Introduction: Neurologic disorders with autoimmune dysregulation are commonly encountered in the critical care setting. Frequently encountered diseases include Guillain-Barré syndrome (GBS), myasthenia gravis, multiple sclerosis, acute demyelinating encephalomyelitis, and encephalitides. Immunomodulatory therapies, including high-dose corticosteroids, plasmapheresis, and intravenous immunoglobulins, are the cornerstone of the treatment of these diseases. Here we review the efficacy and side effects of immunomodulatory therapies commonly utilized in critically ill neurologic patients in the intensive care setting. Methods: Search of Medline, Cochrane databases, and manual review of article bibliographies. Results: The efficacy of high-dose corticosteroids, plasmapheresis, and intravenous immunoglobulins have been studied extensively in GBS, myasthenia gravis, and demyelinating disorders such as multiple sclerosis and acute demyelinating encephalomyelitis. For these diseases, however, the duration of treatment, dosing regimens, and choices among different therapeutic modalities remain controversial. For many of the other diseases (e.g., encephalitis and status epilepticus of autoimmune etiology) discussed in this review, evidence is limited to small case series. Conclusions: There is good evidence for the efficacy and tolerability of immunomodulatory therapies in GBS, myasthenia gravis, and acute central nervous system demyelination, though data to establish superiority of one therapeutic regimen over another remains lacking. For most other conditions, the data for immunomodulatory therapies are limited, and further research is required.

Original languageEnglish (US)
Pages (from-to)132-143
Number of pages12
JournalNeurocritical Care
Volume12
Issue number1
DOIs
StatePublished - Feb 2010
Externally publishedYes

Fingerprint

Immunomodulation
Critical Care
Nervous System
Myasthenia Gravis
Encephalomyelitis
Plasmapheresis
Intravenous Immunoglobulins
Demyelinating Diseases
Encephalitis
Multiple Sclerosis
Adrenal Cortex Hormones
Status Epilepticus
Bibliography
Therapeutics
Nervous System Diseases
Critical Illness
Central Nervous System
Databases
Research

Keywords

  • Corticosteroids
  • Cyclophosphamide
  • Immunoglobulin
  • Immunomodulation
  • Plasmapheresis

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Immunomodulatory therapies in neurologic critical care. / McDaneld, Logan M.; Fields, Jeremy D.; Bourdette, Dennis N.; Bhardwaj, Anish.

In: Neurocritical Care, Vol. 12, No. 1, 02.2010, p. 132-143.

Research output: Contribution to journalArticle

McDaneld, Logan M. ; Fields, Jeremy D. ; Bourdette, Dennis N. ; Bhardwaj, Anish. / Immunomodulatory therapies in neurologic critical care. In: Neurocritical Care. 2010 ; Vol. 12, No. 1. pp. 132-143.
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