IVIG for Small Fiber Neuropathy (SFN)

Studies suggest that intravenous immunoglobulin (IVIG) therapy for small fiber neuropathy (SFN) can only be effective if the underlying cause is known. Small fiber neuropathy is a chronic condition characterized by damage to small unmyelinated nerve fibers of the peripheral nervous system (the network of nerves lying outside the brain and spinal cord).

Normally, these small nerve fibers are present under the skin and go all over your body, most commonly in the hands, legs, and feet, to convey sensory information about pain and temperature.

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Damage to these small nerve fibers results in excruciating pain, burning sensations, tingling, and numbness that begin from the feet and progressively move upward to the rest of the body, such as the hands and arms.

Since there is no standard cure for SFN, treatment strategies (e.g., neuropathic medications and IVIG treatment for small fiber neuropathy) are used to manage the symptoms of this condition, depending on its underlying cause.

IVIG and the Underlying Causes of SFN

Small fiber neuropathy is a confounding disease. It’s associated with various medical health conditions. In 50% of cases, the cause of SFN is clear, while in many cases, the cause of SFN is unknown (idiopathic), which makes the treatment process more complex.

IVIG infusions can only be used for small fiber neuropathy if the underlying cause is an autoimmune condition like systemic lupus erythematosus, Sjogren’s disease, and sarcoidosis.

The following reports demonstrate the effects of intravenous immunoglobulin (IVIG) therapy for small fiber neuropathy in patients diagnosed with both an autoimmune condition and SFN.

IVIG and SFN: What Studies Show

Intravenous immunoglobulin is an FDA-approved therapeutic technique to treat various immune-related nervous disorders. In SFN, neuropathic pain and autonomic dysfunction can lead to disabling symptoms that can worsen over time if not treated early.

Only a few studies reveal the effectiveness of IVIG treatment in reducing the neuropathic pain associated with small fiber neuropathy. For instance, scientists conducted a case study on three patients with small fiber neuropathy associated with celiac disease (CD). It showed improvement in their symptoms (neuropathic pain) when given IVIG for small fiber neuropathy.

Similarly, another case report showed that a female patient with Sjögren’s syndrome (SS) and small-fiber neuropathy responded to IVIG treatment when given 3-course IVIG (high dose of 20 g for 5 consecutive days) for 7 weeks. The patient showed extreme improvement in her paresthesia (burning and prickling sensation) and pain after the first IVIG infusion.

Another small uncontrolled trial of administering IVIG infusion for small fiber neuropathy showed remarkable results in improving the neuropathic pain of SFN when five patients with Sjogren’s syndrome were given 0.4g/kg/day for 5 consecutive days.

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Likewise, a descriptive case series of three patients with sarcoidosis and SFN also shows that IVIG treatment appears to be effective in relieving pain. These case reports have shown promising results on using IVIG for small fiber neuropathy, where the underlying cause is known.

On the other hand, a randomized controlled trial conducted on 60 Dutch patients with painful idiopathic SFN showed no significant improvement in their SFN symptoms (pain) after receiving IVIG infusion, compared to a placebo. Therefore, when the cause of SFN is unclear, IVIG appears to show less promising results.

To date, there have only been a handful of small studies about the effectiveness of IVIG infusion for small fiber neuropathy patients. More randomized controlled trials need to be conducted on a large group of patients with SFN and idiopathic SFN to determine the efficacy of IVIG for small fiber neuropathy and its effective dosage.

REFERENCES:

1. Souayah, N., Chin, R. L., Brannagan, T. H., Latov, N., Green, P. H. R., Kokoszka, A., & Sander, H. W. (2008). Effect of intravenous immunoglobulin on cerebellar ataxia and neuropathic pain associated with celiac disease. European journal of neurology, 15(12), 1300-1303.
2. Wakasugi, D., Kato, T., Gono, T., Ito, E., Nodera, H., Kawaguchi, Y., … & Hara, M. (2009). Extreme efficacy of intravenous immunoglobulin therapy for severe burning pain in a patient with small fiber neuropathy associated with primary Sjögren’s syndrome. Modern rheumatology, 19(4), 437-440.
3. Morozumi, S., Kawagashira, Y., Iijima, M., Koike, H., Hattori, N., Katsuno, M., … & Sobue, G. (2009). Intravenous immunoglobulin treatment for painful sensory neuropathy associated with Sjögren’s syndrome. Journal of the neurological sciences, 279(1-2), 57-61.
4. Parambil, J. G., Tavee, J. O., Zhou, L., Pearson, K. S., & Culver, D. A. (2011). Efficacy of intravenous immunoglobulin for small fiber neuropathy associated with sarcoidosis. Respiratory medicine, 105(1), 101-105.
5. Geerts, M., de Greef, B. T., Sopacua, M., van Kuijk, S. M., Hoeijmakers, J. G., Faber, C. G., & Merkies, I. S. (2021). Intravenous immunoglobulin therapy in patients with painful idiopathic small fiber neuropathy. Neurology, 96(20), e2534-e2545.