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Published in: Journal of Clinical Immunology 1/2014

01-07-2014

Treatment of Multifocal Motor Neuropathy with Intravenous Immunoglobulin

Author: Carol Lee Koski

Published in: Journal of Clinical Immunology | Special Issue 1/2014

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Abstract

Multifocal motor neuropathy (MMN) is a rare inflammatory, chronically progressive, unremitting disorder affecting the peripheral nervous system. Although the etiology of this condition is not known, high titers of IgM Ab to GM1 may serve as a biomarker for this disease. Clinical findings of motor weakness are associated with focal conduction blocks and with time, axonal destruction. Evidence supporting an immune etiology as well as the use of intravenous immunoglobulin to limit the disease progression is reviewed.
Literature
1.
go back to reference Dimachkie MM, Barohn RJ, Katz J. Multifocal motor neuropathy, multifocal acquired demyelinating sensory and motor neuropathy, and other chronic acquired demyelinating polyneuropathy variants. Neurol Clin. 2013;31(2):533–55.PubMedCrossRef Dimachkie MM, Barohn RJ, Katz J. Multifocal motor neuropathy, multifocal acquired demyelinating sensory and motor neuropathy, and other chronic acquired demyelinating polyneuropathy variants. Neurol Clin. 2013;31(2):533–55.PubMedCrossRef
2.
go back to reference Van den Berg-Vos RM, Franssen H, Wokke JH, Van Es HW, Van den Berg LH. Multifocal motor neuropathy: diagnostic criteria that predict the response to immunoglobulin treatment. Ann Neurol. 2000;48(6):919–26.PubMedCrossRef Van den Berg-Vos RM, Franssen H, Wokke JH, Van Es HW, Van den Berg LH. Multifocal motor neuropathy: diagnostic criteria that predict the response to immunoglobulin treatment. Ann Neurol. 2000;48(6):919–26.PubMedCrossRef
3.
go back to reference Nobile-Orazio E, Cappellari A, Meucci N, Carpo M, Terenghi F, Bersano A, et al. Multifocal motor neuropathy: clinical and immunological features and response to IVIg in relation to the presence and degree of motor conduction block. J Neurol Neurosurg Psychiatry. 2002;72(6):761–6.PubMedCentralPubMedCrossRef Nobile-Orazio E, Cappellari A, Meucci N, Carpo M, Terenghi F, Bersano A, et al. Multifocal motor neuropathy: clinical and immunological features and response to IVIg in relation to the presence and degree of motor conduction block. J Neurol Neurosurg Psychiatry. 2002;72(6):761–6.PubMedCentralPubMedCrossRef
4.
go back to reference Vlam L, van der Pol WL, Cats EA, Straver DC, Piepers S, Franssen H, et al. Multifocal motor neuropathy: diagnosis, pathogenesis and treatment strategies. Nat Rev Neurol. 2012;8(1):48–58. Vlam L, van der Pol WL, Cats EA, Straver DC, Piepers S, Franssen H, et al. Multifocal motor neuropathy: diagnosis, pathogenesis and treatment strategies. Nat Rev Neurol. 2012;8(1):48–58.
5.
go back to reference Eftimov F, Van Schaik IN. Immunotherapy of multifocal motor neuropathy. Expert Opin Biol Ther. 2011;11(3):329–42.PubMedCrossRef Eftimov F, Van Schaik IN. Immunotherapy of multifocal motor neuropathy. Expert Opin Biol Ther. 2011;11(3):329–42.PubMedCrossRef
6.
go back to reference Meuth SG, Kleinschnitz C. Multifocal motor neuropathy: update on clinical characteristics, pathophysiological concepts and therapeutic options. Eur Neurol. 2010;63(4):193–204.PubMedCrossRef Meuth SG, Kleinschnitz C. Multifocal motor neuropathy: update on clinical characteristics, pathophysiological concepts and therapeutic options. Eur Neurol. 2010;63(4):193–204.PubMedCrossRef
7.
go back to reference Taylor BV, Dyck PJ, Engelstad J, Gruener G, Grant I, Dyck PJ. Multifocal motor neuropathy: pathologic alterations at the site of conduction block. J Neuropathol Exp Neurol. 2004;63(2):129–37.PubMed Taylor BV, Dyck PJ, Engelstad J, Gruener G, Grant I, Dyck PJ. Multifocal motor neuropathy: pathologic alterations at the site of conduction block. J Neuropathol Exp Neurol. 2004;63(2):129–37.PubMed
8.
go back to reference Corse AM, Chaudhry V, Crawford TO, Cornblath DR, Kuncl RW, Griffin JW. Sensory nerve pathology in multifocal motor neuropathy. Ann Neurol. 1996;39(3):319–25.PubMedCrossRef Corse AM, Chaudhry V, Crawford TO, Cornblath DR, Kuncl RW, Griffin JW. Sensory nerve pathology in multifocal motor neuropathy. Ann Neurol. 1996;39(3):319–25.PubMedCrossRef
9.
go back to reference Cats EA, van der Pol WL, Piepers S, Franssen H, Jacobs BC, van den Berg-Vos RM, et al. Correlates of outcome and response to IVIg in 88 patients with multifocal motor neuropathy. Neurology. 2010;75(9):818–25.PubMedCrossRef Cats EA, van der Pol WL, Piepers S, Franssen H, Jacobs BC, van den Berg-Vos RM, et al. Correlates of outcome and response to IVIg in 88 patients with multifocal motor neuropathy. Neurology. 2010;75(9):818–25.PubMedCrossRef
10.
go back to reference Hahn AF, Beydoun SR, Lawson V, Oh MS, Empson VG, Leibl H, et al. A controlled trial of intravenous immunoglobulin in multifocal motor neuropathy. J Peripher Nerv Syst. 2013;18(4):321–30.PubMedCrossRef Hahn AF, Beydoun SR, Lawson V, Oh MS, Empson VG, Leibl H, et al. A controlled trial of intravenous immunoglobulin in multifocal motor neuropathy. J Peripher Nerv Syst. 2013;18(4):321–30.PubMedCrossRef
11.
go back to reference Cats EA, Jacobs BC, Yuki N, Tio-Gillen AP, Piepers S, Franssen H, et al. Multifocal motor neuropathy: association of anti-GM1 IgM antibodies with clinical features. Neurology. 2010;75(22):1961–7.PubMedCrossRef Cats EA, Jacobs BC, Yuki N, Tio-Gillen AP, Piepers S, Franssen H, et al. Multifocal motor neuropathy: association of anti-GM1 IgM antibodies with clinical features. Neurology. 2010;75(22):1961–7.PubMedCrossRef
12.
go back to reference Pestronk A, Cornblath DR, Ilyas AA, Baba H, Quarles RH, Griffin JW, et al. A treatable multifocal motor neuropathy with antibodies to GM1 ganglioside. Ann Neurol. 1988;24(1):73–8.PubMedCrossRef Pestronk A, Cornblath DR, Ilyas AA, Baba H, Quarles RH, Griffin JW, et al. A treatable multifocal motor neuropathy with antibodies to GM1 ganglioside. Ann Neurol. 1988;24(1):73–8.PubMedCrossRef
13.
go back to reference Galban-Horcajo F, Fitzpatrick AM, Hutton AJ, Dunn SM, Kalna G, Brennan KM, et al. Antibodies to heteromeric glycolipid complexes in multifocal motor neuropathy. Eur J Neurol Off J Eur Fed Neurol Soc. 2013;20(1):62–70. Galban-Horcajo F, Fitzpatrick AM, Hutton AJ, Dunn SM, Kalna G, Brennan KM, et al. Antibodies to heteromeric glycolipid complexes in multifocal motor neuropathy. Eur J Neurol Off J Eur Fed Neurol Soc. 2013;20(1):62–70.
14.
go back to reference Willison HJ, Yuki N. Peripheral neuropathies and anti-glycolipid antibodies. Brain. 2002;125(Pt 12):2591–625.PubMedCrossRef Willison HJ, Yuki N. Peripheral neuropathies and anti-glycolipid antibodies. Brain. 2002;125(Pt 12):2591–625.PubMedCrossRef
15.
go back to reference Yuki N, Kuwabara S. Axonal Guillain-Barre syndrome: carbohydrate mimicry and pathophysiology. J Peripher Nerv Syst. 2007;12(4):238–49.PubMedCrossRef Yuki N, Kuwabara S. Axonal Guillain-Barre syndrome: carbohydrate mimicry and pathophysiology. J Peripher Nerv Syst. 2007;12(4):238–49.PubMedCrossRef
16.
go back to reference Yuki N, Watanabe H, Nakajima T, Spath PJ. IVIG blocks complement deposition mediated by anti-GM1 antibodies in multifocal motor neuropathy. J Neurol Neurosurg Psychiatry. 2011;82(1):87–91.PubMedCrossRef Yuki N, Watanabe H, Nakajima T, Spath PJ. IVIG blocks complement deposition mediated by anti-GM1 antibodies in multifocal motor neuropathy. J Neurol Neurosurg Psychiatry. 2011;82(1):87–91.PubMedCrossRef
17.
go back to reference Takigawa T, Yasuda H, Kikkawa R, Shigeta Y, Saida T, Kitasato H. Antibodies against GM1 ganglioside affect K+ and Na+ currents in isolated rat myelinated nerve fibers. Ann Neurol. 1995;37(4):436–42.PubMedCrossRef Takigawa T, Yasuda H, Kikkawa R, Shigeta Y, Saida T, Kitasato H. Antibodies against GM1 ganglioside affect K+ and Na+ currents in isolated rat myelinated nerve fibers. Ann Neurol. 1995;37(4):436–42.PubMedCrossRef
18.
go back to reference Duarte-Rey C, Bogdanos DP, Leung PS, Anaya JM, Gershwin ME. IgM predominance in autoimmune disease: genetics and gender. Autoimmun Rev. 2012;11(6–7):A404–12.PubMedCrossRef Duarte-Rey C, Bogdanos DP, Leung PS, Anaya JM, Gershwin ME. IgM predominance in autoimmune disease: genetics and gender. Autoimmun Rev. 2012;11(6–7):A404–12.PubMedCrossRef
19.
go back to reference Chaudhry V, Cornblath DR. An open-label trial of rituximab (Rituxan(R)) in multifocal motor neuropathy. J Peripher Nerv Syst. 2010;15(3):196–201.PubMedCrossRef Chaudhry V, Cornblath DR. An open-label trial of rituximab (Rituxan(R)) in multifocal motor neuropathy. J Peripher Nerv Syst. 2010;15(3):196–201.PubMedCrossRef
20.
go back to reference Carpo M, Cappellari A, Mora G, Pedotti R, Barbieri S, Scarlato G, et al. Deterioration of multifocal motor neuropathy after plasma exchange. Neurology. 1998;50(5):1480–2.PubMedCrossRef Carpo M, Cappellari A, Mora G, Pedotti R, Barbieri S, Scarlato G, et al. Deterioration of multifocal motor neuropathy after plasma exchange. Neurology. 1998;50(5):1480–2.PubMedCrossRef
21.
go back to reference Umapathi T, Hughes RA, Nobile-Orazio E, Leger JM. Immunosuppressant and immunomodulatory treatments for multifocal motor neuropathy. Cochrane Database Syst Rev. 2009;1, CD003217.PubMed Umapathi T, Hughes RA, Nobile-Orazio E, Leger JM. Immunosuppressant and immunomodulatory treatments for multifocal motor neuropathy. Cochrane Database Syst Rev. 2009;1, CD003217.PubMed
22.
go back to reference Van Asseldonk JT, Van den Berg LH, Kalmijn S, Van den Berg-Vos RM, Polman CH, Wokke JH, et al. Axon loss is an important determinant of weakness in multifocal motor neuropathy. J Neurol Neurosurg Psychiatry. 2006;77(6):743–7.PubMedCentralPubMedCrossRef Van Asseldonk JT, Van den Berg LH, Kalmijn S, Van den Berg-Vos RM, Polman CH, Wokke JH, et al. Axon loss is an important determinant of weakness in multifocal motor neuropathy. J Neurol Neurosurg Psychiatry. 2006;77(6):743–7.PubMedCentralPubMedCrossRef
23.
go back to reference Vucic S, Black KR, Chong PS, Cros D. Multifocal motor neuropathy: decrease in conduction blocks and reinnervation with long-term IVIg. Neurology. 2004;63(7):1264–9.PubMedCrossRef Vucic S, Black KR, Chong PS, Cros D. Multifocal motor neuropathy: decrease in conduction blocks and reinnervation with long-term IVIg. Neurology. 2004;63(7):1264–9.PubMedCrossRef
24.
go back to reference Terenghi F, Cappellari A, Bersano A, Carpo M, Barbieri S, Nobile-Orazio E. How long is IVIg effective in multifocal motor neuropathy? Neurology. 2004;62(4):666–8.PubMedCrossRef Terenghi F, Cappellari A, Bersano A, Carpo M, Barbieri S, Nobile-Orazio E. How long is IVIg effective in multifocal motor neuropathy? Neurology. 2004;62(4):666–8.PubMedCrossRef
25.
go back to reference Joint Task Force of the E, the PNS. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of multifocal motor neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society--first revision. J Peripher Nerv Syst. 2010;15(4):295–301.CrossRef Joint Task Force of the E, the PNS. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of multifocal motor neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society--first revision. J Peripher Nerv Syst. 2010;15(4):295–301.CrossRef
26.
go back to reference van Schaik IN, van den Berg LH, de Haan R, Vermeulen M. Intravenous immunoglobulin for multifocal motor neuropathy. Cochrane Database Syst Rev. 2005;2, CD004429.PubMed van Schaik IN, van den Berg LH, de Haan R, Vermeulen M. Intravenous immunoglobulin for multifocal motor neuropathy. Cochrane Database Syst Rev. 2005;2, CD004429.PubMed
27.
go back to reference American Association of Electrodiagnostic M, Olney RK. Guidelines in electrodiagnostic medicine. Consensus criteria for the diagnosis of partial conduction block. Muscle Nerve Suppl. 1999;8:S225–9.PubMed American Association of Electrodiagnostic M, Olney RK. Guidelines in electrodiagnostic medicine. Consensus criteria for the diagnosis of partial conduction block. Muscle Nerve Suppl. 1999;8:S225–9.PubMed
28.
go back to reference Sharrack B, Hughes RA. The Guy’s Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis. Mult Scler. 1999;5(4):223–33.PubMedCrossRef Sharrack B, Hughes RA. The Guy’s Neurological Disability Scale (GNDS): a new disability measure for multiple sclerosis. Mult Scler. 1999;5(4):223–33.PubMedCrossRef
29.
go back to reference Stangel M, Kiefer R, Pette M, Smolka MN, Marx P, Gold R. Side effects of intravenous immunoglobulins in neurological autoimmune disorders—a prospective study. J Neurol. 2003;250(7):818–21.PubMedCrossRef Stangel M, Kiefer R, Pette M, Smolka MN, Marx P, Gold R. Side effects of intravenous immunoglobulins in neurological autoimmune disorders—a prospective study. J Neurol. 2003;250(7):818–21.PubMedCrossRef
30.
go back to reference Wittstock M, Benecke R, Zettl UK. Therapy with intravenous immunoglobulins: complications and side-effects. Eur Neurol. 2003;50(3):172–5.PubMedCrossRef Wittstock M, Benecke R, Zettl UK. Therapy with intravenous immunoglobulins: complications and side-effects. Eur Neurol. 2003;50(3):172–5.PubMedCrossRef
31.
go back to reference Caress JB, Hobson-Webb L, Passmore LV, Finkbiner AP, Cartwright MS. Case–control study of thromboembolic events associated with IV immunoglobulin. J Neurol. 2009;256(3):339–42.PubMedCrossRef Caress JB, Hobson-Webb L, Passmore LV, Finkbiner AP, Cartwright MS. Case–control study of thromboembolic events associated with IV immunoglobulin. J Neurol. 2009;256(3):339–42.PubMedCrossRef
32.
go back to reference Rajabally YA, Kearney DA. Thromboembolic complications of intravenous immunoglobulin therapy in patients with neuropathy: a two-year study. J Neurol Sci. 2011;308(1–2):124–7.PubMedCrossRef Rajabally YA, Kearney DA. Thromboembolic complications of intravenous immunoglobulin therapy in patients with neuropathy: a two-year study. J Neurol Sci. 2011;308(1–2):124–7.PubMedCrossRef
33.
go back to reference Gelfand EW. Differences between IGIV products: impact on clinical outcome. Int Immunopharmacol. 2006;6(4):592–9.PubMedCrossRef Gelfand EW. Differences between IGIV products: impact on clinical outcome. Int Immunopharmacol. 2006;6(4):592–9.PubMedCrossRef
34.
go back to reference Ballow M. Safety of IGIV therapy and infusion-related adverse events. Immunol Res. 2007;38(1–3):122–32.PubMedCrossRef Ballow M. Safety of IGIV therapy and infusion-related adverse events. Immunol Res. 2007;38(1–3):122–32.PubMedCrossRef
Metadata
Title
Treatment of Multifocal Motor Neuropathy with Intravenous Immunoglobulin
Author
Carol Lee Koski
Publication date
01-07-2014
Publisher
Springer US
Published in
Journal of Clinical Immunology / Issue Special Issue 1/2014
Print ISSN: 0271-9142
Electronic ISSN: 1573-2592
DOI
https://doi.org/10.1007/s10875-014-0016-5

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