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Soontrapa P, Klein CJ, Dyck PB, Berini SE, McPhail ED, Binder M, Chompoopong P, Engelstad J, Shouman K. Amyloid-like IgM deposition neuropathy with multiple mononeuropathies and generalized neuropathy. Neuromuscul Disord 2023; 33:391-395. [PMID: 37028153 DOI: 10.1016/j.nmd.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 04/08/2023]
Abstract
Amyloid-like IgM deposition neuropathy is a distinct entity in the setting of IgM monoclonal gammopathy in which endoneurial perivascular entire IgM-particle accumulation leads to a painful sensory followed by motor peripheral neuropathy. We report a 77-year-old man presenting with progressive multiple mononeuropathies starting with painless right foot drop. Electrodiagnostic studies showed severe axonal sensory-motor neuropathy superimposed by multiple mononeuropathies. Laboratory investigations were remarkable for biclonal gammopathy of IgM kappa, IgA lambda and severe sudomotor and mild cardiovagal autonomic dysfunction. A right sural nerve biopsy showed multifocal axonal neuropathy, prominent microvasculitis, and prominent large endoneurial deposits of Congo-red negative amorphous material. Laser dissected mass spectrometry-based proteomics identified IgM kappa deposit without serum amyloid-P protein. This case has several distinctive features, including motor preceding sensory involvement, prominent IgM-kappa proteinaceous deposits replacing most of the endoneurium, a prominent inflammatory component, and improvement of motor strength after immunotherapy.
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2
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Zoccarato M, Grisold W, Grisold A, Poretto V, Boso F, Giometto B. Paraneoplastic Neuropathies: What's New Since the 2004 Recommended Diagnostic Criteria. Front Neurol 2021; 12:706169. [PMID: 34659082 PMCID: PMC8517070 DOI: 10.3389/fneur.2021.706169] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/30/2021] [Indexed: 12/22/2022] Open
Abstract
The diagnostic criteria published by the PNS (Paraneoplastic Neurological Syndromes) Euronetwork in 2004 provided a useful classification of PNS, including paraneoplastic neuropathies. Subacute sensory neuronopathy (SSN) was the most frequently observed peripheral PNS, whereas other forms of neuropathy, as sensory polyneuropathy, sensorimotor polyneuropathy, demyelinating neuropathies, autonomic neuropathies, and focal nerve or plexus lesions, were less frequent. At the time of publication, the main focus was on onconeural antibodies, but knowledge regarding the mechanisms has since expanded. The antibodies associated with PNS are commonly classified as onconeural (intracellular) and neuronal surface antibodies (NSAbs). Since 2004, the number of antibodies and the associated tumors has increased. Knowledge has grown on the mechanisms underlying the neuropathies observed in lymphoma, paraproteinemia, and multiple myeloma. Moreover, other unrevealed mechanisms underpin sensorimotor neuropathies and late-stage neuropathies, where patients in advanced stages of cancer—often associated with weight loss—experience some mild sensorimotor neuropathy, without concomitant use of neurotoxic drugs. The spectrum of paraneoplastic neuropathies has increased to encompass motor neuropathies, small fiber neuropathies, and autonomic and nerve hyperexcitability syndromes. In addition, also focal neuropathies, as cranial nerves, plexopathies, and mononeuropathies, are considered in some cases to be of paraneoplastic origin. A key differential diagnosis for paraneoplastic neuropathy, during the course of cancer disease (the rare occurrence of a PNS), is chemotherapy-induced peripheral neuropathy (CIPN). Today, novel complications that also involve the peripheral nervous system are emerging from novel anti-cancer therapies, as targeted and immune checkpoint inhibitor (ICH) treatment. Therapeutic options are categorized into causal and symptomatic. Causal treatments anecdotally mention tumor removal. Immunomodulation is sometimes performed for immune-mediated conditions but is still far from constituting evidence. Symptomatic treatment must always be considered, consisting of both drug therapy (e.g., pain) and attempts to treat disability and neuropathic pain.
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Affiliation(s)
- Marco Zoccarato
- Neurology Unit O.S.A., Azienda Ospedale-Università di Padova, Padova, Italy
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology Donaueschingenstraße 13 A-1200 Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Valentina Poretto
- Neurology Unit, Ospedale S Chiara, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Federica Boso
- Neurology Unit, Ospedale S Chiara, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Bruno Giometto
- Neurology Unit, Ospedale S Chiara, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.,Department of Neurology, University of Trieste, Trieste, Italy
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3
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Sommer C, Carroll AS, Koike H, Katsuno M, Ort N, Sobue G, Vucic S, Spies JM, Doppler K, Kiernan MC. Nerve biopsy in acquired neuropathies. J Peripher Nerv Syst 2021; 26 Suppl 2:S21-S41. [PMID: 34523188 DOI: 10.1111/jns.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/02/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
A diagnosis of neuropathy can typically be determined through clinical assessment and focused investigation. With technological advances, including significant progress in genomics, the role of nerve biopsy has receded over recent years. However, making a specific and, in some cases, tissue-based diagnosis is essential across a wide array of potentially treatable acquired peripheral neuropathies. When laboratory investigations do not suggest a definitive diagnosis, nerve biopsy remains the final step to ascertain the etiology of the disease. The present review highlights the utility of nerve biopsy in confirming a diagnosis, while further illustrating the importance of a tissue-based diagnosis in relation to treatment strategies, particularly when linked to long-term immunosuppressive therapies.
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Affiliation(s)
- Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Antonia S Carroll
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology and Neurophysiology, St Vincent's Hospital, The University of NSW, Sydney, New South Wales, Australia
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nora Ort
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan.,Aichi Medical University, Nagakute, Japan
| | - Steve Vucic
- Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Judith M Spies
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, New South Wales, Australia
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4
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Abstract
Paraproteinaemic neuropathies comprise a heterogeneous group of neuro-haematological conditions with some distinct neurological, haematological and systemic phenotypes. The spectrum of disease varies from mild to severe, indolent to rapidly progressive and from small fibre sensory involvement to dramatic sensorimotor deficits. The haematological association may be overlooked, resulting in delayed treatment, disability, impaired quality of life and increased mortality. However, the presence of an irrelevant benign paraprotein can sometimes lead to inappropriate treatment. In this review, we outline our practical approach to paraproteinaemic disorders, discuss the utility and limitations of diagnostic tests and the distinctive clinical phenotypes and touch on the complex multidisciplinary management approaches.
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Affiliation(s)
- Antonia S Carroll
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,National Hospital for Neurology and Neurosurgery, London, UK
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5
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Kuang Q, Yu J, Zhang X, Yang F, Chen X, Xiao W, Fan Y, Wang Y. Trochlear nerve damage resulting from Waldenstrom's macroglobulinemia: A case report and literature review. Rev Neurol (Paris) 2020; 177:317-319. [PMID: 32807406 DOI: 10.1016/j.neurol.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Qing Kuang
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China.
| | - Juming Yu
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - Xiaodong Zhang
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - Fei Yang
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - Xiaoling Chen
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - Wei Xiao
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - Yang Fan
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
| | - Yirong Wang
- Affiliated Hospital of North Sichuan Medical College Nanchong, 637000 Sichuan, China
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Romano A, Riso V, Bisogni G, Di Paolantonio A, Rossi E, Sabatelli M, Servidei S, Luigetti M. Isolated light chain deposition disease neuropathy in a patient with multiple myeloma. Amyloid 2020; 27:67-68. [PMID: 31566029 DOI: 10.1080/13506129.2019.1669554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | | | | | - Elena Rossi
- UOC Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Mario Sabatelli
- Università Cattolica Del Sacro Cuore, Roma, Italia.,Centro Clinico NEMO Adulti, Roma, Italia
| | - Serenella Servidei
- Università Cattolica Del Sacro Cuore, Roma, Italia.,UOC Neurofisiopatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Marco Luigetti
- Università Cattolica Del Sacro Cuore, Roma, Italia.,UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
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7
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Sural nerve biopsy in peripheral neuropathies: 30-year experience from a single center. Neurol Sci 2019; 41:341-346. [DOI: 10.1007/s10072-019-04082-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/18/2019] [Indexed: 12/15/2022]
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8
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Lizarraga AA, Lizarraga KJ, Hoffman JE, Ascherman DP, Shebert RT, Verma A. Severe mononeuritis multiplex after rituximab in IgM‐κ monoclonal gammopathy. Muscle Nerve 2018; 57:E115-E118. [DOI: 10.1002/mus.26005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/20/2017] [Accepted: 10/31/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Alexis A. Lizarraga
- Department of NeurologyUniversity of Miami School of MedicineMiami Florida USA
| | - Karlo J. Lizarraga
- Department of NeurologyUniversity of Miami School of MedicineMiami Florida USA
| | - James E. Hoffman
- Division of Hematology/Oncology, Sylvester Comprehensive Cancer CenterUniversity of Miami School of MedicineMiami Florida USA
| | - Dana P. Ascherman
- Division of Rheumatology, Department of MedicineUniversity of Miami School of MedicineMiami Florida USA
| | - Robert T. Shebert
- Department of NeurologyUniversity of Miami School of MedicineMiami Florida USA
| | - Ashok Verma
- Department of NeurologyUniversity of Miami School of MedicineMiami Florida USA
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Kadoya M, Kadoya A, Onoue H, Ikewaki K, Shimizu J, Kaida K. Repeated treatments with rituximab in a patient with amyloid-like IgM deposition neuropathy. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2016; 3:e220. [PMID: 27088116 PMCID: PMC4821664 DOI: 10.1212/nxi.0000000000000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/11/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Masato Kadoya
- Department of Neurology and Anti-aging Medicine (M.K., A.K., H.O., K.I., K.K.), National Defense Medical College; and Department of Neurology (J.S.), The University of Tokyo, Japan
| | - Akiko Kadoya
- Department of Neurology and Anti-aging Medicine (M.K., A.K., H.O., K.I., K.K.), National Defense Medical College; and Department of Neurology (J.S.), The University of Tokyo, Japan
| | - Hiroyuki Onoue
- Department of Neurology and Anti-aging Medicine (M.K., A.K., H.O., K.I., K.K.), National Defense Medical College; and Department of Neurology (J.S.), The University of Tokyo, Japan
| | - Katsunori Ikewaki
- Department of Neurology and Anti-aging Medicine (M.K., A.K., H.O., K.I., K.K.), National Defense Medical College; and Department of Neurology (J.S.), The University of Tokyo, Japan
| | - Jun Shimizu
- Department of Neurology and Anti-aging Medicine (M.K., A.K., H.O., K.I., K.K.), National Defense Medical College; and Department of Neurology (J.S.), The University of Tokyo, Japan
| | - Kenichi Kaida
- Department of Neurology and Anti-aging Medicine (M.K., A.K., H.O., K.I., K.K.), National Defense Medical College; and Department of Neurology (J.S.), The University of Tokyo, Japan
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10
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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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11
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Luigetti M, Padua L. Reply to “The significance of significance: Overstating in the setting of many comparisons”. Clin Neurophysiol 2014; 125:1073-4. [DOI: 10.1016/j.clinph.2013.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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12
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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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13
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Castelluccia A, Nociti V, Frisullo G, Batocchi AP. A prospective study on 132 cases of ocular palsy. Eur Neurol 2013; 70:10-5. [PMID: 23652573 DOI: 10.1159/000348717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/28/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES In this prospective study, we used one diagnostic protocol to establish an early diagnosis in patients with ocular palsies in absence of other neurological findings. MATERIALS AND METHODS The study was performed on a consecutive series of 132 patients who visited our Neurological Department for ptosis and/or diplopia in absence of other neurological signs, using the same diagnostic protocol. RESULTS An etiological diagnosis was made in 74% of cases during a mean time of 17 ± 23 months from symptom onset. Myasthenia gravis was the most common diagnosis (n = 60, 45.5%). Thirty-four cases (26%) remained undiagnosed in spite of a follow-up lasting 32 ± 33 months on average. CONCLUSIONS Identifying the cause of an isolated ocular palsy can be difficult, and an extended follow-up time does not aid in further establishment of the diagnosis.
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Affiliation(s)
- A Castelluccia
- Department of Neurosciences, Catholic University, Rome, Italy
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14
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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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15
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Figueroa JJ, Bosch EP, Dyck PJB, Singer W, Vrana JA, Theis JD, Dogan A, Klein CJ. Amyloid-like IgM deposition neuropathy: a distinct clinico-pathologic and proteomic profiled disorder. J Peripher Nerv Syst 2012; 17:182-90. [PMID: 22734903 DOI: 10.1111/j.1529-8027.2012.00406.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Some patients with immunoglobulin paraproteinemic neuropathy have intra-nerve deposits that morphologically mimick amyloid, but do no stain with Congo red. Patients with amyloid-like deposits were identified. The nerve amyloid-like aggregates were studied by laser microdissection and dual mass spectrometry. Three male patients, all with IgM gammopathy, and neuropathy were identified. Follow-up, disease duration was 5, 19, and 7 years, respectively. All had progressive asymmetric sensory-onset distal axonal polyneuropathy with late motor involvement. Autonomic symptoms occurred in only one after 13 years of symptoms. None had clinical cardio-renal involvement. One had skin papules with dermal amyloid-like deposits. Endoneurial amyloid-like deposits had granulo-fibrillar ultrastructure. Mass spectrometry of laser-dissected deposits identified IgM pentameric macroglobulin (heavy, light, and joining chains) without amyloid-associated proteins including absent apolipoprotein E and serum amyloid P-component. Amyloid-like neuropathy has distinct clinical, pathologic, and proteomic features which expand the spectrum of IgM neuropathies. Patients have favorable survival, relative absence of autonomic features, and distinct proteomic profiles of the infiltrative protein in nerve.
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16
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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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17
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Nobile-Orazio E. Update on neuropathies associated with monoclonal gammopathy of undetermined significance (2008-2010). J Peripher Nerv Syst 2011; 15:302-6. [PMID: 21199101 DOI: 10.1111/j.1529-8027.2010.00283.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies on paraproteinemic neuropathies have appeared in the last 2 years improving the diagnosis of these neuropathies, clarifying their pathogenesis, and informing practice by randomized clinical trial publications. Two recent randomized controlled trials with rituximab failed to provide evidence of efficacy in primary outcome measures, despite the fact that anti-myelin-associated glycoprotein (MAG) antibodies were reduced in most treated patients. This discrepancy, besides inducing the search for more effective therapy for this neuropathy, indicates that some aspects on the pathogenesis of this neuropathy probably need further clarification.
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Affiliation(s)
- Eduardo Nobile-Orazio
- 2nd Neurology, Department of Translational Medicine, IRCCS Humanitas Clinical Institute, Milan University, Rozzano, Milan, Italy.
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18
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Cassereau J, Letournel F, François S, Dubas F, Nicolas G. Chronic inflammatory demyelinating polyneuropathy in Waldenström's macroglobulinemia. Rev Neurol (Paris) 2011; 167:343-7. [DOI: 10.1016/j.neurol.2010.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 08/20/2010] [Accepted: 10/26/2010] [Indexed: 10/18/2022]
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