Sunday, February 3, 2013

EMG and IVIG

The diagnosis of chronic Lyme disease is more often than not accompanied by a subjective complain of numbess and tingling, often accompanied by weakness, dizzininess, loss of balance and other neurological complaints. The examination frequently demonstrates a lack of sensation to vibration, pin-prick or temperature in a distal, "stocking/glove" distribution, as well as muscle weakness. The workup for this scenario should include "electro-diagnostic" testing (EMG/NCV - electromyogram and nerve conduction velocity testing), which can demonstrate the presence of a peripheral neuropathy, axonal or demyelinating. If this is negative, a skin biopsy may show the presence of a small fiber neuropathy. These findings may be of profound clinical consequences.

Numerous patients come to mind. One patient, a 55 year old dog groomer came in for the treatment of chronic Lyme disease. He had been sick for years and only getting sicker. His major initail concerns were, progressive fatigue, overall aching of both muscles and joints and increasing forgetfulness/brain fog. He was not significantly bothered by the lack of sensation in both legs. I was. I ordered an EMG.

The EMG revealed a severe peripheral neuropathy.

Because of this, the insurance company approved the use of IVIG, an intravenous blood product consisting of concentrated iG antibodies from a large pool of donors. Without insurance approval for the "right" diagnosis, the cost of this treatment is prohibitive.

After a year of treatment with up and down results. He came into the office recently having now been on IVIG for several months,

"knock on wood," he said.  He felt terrific. The fatigue was dramatically better; the pains were nearly gone, and the cognitive dysfunction had greatly improved. Sensation was returning to his feet.

Like all therapies, IVIG, carries with it serious risks, including the possibility of severe allergic reactions.  Patients with IgA deficiency must recevie a special product.

But these kinds of results have been reproduced in many of my patients.

2 comments:

Fallen Star Reaching For The Sky said...

I am glad to see you that you are blogging again. I hope that the issues through which you have been going both personally and professionally have come to the best possible resolution at this time. I am asking you and those who read your blog to read the following petition, and if agreeable sign it by February 10th and advocate for others to sign it by then as well.

https://petitions.whitehouse.gov/petition/reform-infectious-disease-society-america-treatment-guidelines-lyme-disease/Pj9jG0pX

Lyme report: Montgomery County, MD said...

thank you