Intravenous immune globulin (IVIg) use for labeled and unlabeled indications has grown in the last years. Aim of this study was to evaluate the IVIg usage profile for neurological inpatients in a single academic medical centre, over a long period of time. We retrospectively reviewed all approved IVIg transfusions for neurological disorders at Careggi Hospital from 2003 to 2006. The pharmacy records were then cross-referenced with patient medical records to determine the indication for IVIg administration. From 2003 to 2006 we observed a tremendous increase in IVIg administration, in the annual number of treated patients and in the mean annual courses. Fifty-seven patients (24%) received a long-term IVIg treatment, which accounted for 61% of the total IVIg consumption. The use of IVIg continues to expand despite concerns on future availability and long-term safety; alternative treatment strategies in chronic neurological disorders which require long-term, potentially indefinite therapy are warranted.