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Al‐Zuhairy A, Jakobsen J, Krarup C. Prevention of axonal loss after immediate dosage titration of immunoglobulin in multifocal motor neuropathy. Eur J Neurol 2024; 31:e16305. [PMID: 38651498 PMCID: PMC11235608 DOI: 10.1111/ene.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/27/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND To evaluate whether ongoing axonal loss can be prevented in multifocal motor neuropathy (MMN) treated with immunoglobulin G (IgG), a group of patients with a median disease duration of 15.7 years (range: 8.3-37.8), treated with titrated dosages of immunoglobulins, was studied electrophysiologically at time of diagnosis and at follow-up. RESULTS At follow-up, the Z-score of the compound motor action potential amplitude of the median, fibular, and tibial nerves and the neurological performances were determined. In seven patients with a treatment-free period of 0.3 years (0.2-0.4), there was no progression of axonal loss (p = 0.2), whereas a trend toward further axonal loss by 1.3 Z-scores (0.9-17.0, p = 0.06) was observed in five patients with a treatment-free period of 4.0 years (0.9-9.0). The axonal loss in the group with a short treatment delay was significantly smaller than in the group with a longer treatment delay (p = 0.02). Also, there was an association between treatment delay and ongoing axonal loss (p = 0.004). The electrophysiological findings at follow-up were associated with the isokinetic strength performance, the neurological impairment score, and the disability, supporting the clinical relevance of the electrophysiological estimate of axonal loss. CONCLUSION Swift initiation of an immediately titrated IgG dosage can prevent further axonal loss and disability in continuously treated MMN patients.
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Affiliation(s)
- Ali Al‐Zuhairy
- Department of NeurologyCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
| | - Johannes Jakobsen
- Department of NeurologyCopenhagen University Hospital (Rigshospitalet)CopenhagenDenmark
| | - Christian Krarup
- Department of Clinical NeurophysiologyRigshospitaletCopenhagenDenmark
- Department of NeuroscienceUniversity of CopenhagenCopenhagenDenmark
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2
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Stikvoort García DJL, Kovalchuk MO, Goedee HS, van Schelven LJ, van den Berg LH, Franssen H, Sleutjes BTHM. Motor unit integrity in multifocal motor neuropathy: A systematic evaluation with CMAP scans. Muscle Nerve 2021; 65:317-325. [PMID: 34854491 PMCID: PMC9300115 DOI: 10.1002/mus.27469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/09/2022]
Abstract
Introduction/Aims Progressive axonal loss in multifocal motor neuropathy (MMN) is often assessed with nerve conduction studies (NCS), by recording maximum compound muscle action potentials (CMAPs). However, reinnervation maintains the CMAP amplitude until a significant portion of the motor unit (MU) pool is lost. Therefore, we performed more informative CMAP scans to study MU characteristics in a large cohort of patients with MMN. Methods We derived the maximum CMAP amplitude (CMAPmax), an MU number estimate (MUNE), and the largest MU amplitude stimulus current required to elicit 5%, 50%, and 95% of CMAPmax (S5, S50, S95) and relative ranges ([S95 − S5] × 100 / S50) from the scans. These metrics were compared with clinical, laboratory, and NCS results. Results Forty MMN patients and 24 healthy controls were included in the study. CMAPmax and MUNE were reduced in MMN patients (both P < .001). Largest MU amplitude as a percentage of CMAPmax was increased in MMN patients (P < .001). Disease duration and treatment duration were not associated with MUNE. Relative range was larger in patients with anti‐GM1 antibodies than in those without anti‐GM1 antibodies (P = .016) and controls (P < .001). The largest MU amplitudes were larger in patients without anti‐GM1 antibodies than in patients with anti‐GM1 antibodies (P = .037) and controls (P = .044). Discussion We found that MU loss is common in MMN and accompanied by enlarged MUs. Presence of anti‐GM1 antibodies was associated with increased relative range of MU thresholds and reduction in largest MU amplitude. Our findings indicate that CMAP scans complement routine NCS, and may have potential for practical monitoring of treatment efficacy and disease progression.
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Affiliation(s)
| | - Maria O Kovalchuk
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H Stephan Goedee
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Leonard J van Schelven
- Department of Medical Technology and Clinical Physics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hessel Franssen
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Boudewijn T H M Sleutjes
- Department of Neurology, Brain Centre Utrecht, University Medical Centre Utrecht, Utrecht, The Netherlands
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3
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Tsuji Y, Noto YI, Kitaoji T, Kojima Y, Mizuno T. Difference in distribution of fasciculations between multifocal motor neuropathy and amyotrophic lateral sclerosis. Clin Neurophysiol 2020; 131:2804-2808. [PMID: 33137570 DOI: 10.1016/j.clinph.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/28/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine differences in fasciculation distribution between patients with multifocal motor neuropathy (MMN) and amyotrophic lateral sclerosis (ALS) based on muscle ultrasound. METHODS Forty-one muscles (tongue muscle and 40 muscles of the trunk and limbs on both sides) in 5 MMN patients and 21 muscles (tongue muscle and 20 muscles on the onset side) in 21 ALS patients were subjected to muscle ultrasound individually for 60 seconds to detect the presence of fasciculations. RESULTS Fasciculation detection rates on the onset side were significantly higher in ALS (42.4 ± 18.3%, mean ± SD) than in MMN (21.9 ± 8.8%) patients (p < 0.05). In MMN patients, no fasciculation was detected in the tongue or truncal muscles. There was no difference in the fasciculation detection rate between the onset and non-onset sides or between upper and lower limbs in MMN patients. CONCLUSIONS In MMN patients, fasciculations were detected extensively in the limbs. However, the detection rate in patients with MMN was lower than in those with ALS. SIGNIFICANCE Demonstration of the absence of fasciculations in the tongue and truncal muscles in MMN patients by extensive muscle ultrasound examination may help distinguish MMN from ALS.
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Affiliation(s)
- Yukiko Tsuji
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Takamasa Kitaoji
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuta Kojima
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Garg N, Park SB, Howells J, Vucic S, Yiannikas C, Mathey EK, Nguyen T, Noto Y, Barnett MH, Krishnan AV, Spies J, Bostock H, Pollard JD, Kiernan MC. Conduction block in immune-mediated neuropathy: paranodopathy versus axonopathy. Eur J Neurol 2019; 26:1121-1129. [PMID: 30882969 DOI: 10.1111/ene.13953] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Conduction block is a pathognomonic feature of immune-mediated neuropathies. The aim of this study was to advance understanding of pathophysiology and conduction block in chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN). METHODS A multimodal approach was used, incorporating clinical phenotyping, neurophysiology, immunohistochemistry and structural assessments. RESULTS Of 49 CIDP and 14 MMN patients, 25% and 79% had median nerve forearm block, respectively. Clinical scores were similar in CIDP patients with and without block. CIDP patients with median nerve block demonstrated markedly elevated thresholds and greater threshold changes in threshold electrotonus, whilst those without did not differ from healthy controls in electrotonus parameters. In contrast, MMN patients exhibited marked increases in superexcitability. Nerve size was similar in both CIDP groups at the site of axonal excitability. However, CIDP patients with block demonstrated more frequent paranodal serum binding to teased rat nerve fibres. In keeping with these findings, mathematical modelling of nerve excitability recordings in CIDP patients with block support the role of paranodal dysfunction and enhanced leakage of current between the node and internode. In contrast, changes in MMN probably resulted from a reduction in ion channel density along axons. CONCLUSIONS The underlying pathologies in CIDP and MMN are distinct. Conduction block in CIDP is associated with paranodal dysfunction which may be antibody-mediated in a subset of patients. In contrast, MMN is characterized by channel dysfunction downstream from the site of block.
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Affiliation(s)
- N Garg
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - S B Park
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - J Howells
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - S Vucic
- Departments of Neurology and Neurophysiology, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - C Yiannikas
- Department of Neurology, Concord and Royal North Shore Hospitals, University of Sydney, Sydney, NSW, Australia
| | - E K Mathey
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - T Nguyen
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Y Noto
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - M H Barnett
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - A V Krishnan
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - J Spies
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - H Bostock
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK.,Institute of Neurology, University College London, London, UK
| | - J D Pollard
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - M C Kiernan
- Brain and Mind Centre, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Garg N, Howells J, Yiannikas C, Vucic S, Krishnan AV, Spies J, Bostock H, Mathey EK, Pollard JD, Park SB, Kiernan MC. Motor unit remodelling in multifocal motor neuropathy: The importance of axonal loss. Clin Neurophysiol 2017; 128:2022-2028. [DOI: 10.1016/j.clinph.2017.07.414] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 12/13/2022]
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6
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Garg N, Park SB, Vucic S, Yiannikas C, Spies J, Howells J, Huynh W, Matamala JM, Krishnan AV, Pollard JD, Cornblath DR, Reilly MM, Kiernan MC. Differentiating lower motor neuron syndromes. J Neurol Neurosurg Psychiatry 2017; 88:474-483. [PMID: 28003344 PMCID: PMC5529975 DOI: 10.1136/jnnp-2016-313526] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/21/2016] [Indexed: 12/12/2022]
Abstract
Lower motor neuron (LMN) syndromes typically present with muscle wasting and weakness and may arise from pathology affecting the distal motor nerve up to the level of the anterior horn cell. A variety of hereditary causes are recognised, including spinal muscular atrophy, distal hereditary motor neuropathy and LMN variants of familial motor neuron disease. Recent genetic advances have resulted in the identification of a variety of disease-causing mutations. Immune-mediated disorders, including multifocal motor neuropathy and variants of chronic inflammatory demyelinating polyneuropathy, account for a proportion of LMN presentations and are important to recognise, as effective treatments are available. The present review will outline the spectrum of LMN syndromes that may develop in adulthood and provide a framework for the clinician assessing a patient presenting with predominantly LMN features.
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Affiliation(s)
- Nidhi Garg
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Susanna B Park
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Steve Vucic
- Departments of Neurology and Neurophysiology, Westmead Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Con Yiannikas
- Department of Neurology, Concord and Royal North Shore Hospitals, The University of Sydney, Sydney, New South Wales, Australia
| | - Judy Spies
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - James Howells
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - William Huynh
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - José M Matamala
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - John D Pollard
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - David R Cornblath
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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The utility of electrodiagnostic tests for the assessment of medically unexplained weakness and sensory deficit. Clin Neurophysiol Pract 2016; 1:2-8. [PMID: 30214953 PMCID: PMC6123842 DOI: 10.1016/j.cnp.2016.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/10/2016] [Indexed: 12/14/2022] Open
Abstract
Medically unexplained symptoms (MUS) are challenge for electrodiagnostic testing. Weakness and sensory deficit can be manifestations of psychogenic disorders. This is a review of electrodiagnostic methods used for the assessment of MUS.
Patients with suspected medically unexplained symptoms or psychogenic disorders are frequently requested to undergo an EMG exam. However, the suspected diagnosis is not always told to the electromyography practitioner, who must be able to recognize such a condition to avoid false positive diagnosis without dismissing the possibility to uncover any true dysfunction. There are many clinical manoeuvers to assess the consistency of the patients’ reported weakness or sensory deficit. The electrodiagnostic practitioner should be aware of those clinical tricks and interpret the electrodiagnostic findings in the clinical context. There are many electrodiagnostic tests that the practitioner can use for the assessment of motor and sensory functions but these tests have also important drawbacks and limitations. Only after a good clinical evaluation would the practitioner be able to give his/her opinion on the clinical relevance of the electrodiagnostic findings. Here we review some of the tests that can help the practitioner to define the electrophysiological characteristics of a suspected functional disorder presenting with weakness or sensory deficit.
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Huang C, Ouyang Y, Niu H, He N, Ke Q, Jin X, Li D, Fang J, Liu W, Fan C, Lin T. Nerve guidance conduits from aligned nanofibers: improvement of nerve regeneration through longitudinal nanogrooves on a fiber surface. ACS APPLIED MATERIALS & INTERFACES 2015; 7:7189-7196. [PMID: 25786058 DOI: 10.1021/am509227t] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A novel fibrous conduit consisting of well-aligned nanofibers with longitudinal nanogrooves on the fiber surface was prepared by electrospinning and was subjected to an in vivo nerve regeneration study on rats using a sciatic nerve injury model. For comparison, a fibrous conduit having a similar fiber alignment structure without surface groove and an autograft were also conducted in the same test. The electrophysiological, walking track, gastrocnemius muscle, triple-immunofluorescence, and immunohistological analyses indicated that grooved fibers effectively improved sciatic nerve regeneration. This is mainly attributed to the highly ordered secondary structure formed by surface grooves and an increase in the specific surface area. Fibrous conduits made of longitudinally aligned nanofibers with longitudinal nanogrooves on the fiber surface may offer a new nerve guidance conduit for peripheral nerve repair and regeneration.
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Affiliation(s)
- Chen Huang
- †Key Laboratory of Textile Science and Technology, College of Textiles, Donghua University, Shanghai 201620, China
| | - Yuanming Ouyang
- †Key Laboratory of Textile Science and Technology, College of Textiles, Donghua University, Shanghai 201620, China
- ‡Department of Orthopaedic Surgery, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
| | - Haitao Niu
- §Institute for Frontier Materials, Deakin University, Geelong, Victoria 3216, Australia
| | - Nanfei He
- †Key Laboratory of Textile Science and Technology, College of Textiles, Donghua University, Shanghai 201620, China
| | - Qinfei Ke
- †Key Laboratory of Textile Science and Technology, College of Textiles, Donghua University, Shanghai 201620, China
| | - Xiangyu Jin
- †Key Laboratory of Textile Science and Technology, College of Textiles, Donghua University, Shanghai 201620, China
| | - Dawei Li
- †Key Laboratory of Textile Science and Technology, College of Textiles, Donghua University, Shanghai 201620, China
| | - Jun Fang
- †Key Laboratory of Textile Science and Technology, College of Textiles, Donghua University, Shanghai 201620, China
| | - Wanjun Liu
- †Key Laboratory of Textile Science and Technology, College of Textiles, Donghua University, Shanghai 201620, China
| | - Cunyi Fan
- ‡Department of Orthopaedic Surgery, the Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China
| | - Tong Lin
- §Institute for Frontier Materials, Deakin University, Geelong, Victoria 3216, Australia
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Bromberg MB, Franssen H. Practical rules for electrodiagnosis in suspected multifocal motor neuropathy. J Clin Neuromuscul Dis 2015; 16:141-152. [PMID: 25695919 DOI: 10.1097/cnd.0000000000000044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Multifocal motor neuropathy (MMN) with conduction block (CB) is a rare chronic immune-mediated neuropathy, but important to diagnose as it is treatable. The key features in prototypic MMN are electrodiagnostic demonstration of focal CB away from common sites of entrapment and normal sensory conduction across these sites. However, there are challenges in distinguishing CB from the effects of abnormal temporal dispersion. Consensus electrodiagnostic criteria, reinforced by modeling studies, are available to support definite or probable CB. In addition, consideration of technical issues can guard against false-positive and false-negative conclusions. These include limb temperature, stimulus site, inadvertent stimulating electrode movement, and supramaximal and submaximal responses, as well as the possibility of Martin-Gruber anastamosis. Robust evidence supports the treatment of MMN with intravenous immunoglobulin, and guidelines have been developed. Application of practical and simple rules including a 4-step diagnostic algorithm can help practitioners correctly diagnose this treatable condition and improve patient outcomes.
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Affiliation(s)
- Mark B Bromberg
- *Department of Neurology, University of Utah, Salt Lake City, UT; and †Department of Neurology, Neuromuscular Disease Group, Brain Center Rudolf Magnus, University Medical Center, Utrecht, the Netherlands
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Diagnostic Signs of Motor Neuropathy in MR Neurography: Nerve Lesions and Muscle Denervation. Eur Radiol 2014; 25:1497-503. [DOI: 10.1007/s00330-014-3498-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/23/2014] [Accepted: 11/11/2014] [Indexed: 12/30/2022]
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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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Nodo-paranodopathy: Beyond the demyelinating and axonal classification in anti-ganglioside antibody-mediated neuropathies. Clin Neurophysiol 2013; 124:1928-34. [DOI: 10.1016/j.clinph.2013.03.025] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/02/2013] [Accepted: 03/05/2013] [Indexed: 11/21/2022]
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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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Mathis S, Magy L, Diallo L, Boukhris S, Vallat JM. Amyloid neuropathy mimicking chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2011; 45:26-31. [DOI: 10.1002/mus.22229] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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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: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Burrell JR, Yiannikas C, Rowe D, Kiernan MC. Predicting a positive response to intravenous immunoglobulin in isolated lower motor neuron syndromes. PLoS One 2011; 6:e27041. [PMID: 22066029 PMCID: PMC3204999 DOI: 10.1371/journal.pone.0027041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 10/09/2011] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine clinically related characteristics in patients with pure lower motor neuron (LMN) syndromes, not fulfilling accepted diagnostic criteria, who were likely to respond to intravenous immunoglobulin (IVIg) treatment. METHODS Demographic, clinical, laboratory and neurophysiological characteristics were prospectively collected from patients with undifferentiated isolated LMN syndromes who were then treated with IVIg. Patients were classified as either responders or non-responders to therapy with IVIg based on clinical data and the two groups were compared. RESULTS From a total cohort of 42 patients (30 males, 12 females, aged 18-83 years), 31 patients responded to IVIg and 11 did not. Compared to patients that developed progressive neurological decline, responders were typically younger (45.8 compared to 56.0 years, P<0.05) and had upper limb (83.9% compared to 63.6%, NS), unilateral (80.6% compared to 45.5%, P<0.05), and isolated distal (54.1% compared to 9.1%, P<0.05) weakness. Patients with predominantly upper limb, asymmetrical, and distal weakness were more likely to respond to IVIg therapy. Of the patients who responded to treatment, only 12.9% had detectable GM(1) antibodies and conduction block (not fulfilling diagnostic criteria) was only identified in 22.6%. CONCLUSIONS More than 70% of patients with pure LMN syndromes from the present series responded to treatment with IVIg therapy, despite a low prevalence of detectable GM(1) antibodies and conduction block. Patients with isolated LMN presentations, not fulfilling accepted diagnostic criteria, may respond to IVIg therapy, irrespective of the presence of conduction block or GM(1) antibodies, and should be given an empirical trial of IVIg to determine treatment responsiveness.
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Affiliation(s)
- James R. Burrell
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Con Yiannikas
- Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Dominic Rowe
- Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Matthew C. Kiernan
- Neuroscience Research Australia, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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Sartucci F, Bocci T, Borghetti D, Orlandi G, Manfredonia F, Murri L, Giannini F, Rossi A. Further insight on A-wave in acute and chronic demyelinating neuropathies. Neurol Sci 2010; 31:609-16. [DOI: 10.1007/s10072-010-0354-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 06/03/2010] [Indexed: 11/27/2022]
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Delmont E, Benaïm C, Launay M, Sacconi S, Soriani MH, Desnuelle C. Do patients having a decrease in SNAP amplitude during the course of MMN present with a different condition? J Neurol 2009; 256:1876-80. [DOI: 10.1007/s00415-009-5217-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 06/09/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
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