Author Response: Intravenous Immunoglobulin Therapy in Patients With Painful Idiopathic Small Fiber Neuropathy

We would like to respond to the comments made by Mr. Franco Gemignani on our article1 regarding the nonlength-dependent small fiber neuropathy (NLD-SFN) phenotype as a potential condition that could benefit from intravenous immunoglobulin therapy (IVIg). We fully agree that future studies in NLD-SFN would be needed to determine whether IVIg would have a therapeutic role in these conditions. There are some open-label clinical studies suggesting a potential therapeutic role,1,2 as well as distal SFN case-studies showing a positive effect of IVIg, whereas the results of our RCT showed that IVIg treatment had no significant effect on pain in patients with painful idiopathic SFN. This underlines the pitfalls of case reports or open case studies and the importance of double-blind randomized trials.

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