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Abstract
Subcutaneous administration of IgG (SCIG) has become widely used in primary immune deficiency diseases but it has only recently been studied for maintenance therapy in autoimmune peripheral neuropathies, such as chronic idiopathic demyelinating polyneuropathy and multifocal motor neuropathy. Weekly self-administration of SCIG is safe and well-tolerated, and results in steady-state serum IgG levels, as contrasted with the peaks and troughs of monthly immune globulin (human) for intravenous use. Freedom from the need for venous access or medical personnel for infusions, flexibility in scheduling, convenience of home therapy, and improved clinical stability due to the steady-state IgG levels, lead many patients to prefer SCIG to immune globulin (human) for intravenous use. Long-term studies are needed to determine if the constant IgG levels and clinical stability translate into better long-term outcomes.
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Affiliation(s)
- Melvin Berger
- Immunology Research & Development, CSL Behring, LLC, 1020 First Avenue, King of Prussia, PA 19406, USA and Pediatrics & Pathology, Case Western Reserve University, Cleveland, OH, USA
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252
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Efficacité à moyen terme de l’autogreffe de cellules souches hématopoïétiques périphériques sur la polyneuropathie du syndrome POEMS : expérience chez 5 cas. Rev Neurol (Paris) 2014; 170:37-45. [DOI: 10.1016/j.neurol.2013.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/20/2022]
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253
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Hahn AF, Beydoun SR, Lawson V, Oh M, Empson VG, Leibl H, Ngo LY, Gelmont D, Koski CL. A controlled trial of intravenous immunoglobulin in multifocal motor neuropathy. J Peripher Nerv Syst 2013; 18:321-30. [DOI: 10.1111/jns5.12046] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 09/25/2013] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Angelika F. Hahn
- Department of Neurology; London Health Sciences Centre; London Ontario Canada
| | - Said R. Beydoun
- Department of Neurology; University of Southern California; Los Angeles CA USA
| | - Victoria Lawson
- Department of Neurology; The Ohio State University; Columbus OH USA
| | - MyungShin Oh
- Clinical Biostatistics; Baxter Healthcare Corporation; Westlake Village CA USA
| | | | - Heinz Leibl
- Clinical Research, BioTherapeutics; Baxter Innovations GmbH; Vienna Austria
| | - Leock Y. Ngo
- Clinical Research, BioTherapeutics; Baxter Healthcare Corporation; Westlake Village CA USA
| | - David Gelmont
- Clinical Research, BioTherapeutics; Baxter Healthcare Corporation; Westlake Village CA USA
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254
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Markvardsen LH, Christiansen I, Harbo T, Jakobsen J. Hemolytic anemia following high dose intravenous immunoglobulin in patients with chronic neurological disorders. Eur J Neurol 2013; 21:147-52. [PMID: 24180709 DOI: 10.1111/ene.12287] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/23/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE High dose intravenous immunoglobulin (IVIG) is an established treatment for various neuromuscular disorders. Recently, cases of hemolytic anemia following IVIG have been observed. The objective of this study was to determine the extent of anemia and hemolysis after IVIG and its relationship to the AB0 blood type system. METHODS In a prospective study 34 de novo treated patients were given 2.0 g/kg bodyweight of Privigen and 50 patients received either Privigen [n = 28; 1.53 ± 0.4 g/kg (mean ± SD)] or Kiovig (n = 22; 1.7 ± 0.4 g/kg) as maintenance therapy. The de novo patients all had a post-polio syndrome, whereas the remaining patients received maintenance therapy for the neuromuscular disorders chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy. Blood sampling was performed before and 2 weeks after infusion of IVIG. RESULTS Following IVIG treatment blood hemoglobin declined from 8.6 ± 0.9 to 8.0 ± 1.2 mM, P < 0.001. Reticulocyte counts and levels of bilirubin and lactate dehydrogenase were increased and haptoglobin levels decreased. The decline of hemoglobin was 0.9 ± 1.2 mM after de novo therapy versus 0.4 ± 0.8 mM after maintenance therapy with Privigen (P = 0.05) and 0.2 ± 0.3 mM after maintenance therapy with Kiovig (P = 0.47). In de novo patients compared with patients on maintenance therapy reticulocyte count and lactate dehydrogenase level increased whereas haptoglobin level decreased. Anemia correlated with the AB0 blood type system with a significant difference between type 0 (n = 17; +0.3 ± 0.4 mM) and type A, B and AB (n = 48; -1.0 ± 1.0 mM), anemia being most pronounced in type AB. CONCLUSION Moderate hemolytic anemia is a concomitant complication of high dose IVIG in subjects with blood types A, B and AB.
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Affiliation(s)
- L H Markvardsen
- Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark
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255
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Ultrasound of inherited vs. acquired demyelinating polyneuropathies. J Neurol 2013; 260:3115-21. [PMID: 24101129 DOI: 10.1007/s00415-013-7123-8] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 12/23/2022]
Abstract
We compared features of nerve enlargement in inherited and acquired demyelinating neuropathies using ultrasound. We measured median and ulnar nerve cross-sectional areas in proximal and distal regions in 128 children and adults with inherited [Charcot-Marie-Tooth-1 (CMT-1) (n = 35)] and acquired [chronic inflammatory demyelinating polyneuropathy (CIDP) (n = 55), Guillaine-Barre syndrome (GBS) (n = 21) and multifocal motor neuropathy (MMN) (n = 17)] demyelinating neuropathies. We classified nerve enlargement by degree and number of regions affected. We defined patterns of nerve enlargement as: none, no enlargement; mild, nerves enlarged but never more than twice normal; regional, nerves normal in at least one region and enlarged more than twice normal in at least one region; diffuse, nerves enlarged at all four regions with at least one region more than twice normal size. Nerve enlargement was commonly diffuse (89 %) and generally more than twice normal size in CMT-1, but not (p < 0.001) in acquired disorders which mostly had either no, mild or regional nerve enlargement [CIDP (64 %), GBS (95 %), and MMN (100 %)]. In CIDP, subjects treated within 3 months of disease onset had less nerve enlargement than those treated later. Ultrasound identified patterns of diffuse nerve enlargement can be used to screen patients suspected of having CMT-1. Normal, mildly, or regionally enlarged nerves in demyelinating polyneuropathy suggests an acquired etiology. Early treatment in CIDP may impede nerve enlargement.
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256
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Uncini A, Notturno F, Capasso M. Natura Non Facit Saltusin Anti-Ganglioside Antibody-Mediated Neuropathies. Muscle Nerve 2013; 48:484-7. [DOI: 10.1002/mus.23881] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Antonino Uncini
- Department of Neuroscience and Imaging; University “G. d'Annunzio,”; Chieti-Pescara Italy
| | - Francesca Notturno
- Department of Neuroscience and Imaging; University “G. d'Annunzio,”; Chieti-Pescara Italy
| | - Margherita Capasso
- Department of Neuroscience and Imaging; University “G. d'Annunzio,”; Chieti-Pescara Italy
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257
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Kusunoki S. [New and future treatments for neurological disorders--knowledge essential to daily clinics and future prospects. Topics: 8. Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2013; 102:1965-1970. [PMID: 24167855 DOI: 10.2169/naika.102.1965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Susumu Kusunoki
- Department of Neurology, Kinki University School of Medicine, Japan
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258
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Briani C, Cacciavillani M, Lucchetta M, Cecchin D, Gasparotti R. MR neurography findings in axonal multifocal motor neuropathy. J Neurol 2013; 260:2420-2. [PMID: 23893000 DOI: 10.1007/s00415-013-7052-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/14/2013] [Accepted: 07/15/2013] [Indexed: 12/01/2022]
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259
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Gilbee ES. Lightning can strike twice: an unlucky patient of neurological interest. BMJ Case Rep 2013; 2013:bcr2013009475. [PMID: 23814000 PMCID: PMC3703035 DOI: 10.1136/bcr-2013-009475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Poliomyelitis, once a worldwide epidemic, is becoming increasingly rare owing to the introduction of the polio vaccine in the 1950s. It is estimated that the number of cases of polio has reduced by 99% since the Global Polio Eradication Initiative (GPEI) started in 1988. Amyotrophic lateral sclerosis (ALS) is another relatively uncommon condition which also affects anterior horn cells with debilitating neurological, and deadly, consequences. An unusual case of an aggressive form of ALS developing in a 72-year-old patient with paralytic poliomyelitis in childhood is presented. Her initial presentation was puzzling, and our approach to the diagnostic dilemma is discussed.
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260
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Buttmann M, Kaveri S, Hartung HP. Polyclonal immunoglobulin G for autoimmune demyelinating nervous system disorders. Trends Pharmacol Sci 2013; 34:445-57. [PMID: 23791035 DOI: 10.1016/j.tips.2013.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/08/2013] [Accepted: 05/22/2013] [Indexed: 12/13/2022]
Abstract
Demyelinating diseases with presumed autoimmune pathogenesis are characterised by direct or indirect immune-mediated damage to myelin sheaths, which normally surround nerve fibres to ensure proper electrical nerve conduction. Parenteral administration of polyclonal IgG purified from multi-donor human plasma pools may beneficially modulate these misguided immune reactions via several mechanisms that are outlined in this review. Convincing therapeutic evidence from controlled trials now exists for certain disorders of the peripheral nervous system, including Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, and multifocal motor neuropathy. In addition, there is evidence for potential therapeutic benefits of IgG in patients with chronic inflammatory demyelinating diseases of the central nervous system, including multiple sclerosis and neuromyelitis optica. This review introduces these disorders, briefly summarises the established treatment options, and discusses therapeutic evidence for the use of polyclonal immunoglobulins with a particular emphasis on recent clinical trials and meta-analyses.
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Affiliation(s)
- Mathias Buttmann
- Department of Neurology, University of Würzburg, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany
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261
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Guimarães-Costa R, Bombelli F, Léger JM. Multifocal motor neuropathy. Presse Med 2013; 42:e217-24. [PMID: 23623583 DOI: 10.1016/j.lpm.2013.01.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 01/13/2013] [Indexed: 11/29/2022] Open
Abstract
Multifocal motor neuropathy (MMN) is a chronic immune-mediated neuropathy that is particular for its asymmetric, multifocal, purely motor clinical presentation, often related to the distribution of individual nerves. Upper limbs are usually primarily and more severely affected, but lower limbs may be involved during the course of the disease. The hallmark of the disease is the presence, in electrophysiological studies, of persistent conduction blocks in the affected motor nerves, located outside the usual sites of nerve compression, contrasting with normal sensory nerve conduction velocities. The most typical laboratory finding is the presence of high levels of serum IgM antibodies to the ganglioside GM1, and less frequently to asialo-GM1, GD1a or GM2. These striking features may help distinguishing this neuropathy from both motor neuron disease and other chronic immune-mediated neuropathies. Several randomized controlled trials (RCT) have established the efficacy of high-dose intravenous immunoglobulin (IVIg), as well as subcutaneous immunoglobulin (SCIg). However, this therapy has a short-lasting effect, and need to be maintained with periodic infusions. This disappointing status has led to the search of other immune therapies whose efficacy has not been so far confirmed in RCT. This review intends to summarize current contents in the diagnosis and the treatment of MMN.
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Affiliation(s)
- Raquel Guimarães-Costa
- Hôpital de la Salpêtrière, Referral Center for Rare Neuromuscular Diseases, Bâtiment Babinski, Paris, France
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262
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Ioannides ZA, Airey C, Fagermo N, Blum S, McCombe PA, Henderson RD, Henderson RJ. Susac syndrome and multifocal motor neuropathy first manifesting in pregnancy. Aust N Z J Obstet Gynaecol 2013; 53:314-7. [PMID: 23521040 DOI: 10.1111/ajo.12069] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/26/2013] [Indexed: 11/27/2022]
Abstract
Susac Syndrome (SS) and multifocal motor neuropathy (MMN) are rare autoimmune neurological conditions which can affect women of childbearing years. The effect of pregnancy on these disorders is poorly characterised. We report a case of SS first manifesting in pregnancy with challenges in diagnosis and management and a poor clinical outcome, and a case of MMN manifesting in pregnancy then relapsing in a subsequent pregnancy. A summary of other cases in the literature and the postulated underlying immune mechanisms is presented.
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Affiliation(s)
- Zara A Ioannides
- Royal Brisbane and Women's Hospital-Neurology, Butterfield Street, Herston, Brisbane, QLD 4029, Australia.
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263
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Abstract
Fatigue, a highly debilitating symptom, is reported in most patients with immune-mediated neuropathies, particularly in Guillain-Barré syndrome, chronic immune-mediated demyelinating polyradiculoneuropathy, monoclonal gammopathy of undetermined significance related polyneuropathy, and multifocal motor neuropathy. Aspects like the degree of known fatigue in these disorders, its impact on daily functioning and quality of life, the suggested underlying mechanisms, and possible therapeutic interventions for fatigue will be addressed in this review.
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264
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Multifocal motor neuropathy, multifocal acquired demyelinating sensory and motor neuropathy, and other chronic acquired demyelinating polyneuropathy variants. Neurol Clin 2013; 31:533-55. [PMID: 23642723 DOI: 10.1016/j.ncl.2013.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Chronic acquired demyelinating neuropathies (CADP) constitute an important group of immune neuromuscular disorders affecting myelin. This article discusses CADP with emphasis on multifocal motor neuropathy, multifocal acquired demyelinating sensory and motor neuropathy, distal acquired demyelinating symmetric neuropathy, and less common variants. Although each of these entities has distinctive laboratory and electrodiagnostic features that aid in their diagnosis, clinical characteristics are of paramount importance in diagnosing specific conditions and determining the most appropriate therapies. Knowledge regarding pathogenesis, diagnosis, and management of these disorders continues to expand, resulting in improved opportunities for identification and treatment.
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265
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Abstract
Multifocal motor neuropathy (MMN) is a rare disorder in which the symptoms are caused by persistent conduction block lesions. The mononeuropathy multiplex progresses over time with increasing axonal loss. The cause of the conduction blocks and axonal loss are not completely understood but immune mechanisms are involved and response to intravenous immunoglobulin has been established. The importance of MMN goes beyond its clinical incidence as the increasing understanding of the pathogenesis of this disorder has implications for other peripheral nerve diseases and for our knowledge of peripheral nerve biology.
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Affiliation(s)
- Ximena Arcila-Londono
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
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266
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[Focal neuropathy]. DER NERVENARZT 2012; 83:1313-24; quiz 1325-6. [PMID: 23015195 DOI: 10.1007/s00115-012-3577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The differential diagnosis of focal neuropathy continues to be one of the main tasks in peripheral neurology and clinical neurophysiology. In this respect a detailed medical history a topologically oriented clinical examination based on profound anatomical knowledge and a targeted neurophysiological examination are the cornerstones of successful diagnosis. Refined imaging techniques, such as sonography and magnetic resonance imaging provide - additional and valuable morphological information especially in atypical or unresolved cases. The aim of this overview is therefore to summarize the spectrum of focal neuropathy and diagnostic approaches, particularly in terms of a well-founded differential diagnosis.
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267
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Baig F, Knopp M, Rajabally YA. Diagnosis, epidemiology and treatment of inflammatory neuropathies. Br J Hosp Med (Lond) 2012; 73:380-5. [PMID: 22875431 DOI: 10.12968/hmed.2012.73.7.380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reviews the main diagnostic, epidemiological and therapeutic issues relating to the three main inflammatory neuropathies: Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy. The current knowledge base and recent developments are described.
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Affiliation(s)
- Fahd Baig
- Department of Neurology, University Hospitals of Leicester, Leicester, UK
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268
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Braine ME, Woodall A. A comparison between intravenous and subcutmaneous immunogobulin. ACTA ACUST UNITED AC 2012; 21:S21-2, S24-7. [PMID: 22629593 DOI: 10.12968/bjon.2012.21.sup8.s21] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Multifocal motor neuropathy (MMN) is a rare immune-mediated disease that presents with predominantly distal motor weakness in one or more limbs without sensory loss. Symptoms may give riseto functional impairment and consequently may affect quality of life. High-dose intravenous immunoglobulin's therapy (IVIg) is the current mainstay treatment, however, subcutaneous immunoglobuli(SCIg) is emerging as a viable alternative. The purpose of this study was to explore the patients' experience of SCIg and ascertain if those receiving it had an improved quality of life and treatmentsatisfaction compared to those receiving IVIg. Using a mixed method approach this paper will present its findings and key implications for clinical and research practice are considered. The results from this study suggest that home SCIg therapy may prove a more desirable treatment option than IVIg for a proportion of MMN patients.
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Affiliation(s)
- Mary E Braine
- School of Nursing, Midwifery and Social Work, College of Health and Social Care, University of Salford
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269
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Padua L, Martinoli C, Pazzaglia C, Lucchetta M, Granata G, Erra C, Briani C. Intra- and internerve cross-sectional area variability: new ultrasound measures. Muscle Nerve 2012; 45:730-3. [PMID: 22499101 DOI: 10.1002/mus.23252] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Nerve involvement in immune-related neuropathies is non-homogeneous, and therefore characterization of ultrasound (US) abnormalities is difficult. We developed two measures to quantify US abnormalities in immune-related neuropathies. METHODS Intranerve cross-sectional area (CSA) variability for each nerve was calculated as: maximal CSA/minimal CSA. Internerve CSA variability for each patient was calculated as: maximal intranerve CSA variability/minimal intranerve CSA variability. Six patients underwent US evaluation of the median, ulnar, and fibular nerves, and the abnormalities were scored with our newly developed measures. RESULTS The new measures were applicable to all nerves and patients. The highest degree of intra- and internerve CSA variability was observed in multifocal motor neuropathy, consistent with the asymmetric characteristics of this neuropathy. CONCLUSIONS The application of intra- and internerve CSA variability measures allows us to quantify the heterogeneity of nerves and nerve segments and identify different US patterns in diverse immune-related neuropathies.
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Affiliation(s)
- Luca Padua
- Department of Neurosciences, Institute of Neurology, Catholic University, Rome, Italy.
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270
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Mostoufizadeh S, Souri M, de Seze J. A case of paraneoplastic demyelinating motor polyneuropathy. Case Rep Neurol 2012; 4:71-6. [PMID: 22649345 PMCID: PMC3362224 DOI: 10.1159/000338296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Peripheral neuropathy is commonly accompanied by cancer but demyelinating ones are not commonly reported. We report the clinical, neurophysiological, and biological characteristics of an 82-year-old patient who presented with a demyelinating motor neuropathy and high titre of anti-ganglioside antibodies associated with oesophageal cancer. The neurological course worsened rapidly despite immunotherapy, leading to a bedridden status. We propose to suspect a paraneoplastic origin in older patients or when the clinical course progresses rapidly within a few weeks or months.
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271
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Park SB, Lin CSY, Burke D, Kiernan MC. Activity-dependent conduction failure: molecular insights. J Peripher Nerv Syst 2012; 16:159-68. [PMID: 22003929 DOI: 10.1111/j.1529-8027.2011.00358.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Weakness and fatigue are commonly encountered symptoms in neurological disorders and significantly impair quality of life. In the case of motor axons, conduction block contributes to weakness and fatigue and may be associated with aberrant nerve activity including fasciculations and cramp. These symptoms result from dysfunction of the constituent channels and pumps of the axonal membrane. In critically conducting axons, impulse conduction can be impaired by the effects of activity or by other mechanisms that produce a significant shift in membrane potential. Conduction failure may be accentuated or relieved by maneuvers that manipulate the time course of the driving current, including the administration of agents that interfere with Na(+) channel function. In patients with inflammatory neuropathies, normal activity may be sufficient to precipitate conduction failure at sites of impaired function in multifocal motor neuropathy (MMN) and chronic inflammatory demyelinating polyneuropathy (CIDP). From a clinical perspective, these features are not assessed adequately by conventional neurophysiological techniques. As weakness and fatigue may only develop following activity or exertion, it is useful to assess the effects of impulse trains to determine the extent of conduction failure and the resulting symptoms in neurological patients. These techniques and the physiological mechanisms underlying the development of activity-dependent hyperpolarization will be critically appraised in this review, with a focus on demyelinating neuropathies, MMN and the neurodegenerative disease, and amyotrophic lateral sclerosis (ALS).
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Affiliation(s)
- Susanna B Park
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
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272
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Riva N, Gallia F, Iannaccone S, Corbo M, Terenghi F, Lazzerini A, Cerri F, Comi G, Quattrini A, Nobile-Orazio E. Chronic motor axonal neuropathy. J Peripher Nerv Syst 2011; 16:341-6. [DOI: 10.1111/j.1529-8027.2011.00366.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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273
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Vlam L, van der Pol WL, Cats EA, Straver DC, Piepers S, Franssen H, van den Berg LH. Multifocal motor neuropathy: diagnosis, pathogenesis and treatment strategies. Nat Rev Neurol 2011; 8:48-58. [PMID: 22105211 DOI: 10.1038/nrneurol.2011.175] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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274
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Cats EA, van der Pol WL, Bertens AS, van den Berg LH. Home-based IVIg treatment is convenient and time-saving in patients with multifocal motor neuropathy. J Peripher Nerv Syst 2011; 16:147-9. [PMID: 21692915 DOI: 10.1111/j.1529-8027.2011.00341.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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275
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O'Ferrall EK, White CM, Zochodne DW. Reply. Muscle Nerve 2011. [DOI: 10.1002/mus.22105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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