By John D. England, MD
John D. England, MD
On behalf of the Editorial Board, I would like to thank all of the individuals who review articles for the Journal of the Neurological Sciences (JNS). The integrity of a scientific journal such as JNS depends heavily upon the quality of independent peer-review.
I continue to be impressed with the high quality and thoroughness of the reviewers’ critiques of manuscripts. I am especially impressed and thankful that such busy and committed individuals still take the time to review articles. One of my goals for this year is to seek advice from the Editorial Board and Elsevier about how we might be able to recognize the efforts and importance of our reviewers in a more tangible manner.
Most readers are becoming aware of the fact that Elsevier, the publisher of JNS, now provides free access to selected articles from JNS for members of the World Federation of Neurology. In consultation with members of the Editorial Board, I select two “free-access” articles, which are profiled in each issue of World Neurology.
In this issue, we feature two paired articles:
- Hellmann, et al. reviewed the response to maintenance intravenous immununoglobulin (IVIg) in a cohort of 52 patients with myasthenia gravis (MG) who had not responded adequately to pyridostigmine, prednisone, azathioprine, or combinations of these medications. Fifteen of the patients did not respond to an initial trial of IVIg, and were not treated with additional doses of IVIg. Thirty-seven patients responded to the initial trial and were treated with maintenance IVIg (0.4 g/kg every three to six weeks) for an average of 5.9 years (range 1 to 17 years). Twenty-three patients achieved mild improvement, and 14 patients achieved moderate improvement as measured by the Myasthenia Gravis Foundation of America (MGFA) clinical classification scheme. A beneficial response was associated with bulbar onset, seropositivity and high titer of acetylcholine receptor antibody, and older age of disease onset. Probably the most important observation in this study was that none of the patients achieved full remission with maintenance IVIg. Although IVIg improved symptoms of MG and allowed reduction of other medications, it did not provide a sustained effect or true remission of the disease. (Hellmann MA, Mosberg-Galili R, Lotan I, Steiner I. Maintenance IVIg therapy in myasthenia gravis does not affect disease activity. J Neurol Sci 2014;338:39-42)
- Marinos Dalakas provides a thoughtful editorial on the above-noted article and places its results into the perspective of current treatment options for myasthenia gravis (MG). He emphasizes the point that IVIg appears to exert only a short-term and transient immunomodulation in MG and does not provide immunosuppression of the disease. At this time, the evidence supports restricting the use of IVIg in MG to short-term treatment of unstable patients until immunosuppressive treatments become effective. However, only a prospective trial of IVIg therapy for MG will provide definitive conclusions regarding its long-term effectiveness in managing this disease. (Dalakas M. IVIg in the chronic management of myasthenia gravis: Is it enough for your money? J Neurol Sci 2014;338:1-2)
England is editor-in-chief of the Journal of the Neurological Sciences.
