Intravenous Immunoglobulin

Intravenous immunoglobulin therapy (IVIg) is FDA approved for immune-mediated peripheral nerve disorders including Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy. While not yet FDA approved, immunoglobulin therapy can be beneficial for patients with disabling autoimmune forms of dysautonomia, including small fiber polyneuropathy. IVIG showed improvement in approximately 80% of people with small fiber polyneuropathy. Caution is warranted, however, as patients with autonomic dysfunction develop aseptic meningitis or severe lingering headache when used in traditional fashion (1-2 g/kg given over 2-5 days).

Small fiber polyneuropathy may be co-morbid with:

Postural tachycardia syndrome Orthostatic intolerance Orthostatic hypotension Inappropriate sinus tachycardia

Gastrointestinal dysmotility Complex regional pain syndrome Neurogenic bladder

In addition, dysautonomia may occur in association with

• Primary antineuronal autoimmunity: antibodies to adrenergic and muscarinic receptors, ganglionic acetylcholine receptor, NMDA receptor and others
• Systemic autoimmune disease and autonomic neuropathy including Sjogren syndrome and antiphospholipid syndrome
• Many other autoimmune diseases, including:

Celiac disease Hashimoto thyroiditis Inflammatory bowel disease Lupus Multiple sclerosis

Myasthenia gravis Rheumatoid arthritis Spondylarthropathy Systemic sclerosis