| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Department of Clinical Neurosciences (Drs. Federico, Zochodne, and Feasby), University of Calgary, Alberta, Canada; Department of Clinical Neurological Sciences (Dr. Hahn), University of Western Ontario, London, Ontario, Canada; and Department of Neurology (Dr. Brown), New England Medical Center, Tufts University, Boston, MA.
Address correspondence and reprint requests to Dr. Thomas E. Feasby, Department of Clinical Neurosciences, Foothills Hospital, Room 1166, 1403 29 Street NW, Calgary, Alberta T2N 2T9, Canada; e-mail: feasby{at}dcns.ucalgary.ca
OBJECTIVE: To determine the effect of IV immunoglobulin (IVIg) on neurologic function and electrophysiologic studies in multifocal motor neuropathy with conduction block (MMN).
BACKGROUND: MMN is characterized by progressive, asymmetric, lower motor neuron weakness and is probably immune-mediated. IVIg treatment has been shown to have beneficial effects in several open-label studies and in one small controlled trial. However, larger randomized controlled studies are lacking.
METHODS: The authors recruited 16 patients with MMN. All subjects were given each of two treatments (IVIg [0.4 g/kg/d for 5 consecutive days] or placebo [dextrose or saline]) that were assigned according to a randomized, crossover design under double-blind conditions. Patients were evaluated before and about 28 days after trial treatment for subjective functional improvement, neurologic disability score, grip strength, distal and proximal compound muscle action potential amplitude, and conduction block.
RESULTS: Subjective functional improvement with IVIg treatment was rated as dramatic or very good in nine patients, moderate in one, mild in one, and absent in five patients. This improvement was absent after placebo. The neurologic disability score improved by 6.7 ± 3.3 points with IVIg treatment, whereas it decreased by 2.1 ± 3.0 with placebo (p = 0.038). Grip strength on the weaker side was increased by 6.4 ±1.9 kg with IVIg treatment; it decreased by 1.0 ± 0.8 kg with placebo (p = 0.0021). Conduction block worsened by 12.98 ± 6.52 % with placebo, but improved by 12.68 ± 5.62 % with IVIg treatment (p = 0.037). Conduction block was reversed in five patients with IVIg but not placebo.
CONCLUSION: IVIg improved conduction block as well as subjective and objective clinical measures of function in patients with MMN.
This article has been cited by other articles:
|
|
 |
|
  M. Stangel Review: New advances in the treatment of neurological diseases using high dose intravenous immunoglobulins Therapeutic Advances in Neurological Disorders, September 1, 2008; 1(2): 115 - 124. [Abstract] [PDF]
|
|
|
|
 |
|
 J-M Leger, K Viala, F Cancalon, T Maisonobe, B Gruwez, T Waegemans, and P Bouche Intravenous immunoglobulin as short- and long-term therapy of multifocal motor neuropathy: a retrospective study of response to IVIg and of its predictive criteria in 40 patients J. Neurol. Neurosurg. Psychiatry, January 1, 2008; 79(1): 93 - 96. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Slee, A. Selvan, and M. Donaghy Multifocal motor neuropathy: The diagnostic spectrum and response to treatment Neurology, October 23, 2007; 69(17): 1680 - 1687. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Piepers, R. Van den Berg-Vos, W-L. Van der Pol, H. Franssen, J. Wokke, and L. Van den Berg Mycophenolate mofetil as adjunctive therapy for MMN patients: a randomized, controlled trial Brain, August 1, 2007; 130(8): 2004 - 2010. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. S Baek and N. P Desai ALS: pitfalls in the diagnosis Practical Neurology, April 1, 2007; 7(2): 74 - 81. [Full Text] [PDF]
|
|
|
|
|
|
E. Delmont, J. P. Azulay, R. Giorgi, S. Attarian, A. Verschueren, D. Uzenot, and J. Pouget Multifocal motor neuropathy with and without conduction block: a single entity? Neurology, August 22, 2006; 67(4): 592 - 596. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J T H Van Asseldonk, L H Van den Berg, S Kalmijn, R M Van den Berg-Vos, C H Polman, J H J Wokke, and H Franssen Axon loss is an important determinant of weakness in multifocal motor neuropathy. J. Neurol. Neurosurg. Psychiatry, June 1, 2006; 77(6): 743 - 747. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Ghosh, M Busby, R Kennett, K Mills, and M Donaghy A practical definition of conduction block in IvIg responsive multifocal motor neuropathy J. Neurol. Neurosurg. Psychiatry, September 1, 2005; 76(9): 1264 - 1268. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A Ghosh, A Virgincar, R Kennett, M Busby, and M Donaghy The effect of treatment upon temporal dispersion in IvIg responsive multifocal motor neuropathy J. Neurol. Neurosurg. Psychiatry, September 1, 2005; 76(9): 1269 - 1272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Koller, B. C. Kieseier, S. Jander, and H.-P. Hartung Chronic Inflammatory Demyelinating Polyneuropathy N. Engl. J. Med., March 31, 2005; 352(13): 1343 - 1356. [Full Text] [PDF]
|
|
|
|
|
|
S. Vucic, K. R. Black, P. S. T. Chong, and D. Cros Multifocal motor neuropathy: Decrease in conduction blocks and reinnervation with long-term IVIg Neurology, October 12, 2004; 63(7): 1264 - 1269. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Dalakas Intravenous Immunoglobulin in Autoimmune Neuromuscular Diseases JAMA, May 19, 2004; 291(19): 2367 - 2375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Terenghi, A. Cappellari, A. Bersano, M. Carpo, S. Barbieri, and E. Nobile-Orazio How long is IVIg effective in multifocal motor neuropathy? Neurology, February 24, 2004; 62(4): 666 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. W. Sander and N. Latov Research criteria for defining patients with CIDP Neurology, April 22, 2003; 60(90083): S8 - 15. [Abstract] [Full Text]
|
|
|
|
|
|
A Pestronk, J Florence, T Miller, R Choksi, M T Al-Lozi, and T D Levine Treatment of IgM antibody associated polyneuropathies using rituximab J. Neurol. Neurosurg. Psychiatry, April 1, 2003; 74(4): 485 - 489. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. T. H. Van Asseldonk, L. H. Van den Berg, R. M. Van den Berg-Vos, G. H. Wieneke, J. H. J. Wokke, and H. Franssen Demyelination and axonal loss in multifocal motor neuropathy: distribution and relation to weakness Brain, January 1, 2003; 126(1): 186 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. L. Koski Therapy of CIDP and related immune-mediated neuropathies Neurology, December 24, 2002; 59(90126): S22 - 27. [Abstract] [Full Text]
|
|
|
|
|
|
R. M. Van den Berg-Vos, H. Franssen, J. H. J. Wokke, and L. H. V. d. Berg Multifocal motor neuropathy: long-term clinical and electrophysiological assessment of intravenous immunoglobulin maintenance treatment Brain, August 1, 2002; 125(8): 1875 - 1886. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E Nobile-Orazio, A Cappellari, N Meucci, M Carpo, F Terenghi, A Bersano, A Priori, S Barbieri, and G Scarlato 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, June 1, 2002; 72(6): 761 - 766. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C M Wiles, P Brown, H Chapel, R Guerrini, R A C Hughes, T D Martin, P McCrone, J Newsom-Davis, J Palace, J H Rees, et al. Intravenous immunoglobulin in neurological disease: a specialist review J. Neurol. Neurosurg. Psychiatry, April 1, 2002; 72(4): 440 - 448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.S. Katz, R.J. Barohn, S. Kojan, G.I. Wolfe, S.P. Nations, D.S. Saperstein, and A.A. Amato Axonal multifocal motor neuropathy without conduction block or other features of demyelination Neurology, February 26, 2002; 58(4): 615 - 620. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Turnbull, P. Federico, D. W. Zochodne, and T. E. Feasby Multifocal motor neuropathy improved by IVIg Neurology, June 12, 2001; 56(11): 1608 - 1608. [Full Text] [PDF]
|
|
|
|
|
|
P.A. van Doorn and F.G.A. van der Meche IVIg treatment improves multifocal motor neuropathy: Easy to start but difficult to stop Neurology, November 14, 2000; 55(9): 1246 - 1247. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
