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Many patients notice reduced inflammation and pain within weeks, while others experience more gradual improvements depending on their condition

If pain control persistently fails or progressive/debilitating symptoms remain, we believe that, based on small case series, a trial of intravenous immunoglobulin (see Table 1 for suggested dosages) is the most promising approach [30]

Some patients may require injections more frequently, and if a true deficiency is identified, several injections over 1-2 weeks are needed, known as a loading dose

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This adds to the difficulty in reconciling MS under a single pathophysiological umbrella, but also has implications for therapeutic design: this cytodegenerative component is not expected to respond to current anti-inflammatory disease-modifying drugs targeting acute/adaptive peripheral autoimmunity