FOREWORD

Abstract

a meeting held in Berlin in November 1993 sponsored by The European Charcot Foundation.The symposium "On gammaglobulin treatment in neurology: fundamentals and clinical applications" covered a breadth of basic scientific, immunological and therapeutic topics.Of par- ticular interest were papers on the use of high dose intra- venous immunoglobulin (IVIg) in the treatment of a wide range of neurological disorders, including those of the central nervous system, peripheral neuropathies, myas- thenia gravis and inflammatory myopathies.It is clearly important that the role of IVIg treatment is examined critically.Treatment is relatively very safe but expensive.Informal discussion indicates that IVIg accounts for a major part of the drug budget in some Centres.It is undoubtedly effective in some neurological conditions but, even here, it must be compared with other standard therapies in well-conducted controlled trials.Perhaps the clearest role may be in the treatment of acute and monophasic disorders such as acute Guillain-Barre syndrome.Greater difficulty occurs in defining indications for the use of IVIg in chronic disorders such as chronic inflammatory demyelinating polyneuropathy or myasthenia gravis where there is clinical response but where treatment requires repetition.How often?What is the minimum effective dose?Does treatment alter the long term course of disability?These papers may not offer definitive answers but it is hoped that they will be of general neurological interest, and will stimulate thought and discussion.Importantly, they may encourage the organisation of, and participation