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Giesche N, Böhm‐Gonzalez ST, Kleiser B, Kowarik MC, Dubois E, Stransky E, Armbruster M, Grimm A, Marquetand J. Antiganglioside antibody frequency in routine clinical care settings. Eur J Neurol 2024; 31:e16290. [PMID: 38556758 PMCID: PMC11236029 DOI: 10.1111/ene.16290] [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: 12/19/2023] [Revised: 02/23/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND PURPOSE Antiganglioside antibodies (AGAs) might be involved in the etiopathogenesis of many neurological diseases, such as Miller-Fisher syndrome (MFS) and Guillain-Barré syndrome (GBS). Available comprehensive reference data regarding AGA positivity rates and cross-responsiveness among AGAs (where one line immunoblot is positive for ≥1 AGA) during routine clinical care are scant. METHODS In this 10-year monocentric retrospective study, 3560 immunoglobulin (Ig) G and IgM line blots (GA Generic Assays' Anti-Ganglioside Dot kit) obtained using cerebrospinal fluid (CSF) and serum samples from 1342 patients were analyzed for AGA positivity in terms of 14 diagnosis categories and AGA cross-responsiveness. RESULTS Of all 3560 line blots 158 (4.4%) and of all CSF samples 0.4% (4/924) CSF line blots were AGA positive. For serum IgG, blots with positivity rates higher than the standard deviation of 15.6% were associated with MFS (GD3, GD1a, GT1a and GQ1b) and acute motor axonal neuropathy (AMAN) (GM1, GD1a and GT1a). For serum IgM, blots with positivity rates higher than the standard deviation of 8.1% were associated with AMAN (GM2, GT1a and GQ1b), MFS (GM1, GT1a and GQ1b), multifocal motor neuropathy (MMN) (GM1, GM2 and GQ1b) and chronic inflammatory demyelinating polyneuropathy (CIDP) (GM1). Cross-responsiveness was observed in 39.6% of all positive serum AGA. CONCLUSIONS Testing for AGAs during routine clinical care rarely led to positive findings, both in serum and even less in CSF, except for the diagnoses AMAN, MFS, MMN and CIDP. Nonspecific findings found as cross-responsiveness between different AGA samples occur frequently, impacting the positivity of most AGA subtypes.
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Affiliation(s)
- Niklas Giesche
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Samuel Tobias Böhm‐Gonzalez
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Benedict Kleiser
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Markus C. Kowarik
- Department of Neurology and Stroke, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Evelyn Dubois
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Elke Stransky
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Marcel Armbruster
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Alexander Grimm
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Justus Marquetand
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
- Department of Neural Dynamics and Magnetoencephalography, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
- MEG‐CenterUniversity of TübingenTübingenGermany
- Institute for Modelling and Simulation of Biomechanical SystemsStuttgartGermany
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2
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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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3
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Adreana Kleinveld VE, Wanschitz J, Löscher WN, Hotter A, Cornelia Horlings CG. Deterioration in multifocal motor neuropathy upon treatment of immune-related adverse events of checkpoint inhibition. Immunotherapy 2024; 16:597-601. [PMID: 39052281 PMCID: PMC11287915 DOI: 10.1080/1750743x.2024.2342238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/09/2024] [Indexed: 07/27/2024] Open
Abstract
Immune checkpoint inhibitors (ICIs) have significantly improved the clinical outcome in multiple types of advanced or metastatic malignancies and are prescribed increasingly. However, immune-related adverse events (irAEs) occur frequently. Here, we present a patient with multifocal motor neuropathy and melanoma, with worsening of muscle weakness upon ICI therapy and concomitant use of steroids for the treatment of hepatitis, which was considered an irAE. Upon treatment with highly dosed immunoglobulins and steroid tapering, the patients' muscular symptoms improved while hepatitis resolved. This case highlights the importance of careful evaluation of patients with multifocal motor neuropathy treated with ICIs, highlights the risks of treatment with steroids in multifocal motor neuropathy patients and suggests an alternative treatment of irAEs with intravenous immunoglobulins.
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Affiliation(s)
| | - Julia Wanschitz
- University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Wolfgang N Löscher
- University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Anna Hotter
- University Hospital of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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4
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Allen JA, Clarke AE, Harbo T. A Practical Guide to Identify Patients With Multifocal Motor Neuropathy, a Treatable Immune-Mediated Neuropathy. Mayo Clin Proc Innov Qual Outcomes 2024; 8:74-81. [PMID: 38283096 PMCID: PMC10819864 DOI: 10.1016/j.mayocpiqo.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
Multifocal motor neuropathy (MMN) is a rare immune-mediated motor neuropathy characterized by asymmetric weakness that preferentially affects distal upper limb muscles. The clinical features of MMN may be difficult to differentiate from motor neuron disease. Other conditions that may be mistaken for MMN include inclusion body myositis, chronic inflammatory demyelinating polyradiculoneuropathy, hereditary neuropathy with liability to pressure palsy, focal neuropathies, and radiculopathies. A key distinguishing electrophysiologic feature of MMN is the motor nerve conduction block located at noncompressible sites. MMN is a treatable neuropathy; therefore it is important that primary care physicians are aware of the features of the disease to identify potential patients and make referrals to a neuromuscular specialist in a timely manner. This review provides an overview of the disease, highlights key differential diagnoses, and describes available treatment options for patients with MMN.
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Affiliation(s)
- Jeffrey A. Allen
- Department of Neurology, University of Minnesota, Minneapolis, MN
| | | | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, DK
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5
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Dziadkowiak E, Nowakowska-Kotas M, Rałowska-Gmoch W, Budrewicz S, Koszewicz M. Molecular, Electrophysiological, and Ultrasonographic Differences in Selected Immune-Mediated Neuropathies with Therapeutic Implications. Int J Mol Sci 2023; 24:ijms24119180. [PMID: 37298132 DOI: 10.3390/ijms24119180] [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: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The spectrum of immune-mediated neuropathies is broad and the different subtypes are still being researched. With the numerous subtypes of immune-mediated neuropathies, establishing the appropriate diagnosis in normal clinical practice is challenging. The treatment of these disorders is also troublesome. The authors have undertaken a literature review of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), Guillain-Barre syndrome (GBS) and multifocal motor neuropathy (MMN). The molecular, electrophysiological and ultrasound features of these autoimmune polyneuropathies are analyzed, highlighting the differences in diagnosis and ultimately treatment. The immune dysfunction can lead to damage to the peripheral nervous system. In practice, it is suspected that these disorders are caused by autoimmunity to proteins located in the node of Ranvier or myelin components of peripheral nerves, although disease-associated autoantibodies have not been identified for all disorders. The electrophysiological presence of conduction blocks is another important factor characterizing separate subgroups of treatment-naive motor neuropathies, including multifocal CIDP (synonyms: multifocal demyelinating neuropathy with persistent conduction block), which differs from multifocal motor neuropathy with conduction block (MMN) in both responses to treatment modalities and electrophysiological features. Ultrasound is a reliable method for diagnosing immune-mediated neuropathies, particularly when alternative diagnostic examinations yield inconclusive results. In overall terms, the management of these disorders includes immunotherapy such as corticosteroids, intravenous immunoglobulin or plasma exchange. Improvements in clinical criteria and the development of more disease-specific immunotherapies should expand the therapeutic possibilities for these debilitating diseases.
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Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Marta Nowakowska-Kotas
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Wiktoria Rałowska-Gmoch
- Department of Neurology, The St. Jadwiga's Regional Specialist Neuropsychiatric Centre, Wodociągowa 4, 45-221 Opole, Poland
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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6
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Magy L, Duchesne M, Frachet S, Vallat JM. Neuropatie periferiche. Neurologia 2023. [DOI: 10.1016/s1634-7072(22)47358-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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7
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Li C, Xiong W, Wan B, Kong G, Wang S, Wang Y, Fan J. Role of peripheral immune cells in spinal cord injury. Cell Mol Life Sci 2023; 80:2. [PMID: 36478290 PMCID: PMC9729325 DOI: 10.1007/s00018-022-04644-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
Secondary spinal cord injury is caused by an inflammatory response cascade, and the process is irreversible. The immune system, as a mediator of inflammation, plays an important role in spinal cord injury. The spinal cord retains its immune privilege in a physiological state. Hence, elucidating the mechanisms by which peripheral immune cells are recruited to the lesion site and function after spinal cord injury is meaningful for the exploration of clinical therapeutic targets. In this review, we provide an overview of the multifaceted roles of peripheral immune cells in spinal cord injury.
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Affiliation(s)
- Cong Li
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Wu Xiong
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Bowen Wan
- Department of Orthopaedics, Subei People's Hospital of Jiangsu, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Guang Kong
- Nanjing Medical University, Nanjing, 210029, China
| | - Siming Wang
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yingying Wang
- State Key Laboratory of Natural Medicines, Department of Pharmaceutical Science, China Pharmaceutical University, Nanjing, 210009, China
| | - Jin Fan
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China.
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8
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Value of Antibody Determinations in Chronic Dysimmune Neuropathies. Brain Sci 2022; 13:brainsci13010037. [PMID: 36672019 PMCID: PMC9856104 DOI: 10.3390/brainsci13010037] [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: 11/25/2022] [Revised: 12/12/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Chronic dysimmune neuropathies encompass a group of neuropathies that share immune-mediated pathomechanism. Chronic dysimmune antibody-related neuropathies include anti-MAG neuropathy, multifocal motor neuropathy, and neuropathies related to immune attack against paranodal antigens. Such neuropathies exhibit distinguishing pathomechanism, clinical and response to therapy features with respect to chronic inflammatory demyelinating polyradiculoneuropathy and its variants, which represent the most frequent form of chronic dysimmune neuropathy. This narrative review provides an overview of pathomechanism; clinical, electrophysiological, and biochemical features; and treatment response of the antibody-mediated neuropathies, aiming to establish when and why to look for antibodies in chronic dysimmune neuropathies.
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9
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Briani C, Cocito D, Campagnolo M, Doneddu PE, Nobile-Orazio E. Update on therapy of chronic immune-mediated neuropathies. Neurol Sci 2022; 43:605-614. [PMID: 33452933 DOI: 10.1007/s10072-020-04998-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/12/2020] [Indexed: 12/27/2022]
Abstract
Chronic immune-mediated neuropathies, including chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), neuropathies associated with monoclonal gammopathy, and multifocal motor neuropathy (MMN), are a group of disorders deemed to be caused by an immune response against peripheral nerve antigens. Several immune therapies have been reported to be variably effective in these neuropathies including steroids, plasma exchange, and high-dose intravenous (IVIg) or subcutaneous (SCIg) immunoglobulins. These therapies are however far from being invariably effective and may be associated with a number of side effects leading to the use of immunosuppressive agents whose efficacy has not been so far confirmed in randomized trials. More recently, new biological agents, such as rituximab, have proved to be effective in patients with neuropathy associated with IgM monoclonal gammopathy and are currently tested in CIDP.
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Affiliation(s)
- Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Via Giustiniani, 5, 35128, Padova, Italy.
| | - Dario Cocito
- Istituti Clinici Scientifici Maugeri, Torino, Italy
| | - Marta Campagnolo
- Neurology Unit, Department of Neuroscience, University of Padova, Via Giustiniani, 5, 35128, Padova, Italy
| | - Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute, Rozzano, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
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10
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Suresh K, Mereddy P, Lanciano N, Alam MDU. Anti-ganglioside Complex IgM Antibodies in Multifocal Motor Neuropathy Post-influenza Vaccination. Cureus 2022; 14:e22918. [PMID: 35399455 PMCID: PMC8985558 DOI: 10.7759/cureus.22918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/05/2022] Open
Abstract
Multifocal motor neuropathy (MMN) is a peripheral nerve disorder characterized by progressive, predominantly distal, asymmetric limb weakness with minimal or no sensory impairment, and characterized by the presence of antibodies (30-80% cases), mostly IgM, to the gangliosides, mainly ganglioside monosialic acid (GM1). We describe a case of MMN in a patient who developed symptoms of paresthesia and extremity weakness a few days after receiving the influenza vaccine and was found to have high titers of anti-GM1 IgM antibody levels. He was initially treated with intravenous immune globulin (IVIG) which is one of the mainstays of treatment but relapsed and was then successfully treated with plasma exchange.
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11
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Bocci S, Giannini F, Volpi N, Rossi A, Ginanneschi F. Multifocal motor neuropathy occurring after acute motor axonal neuropathy: two stages of the same disease? Neurol Sci 2021; 43:1463-1465. [PMID: 34800200 DOI: 10.1007/s10072-021-05725-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Silvia Bocci
- Department of Medical, Surgery and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Fabio Giannini
- Department of Medical, Surgery and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Nila Volpi
- Department of Medical, Surgery and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Alessandro Rossi
- Department of Medical, Surgery and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Federica Ginanneschi
- Department of Medical, Surgery and Neurological Sciences, Neurology and Clinical Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy.
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12
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Bakers JNE, van Eijk RPA, van den Berg LH, Visser-Meily JMA, Beelen A. Pattern of muscle strength improvement after intravenous immunoglobulin therapy in multifocal motor neuropathy. Muscle Nerve 2021; 63:678-682. [PMID: 33501670 PMCID: PMC8247955 DOI: 10.1002/mus.27185] [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: 05/28/2020] [Revised: 01/21/2021] [Accepted: 01/23/2021] [Indexed: 11/10/2022]
Abstract
Introduction In multifocal motor neuropathy (MMN), knowledge about the pattern of treatment response in a wide spectrum of muscle groups, distal as well as proximal, after intravenous immunoglobulin (IVIg) initiation is lacking. Methods Hand‐held dynamometry data of 11 upper and lower limb muscles, from 47 patients with MMN was reviewed. Linear mixed models were used to determine the treatment response after IVIg initiation and its relationship with initial muscle weakness. Results All muscle groups showed a positive treatment response after IVIg initiation. Changes in SD scores ranged from +0.1 to +0.95. A strong association between weakness at baseline and the magnitude of the treatment response was found. Discussion Improved muscle strength in response to IVIg appears not only in distal, but to a similar degree also in proximal muscle groups in MMN, with the largest response in muscle groups that show the greatest initial weakness.
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Affiliation(s)
- Jaap N E Bakers
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anita Beelen
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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13
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Chia PK, Hung SKY, Hiew FL. Clinical and functional change in multifocal motor neuropathy treated with IVIg. J Clin Neurosci 2019; 69:114-119. [DOI: 10.1016/j.jocn.2019.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/04/2019] [Indexed: 10/26/2022]
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14
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Li Y, Niu J, Liu T, Guan Y, Wu S, Ding Q, Cui L, Liu M. Motor conduction block and conduction velocity in Lewis-Sumner syndrome and multifocal motor neuropathy. J Clin Neurosci 2019; 67:10-13. [PMID: 31272830 DOI: 10.1016/j.jocn.2019.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/31/2019] [Accepted: 06/21/2019] [Indexed: 11/29/2022]
Abstract
Motor conduction blocks (CBs) and decreased motor nerve conduction velocity (MCV) are both demyelination electrophysiological characteristics. Though CBs are both common in Lewis-Sumner syndrome (LSS) and multifocal motor neuropathy (MMN), they are two distinct disease groups, so their MCV and CBs electrophysiological characteristics may be different. In this paper, we aimed to discuss the relationship between CBs and MCV in Lewis-Sumner syndrome (LSS) and multifocal motor neuropathy (MMN). Sixteen patients with LSS and 11 with MMN were retrospectively collected. Motor nerve conduction studies were performed on bilateral median and ulnar nerves. 16/23 segments with CBs in MMN, and 50/53 segments with CBs in LSS had decreased conduction velocities respectively. There was significant difference in MCV between these two groups (MMN 53.1 ± 12.5 m/s; LSS 34.3 ± 17.1 m/s, mean ± SD, P < 0.05) as well as significant difference in MCV for segment with or without CBs between MMN and LSS patients (P < 0.05). Patients with LSS were prone to be found MCV decrease in segments of motor CB than patients with MMN (P = 0.017). Forty one segments in LSS patients and 6 segments in MMN had MCV ≤ 38 m/s (P < 0.05). There exist two relationships between CB and MCV no matter in LSS or MMN. The characteristics of MCV and CB can be used to distinguish these two disease groups.
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Affiliation(s)
- Yi Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jingwen Niu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Tanxin Liu
- Department of Medical English, Peking University Health Science Center, Beijing 100191, China
| | - Yuzhou Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Shuang Wu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Qingyun Ding
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China; Neuroscience Center, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
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15
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Léger JM, Alfa Cissé O, Cocito D, Grouin JM, Katifi H, Nobile-Orazio E, Ouaja R, Pouget J, Rajabally YA, Sevilla T, Merkies ISJ. IqYmune® is an effective maintenance treatment for multifocal motor neuropathy: A randomised, double-blind, multi-center cross-over non-inferiority study vs Kiovig®-The LIME Study. J Peripher Nerv Syst 2018; 24:56-63. [PMID: 30456899 PMCID: PMC6590491 DOI: 10.1111/jns.12291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 12/16/2022]
Abstract
Intravenous immunoglobulin (IVIg) is the gold‐standard for maintenance treatment of multifocal motor neuropathy (MMN). This phase III, randomised, double‐blind, multi‐centre, active‐control, crossover study, aimed to evaluate the non‐inferiority of IqYmune® relative to Kiovig®, primarily based on efficacy criteria. Twenty‐two adult MMN patients, treated with any brand of IVIg (except Kiovig® or IqYmune®) at a stable maintenance dose within the range of 1 to 2 g/kg every 4 to 8 weeks, were randomised to receive either Kiovig® followed by IqYmune®, or IqYmune® followed by Kiovig®. Each product was administered for 24 weeks. The primary endpoint was the difference between IqYmune® and Kiovig® in mean assessments of modified Medical Research Council (MMRC) 10 sum score (strength of 5 upper‐limb and 5 lower‐limb muscle groups, on both sides, giving a score from 0 to 100) during the evaluation period (non‐inferiority margin of Δ = 2). A linear mixed model analysis demonstrated the non‐inferiority of IqYmune® relative to Kiovig®, independently of the covariates (value at baseline, treatment period, and treatment sequence). The estimated “IqYmune® − Kiovig®” difference was −0.01, with a 95% confidence interval (CI) −0.51 to 0.48. The number of adverse reactions (ARs) and the percentage of patients affected were similar for the two products: 39 ARs in 10 patients with IqYmune® vs 32 ARs in 11 patients with Kiovig®. No thromboembolic events nor haemolysis nor renal impairment were observed. In this first clinical trial comparing two IVIg brands for maintenance treatment of MMN, efficacy and tolerability of both brands were similar.
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Affiliation(s)
- Jean-Marc Léger
- National Referral Center for Neuromuscular Diseases, University Hospital Pitié-Salpétrière, Paris, France
| | | | - Dario Cocito
- Department of Neurosciences, Molinette Hospital, Università degli Studi di Torino, Torino, Italy
| | | | - Haider Katifi
- Wessex Neurological Centre, Southampton General Hospital, Southampton, UK
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, Humanitas Clinical and Research Center, Milan University, Milan, Italy
| | - Rabye Ouaja
- Global Medical Affairs, LFB, Les Ulis, France
| | - Jean Pouget
- National Referral Center for Neuromuscular Diseases, University Hospital La Timone, Marseille, France
| | - Yusuf A Rajabally
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK
| | - Teresa Sevilla
- Neurology Department, La Fe University Hospital, Centro de investigación Biomédica en red de enfermedades raras (CIBERER), University of Valencia, Valencia, Spain
| | - Ingemar S J Merkies
- Maastricht University Medical Center, Maastricht, The Netherlands.,St. Elisabeth Hospital, Willemstad, Curacao
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16
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B lymphocytes: Crucial contributors to brain development and neurological diseases. Neurosci Res 2018; 139:37-41. [PMID: 30009855 DOI: 10.1016/j.neures.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 01/06/2023]
Abstract
The immune system is a major contributor to brain homeostasis and pathogenesis of neurological diseases. However, the role of B lymphocytes (cells) in the brain is poorly understood. In this review, we describe the functions of the different subtypes of B cells in brain development and neurological diseases. B cells are classified into several subtypes according their function and gene expression. B-1a cells, which participate in innate immunity by producing natural antibodies, are abundant in the developing brain, and mediate oligodendrocyte development. In conditions such as autoimmune encephalomyelitis, spinal cord injury, and stroke, B-2 cells exacerbate the pathology by producing pathogenic autoantibodies. On the other hand, regulatory B cells suppress inflammation by secreting interleukin-10 and play beneficial roles in pathological conditions. Here, we summarize the distribution and function of B cells during brain development and neurological diseases.
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17
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Bone MA. Multifocal Motor Neuropathy: A clinical case study. AUSTRALASIAN JOURNAL OF NEUROSCIENCE 2018. [DOI: 10.21307/ajon-2017-011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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18
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Neuropatie motorie multifocali con blocco della conduzione. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)85563-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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19
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Philibert M, Grapperon AM, Delmont E, Attarian S. Monitoring the short-term effect of intravenous immunoglobulins in multifocal motor neuropathy using motor unit number index. Clin Neurophysiol 2017; 128:235-240. [PMID: 27988478 DOI: 10.1016/j.clinph.2016.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/30/2016] [Accepted: 11/12/2016] [Indexed: 12/12/2022]
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20
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Chardon JW, Jasmin BJ, Kothary R, Parks RJ. Report on the 3rd Ottawa International Conference on Neuromuscular Biology, Disease and Therapy - September 24-26, 2015, Ottawa, Canada. J Neuromuscul Dis 2016; 3:431-442. [PMID: 27854234 PMCID: PMC5123627 DOI: 10.3233/jnd-169001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jodi Warman Chardon
- Department of Medicine, The Ottawa Hospital and University of Ottawa.,Centre for Neuromuscular Disease, University of Ottawa.,Department of Pediatrics (Genetics), Children's Hospital of Eastern Ontario.,Neurosciences and Clinical Epidemiology Programs, Ottawa Hospital Research Institute
| | - Bernard J Jasmin
- Centre for Neuromuscular Disease, University of Ottawa.,Department of Cellular and Molecular Medicine, University of Ottawa
| | - Rashmi Kothary
- Regenerative Medicine Program, Ottawa Hospital Research Institute.,Department of Medicine, The Ottawa Hospital and University of Ottawa.,Centre for Neuromuscular Disease, University of Ottawa.,Department of Cellular and Molecular Medicine, University of Ottawa
| | - Robin J Parks
- Regenerative Medicine Program, Ottawa Hospital Research Institute.,Department of Medicine, The Ottawa Hospital and University of Ottawa.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa.,Centre for Neuromuscular Disease, University of Ottawa
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21
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Abstract
Immunotherapy has been investigated in a small subset of peripheral neuropathies, including an acute one, Guillain-Barré syndrome, and 3 chronic forms: chronic inflammatory demyelinating polyradiculoneuropathy, multifocal motor neuropathy, and neuropathy associated with IgM anti-myelin-associated glycoprotein. Several experimental studies and clinical data are strongly suggestive of an immune-mediated pathogenesis. Either cell-mediated mechanisms or antibody responses to Schwann cell, compact myelin, or nodal antigens are considered to act together in an aberrant immune response to cause damage to peripheral nerves. Immunomodulatory treatments used in these neuropathies aim to act at various steps of this pathogenic process. However, there are many phenotypic variants and, consequently, there is a significant difference in the response to immunotherapy between these neuropathies, as well as a need to improve our knowledge and long-term management of chronic forms.
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Affiliation(s)
- Jean-Marc Léger
- National Referral Center for Rare Neuromuscular Diseases, Institut Hospitalo-Universitaire de Neurosciences, University Hospital Pitié-Salpêtrière and University Pierre et Marie Curie (Paris VI), Paris, France.
| | - Raquel Guimarães-Costa
- National Referral Center for Rare Neuromuscular Diseases, Institut Hospitalo-Universitaire de Neurosciences, University Hospital Pitié-Salpêtrière and University Pierre et Marie Curie (Paris VI), Paris, France
| | - Cristina Muntean
- National Referral Center for Rare Neuromuscular Diseases, Institut Hospitalo-Universitaire de Neurosciences, University Hospital Pitié-Salpêtrière and University Pierre et Marie Curie (Paris VI), Paris, France
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22
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Jovanovich E, Karam C. Human immune globulin infusion in the management of multifocal motor neuropathy. Degener Neurol Neuromuscul Dis 2015; 6:1-12. [PMID: 30050363 PMCID: PMC6053084 DOI: 10.2147/dnnd.s96258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Multifocal motor neuropathy (MMN) is a debilitating and rare disease causing profound weakness with minimal to no sensory symptoms. Conduction block is frequently seen on electrodiagnostic testing. An immune-mediated pathology is suspected though the exact underlying pathophysiology has yet to be elucidated. The presence of anti-GM1 ganglioside IgM antibodies coupled with favorable response to intravenous and subcutaneous immunoglobulins supports a complement-mediated mechanism which leads to destruction of nerve tissue with probable predilection to the nodes of Ranvier. High-dose immunoglobulin currently is the only treatment with proven efficacy for MMN patients. Unfortunately, many patients experience decreased responsiveness to immunoglobulins over time, requiring higher and more frequent dosing. In this review, we will focus on the pharmacology, efficacy, safety, and tolerability of intravenous and subcutaneous immune globulin infusion for treatment of MMN.
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Affiliation(s)
| | - Chafic Karam
- Department of Neurology, The University of North Carolina, Chapel Hill, NC, USA,
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23
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Amyotrophic lateral sclerosis, channelopathies and peripheral neuropathies: current status and new perspectives. Curr Opin Neurol 2015; 28:453-4. [PMID: 26356409 DOI: 10.1097/wco.0000000000000247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Applying complement therapeutics to rare diseases. Clin Immunol 2015; 161:225-40. [PMID: 26341313 DOI: 10.1016/j.clim.2015.08.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 02/06/2023]
Abstract
Around 350 million people worldwide suffer from rare diseases. These may have a genetic, infectious, or autoimmune basis, and several include an inflammatory component. Launching of effective treatments can be very challenging when there is a low disease prevalence and limited scientific insights into the disease mechanisms. As a key trigger of inflammatory processes, complement has been associated with a variety of diseases and has become an attractive therapeutic target for conditions involving inflammation. In view of the clinical experience acquired with drugs licensed for the treatment of rare diseases such as hereditary angioedema and paroxysmal nocturnal hemoglobinuria, growing evidence supports the safety and efficacy of complement therapeutics in restoring immune balance and preventing aggravation of clinical outcomes. This review provides an overview of the candidates currently in the pharmaceutical pipeline with potential to treat orphan diseases and discusses the molecular mechanisms triggered by complement involved with the disease pathogenesis.
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