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Doneddu PE, Ruiz M, Bianchi E, Liberatore G, Manganelli F, Cocito D, Cosentino G, Benedetti L, Marfia GA, Filosto M, Briani C, Giannotta C, Nobile-Orazio E. A diagnostic score for anti-myelin-associated-glycoprotein neuropathy or chronic inflammatory demyelinating polyradiculoneuropathy in patients with anti-myelin-associated-glycoprotein antibody. Eur J Neurol 2023; 30:501-510. [PMID: 35191144 PMCID: PMC10078711 DOI: 10.1111/ene.15296] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE A diagnostic score was developed to discriminate anti-myelin-associated-glycoprotein (MAG) neuropathy from chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and applied it to patients with atypical anti-MAG neuropathy. METHODS The clinical and electrophysiological features of patients with a diagnosis of typical anti-MAG neuropathy were compared to those of patients with a diagnosis of CIDP. The association of each feature with the diagnosis was assessed in the two groups. Features showing a significant association with the diagnosis were included in a multivariable logistic regression model and adjusted odds ratios were estimated for each feature. A score ranging from 1 to 3 was applied to each feature based on the magnitude of the estimated odds ratios. The score was then applied to patients with a clinical diagnosis of CIDP who also had high anti-MAG antibody titers (CIDP-MAG). RESULTS Thirty-one anti-MAG neuropathy patients, 45 typical CIDP patients and 16 CIDP-MAG patients were included. Scores in anti-MAG antibody patients ranged from 1 to 5 and in CIDP patients from -7 to -1. Using the score, 4/16 CIDP-MAG patients were diagnosed to have anti-MAG neuropathy and 12/16 patients to have CIDP. Response to intravenous immunoglobulin in the CIDP-MAG patients classified as CIDP was similar to that of definite CIDP patients and higher than that of anti-MAG neuropathy patients. CONCLUSIONS Our score allowed an accurate discrimination to be made, amongst patients with anti-MAG antibodies, of those affected by CIDP and the patients with anti-MAG neuropathy. This score may help proper treatment to be chosen for patients with anti-MAG antibodies with a CIDP-like presentation.
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Affiliation(s)
- Pietro E Doneddu
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marta Ruiz
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elisa Bianchi
- Laboratorio di Malattie Neurologiche, IRCCS-Istituto Mario Negri, Milan, Italy
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - Dario Cocito
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Turin, Italy
| | - Giuseppe Cosentino
- IRCCS Foundation C. Mondino National Neurological Institute, Pavia, Italy
| | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Girola A Marfia
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, NeMO-Brescia Clinical Center for Neuromuscular Diseases, University of Brescia, Brescia, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Claudia Giannotta
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
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2
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Koike H, Katsuno M. Paraproteinemia and neuropathy. Neurol Sci 2021; 42:4489-4501. [PMID: 34529193 DOI: 10.1007/s10072-021-05583-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/28/2021] [Indexed: 12/16/2022]
Abstract
Paraproteinemia is associated with different peripheral neuropathies. The major causes of neuropathy correlated with paraproteinemia are the deposition of immunoglobulin in the myelin, represented by anti-myelin-associated glycoprotein (MAG) neuropathy; deposition of immunoglobulin or its fragment in the interstitium, represented by immunoglobulin light chain amyloidosis (AL amyloidosis); and paraneoplastic mechanisms that cannot be solely attributed to the deposition of immunoglobulin or its fragment, represented by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin change (POEMS) syndrome. Patients with anti-MAG neuropathy and POEMS syndrome present with slowing of nerve conduction parameters. This characteristic fulfills the electrodiagnostic criteria for chronic inflammatory demyelinating polyneuropathy (CIDP) defined by the European Academy of Neurology and Peripheral Nerve Society (EAN/PNS). Although direct damage caused by the deposition of amyloid can induce axonal damage in AL amyloidosis, some patients with this condition have features fulfilling the EAN/PNS electrodiagnostic criteria for CIDP. Conventional immunotherapies for CIDP, such as steroids, intravenous immunoglobulin, and plasma exchange, offer no or only minimal-to-modest benefit. Although rituximab can reduce the level of circulating autoantibodies, it may only be effective in some patients with anti-MAG neuropathy. Drugs including melphalan, thalidomide, lenalidomide, and bortezomib for POEMS syndrome and those including melphalan, thalidomide, lenalidomide, pomalidomide, bortezomib, ixazomib, and daratumumab for AL amyloidosis are considered. Since there will be more therapeutic options in the future, thereby enabling appropriate treatments for individual neuropathies, there is an increasing need for early diagnosis.
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Affiliation(s)
- Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
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3
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Long-standing Multifocal Motor Neuropathy Presenting With Delayed Clinical Features of Anti-Myelin-Associated Glycoprotein Neuropathy and Elevated Anti-Myelin-Associated Glycoprotein Antibody Titers. J Clin Neuromuscul Dis 2021; 22:169-172. [PMID: 33596002 DOI: 10.1097/cnd.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Multifocal motor neuropathy with conduction block (MMN) and anti-myelin-associated glycoprotein (MAG) neuropathy are rare chronic acquired demyelinating neuropathies with distinct clinical and electrophysiological characteristics. These neuropathies are generally not known to coexist. This report describes a patient with long-standing MMN who subsequently developed clinical features of anti-MAG neuropathy. This suggests that subtypes of chronic inflammatory neuropathies may not be sharply defined. In addition, a presentation of MMN with anti-MAG titers may be a prognostic indicator of poor response to standard MMN treatment.
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4
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Matà S, Ambrosini S, Saccomanno D, Biagioli T, Carpo M, Amantini A, Giannini F, Barilaro A, Toscani L, Del Mastio M, Comi GP, Sorbi S. Anti-MAG IgM: differences in antibody tests and correlation with clinical findings. Neurol Sci 2019; 41:365-372. [DOI: 10.1007/s10072-019-04089-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/24/2019] [Indexed: 12/28/2022]
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5
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Falzone YM, Campagnolo M, Bianco M, Dacci P, Martinelli D, Ruiz M, Bocci S, Cerri F, Quattrini A, Comi G, Benedetti L, Giannini F, Lauria G, Nobile-Orazio E, Briani C, Fazio R, Riva N. Functioning and quality of life in patients with neuropathy associated with anti-MAG antibodies. J Neurol 2018; 265:2927-2933. [PMID: 30306264 PMCID: PMC6244677 DOI: 10.1007/s00415-018-9081-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/17/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022]
Abstract
Although anti-myelin-associated glycoprotein (MAG) antibody neuropathy is reported as a slowly progressive disease, it can lead to significant disability and impairment of health-related quality of life (HR-QoL) and social participation. The aim of this cross-sectional study was to evaluate the functioning and HR-QoL determinants in 67 patients with anti-MAG neuropathy in terms of the International Classification of Functioning, Disability, and Health (ICF). Evaluations included: Medical Research Council (MRC) sum score, Sensory Modality Sum score (SMS), Berg balance scale (BBS), Fatigue Severity Scale (FSS), Visual Analogue Scale (VAS) for pain, 9-Hole Peg Test (9-HPT), 6-min Walk Distance (6MWD), Impact on Participation and Autonomy (IPA) and the physical component score (PCS) and mental component score (MCS) of the short-form-36 health status scale (SF-36) HR-QoL measure. In the regression models, 6MWD was the most reliable predictor of PCS, explaining the 52% of its variance, while the strongest determinants of 6MWD were BBS and FSS, explaining the 41% of its variance. Consistently, VAS and BBS were good predictor of PCS, explaining together 54% of its variance. FSS was the most reliable determinant of MCS, explaining 25% of its variance. SMS and MRC were not QoL determinants. The results of our study suggest that 6MWD and FSS might be considered as potential meaningful outcome measures in future clinical trials. Furthermore, neurorehabilitation interventions aimed at improving balance and walking performance, fatigue management, and specific pain relief therapy should be considered to ameliorate participation in social life and HR-QoL in anti-MAG neuropathy patients.
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Affiliation(s)
- Yuri M Falzone
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Campagnolo
- Department of Neurosciences, Sciences University of Padova, Padova, Italy
| | - Mariangela Bianco
- Neuromuscular and Neuroimmunology Service, Department of Medical Biotechnology and Translational Medicine, IRCCS Humanitas Clinical and Research Institute, Milan University, Rozzano, Milan, Italy
| | - Patrizia Dacci
- Neurologia III, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Daniele Martinelli
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Ruiz
- Department of Neurosciences, Sciences University of Padova, Padova, Italy
| | - Silvia Bocci
- Department of Medical, Surgical and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Federica Cerri
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angelo Quattrini
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Comi
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita e Salute San Raffaele, Milan, Italy
| | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, IRCCS Policlinico San Martino, Genova, Italy
| | - Fabio Giannini
- Department of Medical, Surgical and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Giuseppe Lauria
- Neurologia III, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, Department of Medical Biotechnology and Translational Medicine, IRCCS Humanitas Clinical and Research Institute, Milan University, Rozzano, Milan, Italy
| | - Chiara Briani
- Department of Neurosciences, Sciences University of Padova, Padova, Italy
| | - Raffaella Fazio
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nilo Riva
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Svahn J, Petiot P, Antoine JC, Vial C, Delmont E, Viala K, Steck AJ, Magot A, Cauquil C, Zarea A, Echaniz-Laguna A, Iancu Ferfoglia R, Gueguen A, Magy L, Léger JM, Kuntzer T, Ferraud K, Lacour A, Camdessanché JP. Anti-MAG antibodies in 202 patients: clinicopathological and therapeutic features. J Neurol Neurosurg Psychiatry 2018; 89:499-505. [PMID: 29070644 DOI: 10.1136/jnnp-2017-316715] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/09/2017] [Accepted: 10/10/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the clinicopathological and therapeutic features of patients with low (≥1000 to <10 000 Bühlmann Titre Units) (BTU), medium (10 000-70 000) or high (≥70 000) anti-myelin-associated glycoprotein (anti-MAG) antibody titres. METHODS We retrospectively and prospectively analysed standardised report forms and medical records of 202 patients from 14 neuromuscular centres. RESULTS Mean age at onset and mean time between symptom onset to last follow-up were respectively 62.6 years (25-91.4) and 8.4 years (0.3-33.3). Anti-MAG antibody titres at diagnosis were low, medium or high in 11%, 51% and 38% of patients. Patients presented with monoclonal gammopathy of undetermined significance in 68% of cases. About 17% of patients presented with 'atypical' clinical phenotype independently of anti-MAG titres, including acute or chronic sensorimotor polyradiculoneuropathies (12.4%), and asymmetric or multifocal neuropathy (3%). At the most severe disease stage, 22.4% of patients were significantly disabled. Seventy-eight per cent of patients received immunotherapies. Transient clinical worsening was observed in 12% of patients treated with rituximab (11/92). Stabilisation after rituximab treatment during the 7-12-month follow-up period was observed in 29% of patients. Clinical response to rituximab during the 6-month and/or 7-12-month follow-up period was observed in 31.5% of patients and correlated with anti-MAG titre ≥10 000 BTU. CONCLUSION Our study highlights the extended clinical spectrum of patients with anti-MAG neuropathy, which appears unrelated to antibody titre. Besides, it may also suggest beneficial use of rituximab in the early phase of anti-MAG neuropathy.
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Affiliation(s)
- Juliette Svahn
- Electroneuromyography and Neuromuscular Department, University Hospital Lyon, Lyon, France
| | - Philippe Petiot
- Electroneuromyography and Neuromuscular Department, University Hospital Lyon, Lyon, France
| | | | - Christophe Vial
- Electroneuromyography and Neuromuscular Department, University Hospital Lyon, Lyon, France
| | - Emilien Delmont
- Department of Neurology, University Hospital Timone, Marseille, France
| | - Karine Viala
- Department of Neurophysiology and Neuropathology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Andreas J Steck
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Armelle Magot
- Neuromuscular Reference Center, University Hospital Nantes, Nantes, France
| | - Cecile Cauquil
- Department of Neurology, University Hospital Bicêtre, Le Kremlin Bicêtre, France
| | - Aline Zarea
- Neuromuscular Competence Center, University Hospital Rouen, Rouen, France
| | | | - Ruxandra Iancu Ferfoglia
- Electroneuromyography and Neuromuscular Disorders Unit, University Hospital Geneva, Geneva, Switzerland
| | - Antoine Gueguen
- Department of Neurology, Fondation Ophtalmologique A. de Rothschild, Paris, France
| | - Laurent Magy
- Department of Neurology, University Hospital Limoges, Limoges, France
| | - Jean-Marc Léger
- Department of Neurology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Thierry Kuntzer
- Department of Clinical Neurosciences, Nerve-Muscle Unit, Neurology Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Karine Ferraud
- Department of Neurology, University Hospital Saint-Etienne, Saint-Etienne, France
| | - Arnaud Lacour
- Department of Neurology, University Hospital Saint-Etienne, Saint-Etienne, France
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7
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Stewart EP, Baudendistel TE, Josephson SA. Unnerving. J Hosp Med 2016; 11:805-808. [PMID: 27339110 DOI: 10.1002/jhm.2629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 05/10/2016] [Accepted: 05/22/2016] [Indexed: 11/10/2022]
Affiliation(s)
- E Pierce Stewart
- Internal Medicine, Kaiser Permanente, Oakland, Oakland, California.
| | | | - S Andrew Josephson
- Department of Neurology, University of California, San Francisco, San Francisco, California, Discussant
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8
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9
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Galassi G, Tondelli M, Ariatti A, Benuzzi F, Nichelli P, Valzania F. Long-term disability and prognostic factors in polyneuropathy associated with anti-myelin-associated glycoprotein (MAG) antibodies. Int J Neurosci 2016; 127:439-447. [PMID: 27188752 DOI: 10.1080/00207454.2016.1191013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM OF THE STUDY Neuropathy associated with IgM monoclonal gammopathy (MGUS) represents distinctive clinical syndrome, characterized by male predominance, late age of onset, slow progression, predominantly sensory symptoms, deep sensory loss, ataxia, minor motor impairment. More than 50% of patients with neuropathy-associated MGUS possess antibodies against myelin-associated glycoprotein (MAG). Purpose of our study was to assess effects on disease progression of demographic, clinical and neurophysiological variables in our large cohort of patients. MATERIALS AND METHODS Forty-three Caucasians patients were followed every eight months for median duration time of 93 months. Extremity strength was assessed with Medical Research Council (MRC) Scale, disability with overall disability status scale (ODSS), modified Rankin Scale and sensory function with Inflammatory Neuropathy Cause and Treatment (INCAT) sensory scale (ISS). Statistical analyses were conducted with parametric or non-parametric measures as appropriate. Survival analysis was used to test predictive value of clinical, demographical and neurophysiological variables. Variance analysis was conducted to explain difference on MRC between patients and groups at different time from onset. RESULTS Results showed that demyelinating pattern, older age and absence of treatment were significant risk factors for disability worsening. No other factors emerged as predictors including gender, ataxia and tremor at baseline, level of anti-MAG and IgM protein concentration in serum. Despite worsening of all outcome measures between first and last visit, quality of life (HRQol) judged by patients did not vary significantly. CONCLUSIONS Our study provides evidence that electrophysiologic pattern, age of onset and absence of treatment are strong predictor of prognosis in anti-MAG polyneuropathy.
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Affiliation(s)
- Giuliana Galassi
- a Department of Biomedical, Metabolic and Neural Science , University of Modena & Reggio Emilia , Modena , Italy
| | - Manuela Tondelli
- a Department of Biomedical, Metabolic and Neural Science , University of Modena & Reggio Emilia , Modena , Italy
| | - Alessandra Ariatti
- a Department of Biomedical, Metabolic and Neural Science , University of Modena & Reggio Emilia , Modena , Italy
| | - Francesca Benuzzi
- a Department of Biomedical, Metabolic and Neural Science , University of Modena & Reggio Emilia , Modena , Italy
| | - Paolo Nichelli
- a Department of Biomedical, Metabolic and Neural Science , University of Modena & Reggio Emilia , Modena , Italy
| | - Franco Valzania
- a Department of Biomedical, Metabolic and Neural Science , University of Modena & Reggio Emilia , Modena , Italy
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10
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Galassi G, Tondelli M. IgM MGUS anti myelin-associated glycoprotein neuropathy can rarely express as a predominantly distal motor neuropathy. Muscle Nerve 2016; 53:827-8. [DOI: 10.1002/mus.25020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Giuliana Galassi
- Department of Biomedical; Metabolic, and Neural Science, University of Modena & Reggio Emilia; Modena Italy
| | - Manuela Tondelli
- Department of Biomedical; Metabolic, and Neural Science, University of Modena & Reggio Emilia; Modena Italy
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11
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Heterogeneity of Polyneuropathy Associated with Anti-MAG Antibodies. J Immunol Res 2015; 2015:450391. [PMID: 26065001 PMCID: PMC4438150 DOI: 10.1155/2015/450391] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 04/07/2015] [Indexed: 11/17/2022] Open
Abstract
Polyneuropathy associated with IgM monoclonal gammopathy and anti-myelin associated glycoprotein (MAG) antibodies is an immune-mediated demyelinating neuropathy. The pathophysiology of this condition is likely to involve anti-MAG antibody deposition on myelin sheaths of the peripheral nerves and it is supposed to be distinct from chronic inflammatory demyelinating neuropathy (CIDP), another immune-mediated demyelinating peripheral neuropathy. In this series, we have retrospectively reviewed clinical and laboratory findings from 60 patients with polyneuropathy, IgM gammopathy, and anti-MAG antibodies. We found that the clinical picture in these patients is highly variable suggesting a direct link between the monoclonal gammopathy and the neuropathy. Conversely, one-third of patients had a CIDP-like phenotype on electrodiagnostic testing and this was correlated with a low titer of anti-MAG antibodies and the absence of widening of myelin lamellae. Our data suggest that polyneuropathy associated with anti-MAG antibodies is less homogeneous than previously said and that the pathophysiology of the condition is likely to be heterogeneous as well with the self-antigen being MAG in most of the patients but possibly being another component of myelin in the others.
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Kawagashira Y, Koike H, Ohyama K, Hashimoto R, Iijima M, Adachi H, Katsuno M, Chapman M, Lunn M, Sobue G. Axonal loss influences the response to rituximab treatment in neuropathy associated with IgM monoclonal gammopathy with anti-myelin-associated glycoprotein antibody. J Neurol Sci 2015; 348:67-73. [DOI: 10.1016/j.jns.2014.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/21/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
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13
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Bridel C, Horvath J, Kurian M, Truffert A, Steck A, Lalive PH. Multifocal motor neuropathy with high titers of anti-MAG antibodies. J Peripher Nerv Syst 2014; 19:180-2. [DOI: 10.1111/jns5.12069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 03/19/2014] [Accepted: 03/31/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Claire Bridel
- Department of Clinical Neurosciences, Division of Neurology; Geneva University Hospital; Geneva Switzerland
| | - Judit Horvath
- Department of Clinical Neurosciences, Division of Neurology; Geneva University Hospital; Geneva Switzerland
| | - Mary Kurian
- Department of Pediatrics; Geneva University Hospital; Geneva Switzerland
| | - André Truffert
- Department of Clinical Neurosciences, Division of Neurology; Geneva University Hospital; Geneva Switzerland
| | - Andreas Steck
- Department of Neurology; Basel University Hospital; Basel Switzerland
| | - Patrice H. Lalive
- Department of Clinical Neurosciences, Division of Neurology; Geneva University Hospital; Geneva Switzerland
- Department of Genetics and Laboratory Medicine, Laboratory Medicine Service; Geneva University Hospital; Geneva Switzerland
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14
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Distinct lymphocytes subsets in IgM-related neuropathy: clinical-immunological correlations. Neurol Sci 2014; 36:303-8. [DOI: 10.1007/s10072-014-1935-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
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Yuki N, Yoshioka A, Horio R, Ohmichi T, Yasuda R, Oka N. [A case of demyelinating polyneuropathy associated with anti-myelin-associated glycoprotein antibodies with progressive quadriparesis and respiratory failure]. Rinsho Shinkeigaku 2014; 54:671-4. [PMID: 25142542 DOI: 10.5692/clinicalneurol.54.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 79-year-old man was admitted due to progressive weakness of both hands for two and a half years. Neurologically, he presented with weakness of the upper limbs, predominantly in the left distal portion, and hypoactive deep tendon reflexes. Nerve conduction studies were consistent with a motor and sensory demyelinating neuropathy. Sural nerve biopsy revealed a decrease of myelinated fibers with a predominance of larger diameter fibers. Widening of myelin lamellae and uncompacted myelin were detected on electron microscopy. Laboratory examinations showed IgM-kappa-type M-protein and anti-myelin-associated glycoprotein (MAG) antibody. He was diagnosed as having anti-MAG-associated demyelinating neuropathy based on the laboratory, electrophysiological, and pathological findings. While no bulbar symptoms or upper motor neuron signs were shown, the patient developed quadriparesis and respiratory failure after three years. Although anti-MAG-associated demyelinating neuropathy is usually characterized by sensory symptoms, particularly sensory ataxia, the present case indicates that motor symptoms such as quadriparesis and respiratory failure can be among the clinical manifestations of antiMAG-associated demyelinating neuropathy.
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Affiliation(s)
- Natsuko Yuki
- Department of Neurology, NHO Maizuru Medical Center
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16
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Abstract
Chronic neuropathies are operationally classified as primarily demyelinating or axonal, on the basis of electrodiagnostic or pathological criteria. Demyelinating neuropathies are further classified as hereditary or acquired-this distinction is important, because the acquired neuropathies are immune-mediated and, thus, amenable to treatment. The acquired chronic demyelinating neuropathies include chronic inflammatory demyelinating polyneuropathy (CIDP), neuropathy associated with monoclonal IgM antibodies to myelin-associated glycoprotein (MAG; anti-MAG neuropathy), multifocal motor neuropathy (MMN), and POEMS syndrome. They have characteristic--though overlapping--clinical presentations, are mediated by distinct immune mechanisms, and respond to different therapies. CIDP is the default diagnosis if the neuropathy is demyelinating and no other cause is found. Anti-MAG neuropathy is diagnosed on the basis of the presence of anti-MAG antibodies, MMN is characterized by multifocal weakness and motor conduction blocks, and POEMS syndrome is associated with IgG or IgA λ-type monoclonal gammopathy and osteosclerotic myeloma. The correct diagnosis, however, can be difficult to make in patients with atypical or overlapping presentations, or nondefinitive laboratory studies. First-line treatments include intravenous immunoglobulin (IVIg), corticosteroids or plasmapheresis for CIDP; IVIg for MMN; rituximab for anti-MAG neuropathy; and irradiation or chemotherapy for POEMS syndrome. A correct diagnosis is required for choosing the appropriate treatment, with the aim of preventing progressive neuropathy.
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Affiliation(s)
- Norman Latov
- Department of Neurology and Neuroscience, Weill Medical College of Cornell University, 1305 York Avenue, Suite 217, New York, NY 10021, USA
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Luigetti M, Padua L, Mazza S, Rossini PM, Sabatelli M, Lo Monaco M. Clinical–neurophysiological correlations in a series of patients with IgM-related neuropathy. Clin Neurophysiol 2013; 124:1899-903. [DOI: 10.1016/j.clinph.2013.02.116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 02/03/2013] [Accepted: 02/18/2013] [Indexed: 01/06/2023]
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Abstract
The association of neuropathy with monoclonal gammopathy has been known for several years, even if the clinical and pathogenetic relevance of this association is not completely defined. This is not a marginal problem since monoclonal gammopathy is present in 1-3% of the population above 50 years in whom it is often asymptomatic, and in at least 8% of patients is associated with a symptomatic neuropathy, representing one of the leading causes of neuropathy in aged people. Monoclonal gammopathy may result from malignant lymphoproliferative diseases including multiple myeloma or solitary plasmocytoma, Waldenström's macroglobulinemia (WM), other IgM-secreting lymphoma or chronic lymphocytic leukemia, and primary systemic amyloidosis (AL). In most instances it is not associated with any of these disorders and is defined monoclonal gammopathy of undetermined significance (MGUS) for its possible, though infrequent, evolution into malignant forms. Several data support the pathogenetic role of the monoclonal gammopathy in the neuropathy particularly when of IgM isotype where IgM reactivity to several neural antigens has been reported. Increased levels of VEGF have been implicated in POEMS syndrome. However, there are as yet no defined therapies for these neuropathies, as their efficacy has not been confirmed in randomized trials.
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Affiliation(s)
- Eduardo Nobile-Orazio
- 2nd Neurology, Department of Translational Medicine, Milan University, IRCCS Humanitas Clinical Institute, Rozzano, Milan, Italy.
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Koike H, Yoshida H, Ito T, Ohyama K, Hashimoto R, Kawagashira Y, Iijima M, Sobue G. Demyelinating neuropathy and autoimmune hemolytic anemia in a patient with pancreatic cancer. Intern Med 2013; 52:1737-40. [PMID: 23903509 DOI: 10.2169/internalmedicine.52.9577] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a patient with pancreatic cancer who manifested features of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and autoimmune hemolytic anemia (AIHA). A 78-year-old Japanese man presented with AIHA and was treated with steroids and splenectomy. Although the AIHA improved following splenectomy, the patient suffered from sensorimotor neuropathy soon after undergoing surgery. The electrophysiological features indicated demyelinating neuropathy. The neuropathy was refractory to immunomodulatory treatment, and intensive investigations revealed pancreatic cancer. The patient's neurological deficits improved significantly after the surgery for cancer. Although the combination of AIHA and CIDP has been reported anecdotally, this is the first case of the coexistence of these diseases as paraneoplastic syndromes.
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Affiliation(s)
- Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
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Luigetti M, Conte A, Montano N, Del Grande A, Madia F, Lo Monaco M, Laurenti L, Sabatelli M. Clinical and pathological heterogeneity in a series of 31 patients with IgM-related neuropathy. J Neurol Sci 2012; 319:75-80. [DOI: 10.1016/j.jns.2012.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
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Diagnostic and therapeutic challenges in chronic inflammatory demyelinating polyneuropathy and other immune-mediated neuropathies. Curr Opin Crit Care 2011; 17:101-5. [DOI: 10.1097/mcc.0b013e328342aded] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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