Switching to home-based SCIg for Multifocal motor neuropathy (MMN).
Br J Nurs. 2010 Mar 11-24;19(5):S27-31.
Woodall A, Jones S.
Multifocal motor neuropathy (MMN) is an immune-mediated disorder with slowly progressive asymmetric weakness of the limbs that can lead to significant disability. The recommended treatment is intravenous immunoglobulin (IVIg) which is often administered in a hospital setting. When self-administered in the home setting both subcutaneously administered immunoglobulin (SCIg) and IVIg provide patients with greater autonomy. The Department of Health's National Service Framework for long-term neurological conditions promotes supported self-care and self-management for patients living with a chronic disease. This paper reports the objective assessment of three adults with MMN who, supported and trained by two specialist nurses, were switched from IVIg to 16% SCIg self-administered at home. Reasons for switching to SCIg included inconvenience of IVIg treatment (2 patients) and pulmonary embolus after IVIg (1 patient). Grip strength, time to complete a 9-hole peg test in the left/right hands (2 patients), and duration of right heel raise (1 patient) were assessed pre-SCIg and during ongoing maintenance treatment (range: 160-200 mL SCIg/week). With regular assessment of patients' responses, the SCIg dose was adjusted, when required, to maintain the patients' normal performance. SCIg self-administered at home was an effective alternative to IVIg in these patients.