Treatment experience in patients with anti-myelin-associated glycoprotein neuropathy

被引:59
作者
Gorson, KC
Ropper, AH
Weinberg, DH
Weinstein, R
机构
[1] Tufts Univ, Sch Med, Div Neurol, St Elizabeths Med Ctr, Boston, MA 02135 USA
[2] Tufts Univ, Sch Med, Div Hematol, St Elizabeths Med Ctr, Boston, MA 02135 USA
关键词
anti-myelin associated glycoprotein (anti-MAG) antibody; intravenous immunoglobulin (IVig); neuropathy; paraprotien; plasma exchange(PE); therapy;
D O I
10.1002/mus.1069
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
We report our experience with 24 consecutively treated patients (15 men and 9 women, median age 64 years) with anti-myelin-associated glycoprotein (anti-MAG) neuropathy, The rates of response to plasma exchange (40%), immune globulin (16%), and cyclophosphamide-based therapy (36%) were similar, Five (24%) responded to the first treatment modality, 32% to a second, alternative modality, and 31% to a third, Only 4 of 12 responders had sustained improvement; the others relapsed after a median of 7 months. In those 4 patients, the median immunoglobulin M (IgM) level dropped by 25% compared to an increase of 24% in the nonresponders (P = 0.04), Thus, most patients with anti-MAG neuropathy failed to have sustained improvement after treatment, and none of the therapies emerged as superior. Disability improved transiently after therapy in approximately 50% of cases. A 25% reduction of the IgM level predicted sustained improvement, but was difficult to achieve. There were no clinical or electrodiagnostic features associated with a treatment response, nor did a reduction of the anti-MAG antibody titer correlate with clinical improvement, (C) 2001 John Wiley & Sons, Inc.
引用
收藏
页码:778 / 786
页数:9
相关论文
共 51 条
[1]   ACQUIRED INFLAMMATORY DEMYELINATING POLYNEUROPATHIES - CLINICAL AND ELECTRODIAGNOSTIC FEATURES [J].
ALBERS, JW ;
KELLY, JJ .
MUSCLE & NERVE, 1989, 12 (06) :435-451
[2]   ANTI-MAG ANTIBODY-ASSOCIATED POLYNEUROPATHIES - IMPROVEMENT FOLLOWING IMMUNOTHERAPY WITH MONTHLY PLASMA-EXCHANGE AND IV-CYCLOPHOSPHAMIDE [J].
BLUME, G ;
PESTRONK, A ;
GOODNOUGH, LT .
NEUROLOGY, 1995, 45 (08) :1577-1580
[3]   HIGH-DOSE INTRAVENOUS IMMUNOGLOBULIN IN THE TREATMENT OF DEMYELINATING NEUROPATHY ASSOCIATED WITH MONOCLONAL GAMMOPATHY [J].
COOK, D ;
DALAKAS, M ;
GALDI, A ;
BIONDI, D ;
PORTER, H .
NEUROLOGY, 1990, 40 (02) :212-214
[4]  
CORNBLATH DR, 1991, NEUROLOGY, V41, P617
[5]   A controlled study of intravenous immunoglobulin in demyelinating neuropathy with IgM gammopathy [J].
Dalakas, MC ;
Quarles, RH ;
Farrer, RG ;
Dambrosia, J ;
Soueidan, S ;
Stein, DP ;
Cupler, E ;
Sekul, EA ;
Otero, C .
ANNALS OF NEUROLOGY, 1996, 40 (05) :792-795
[6]   POLYNEUROPATHY WITH MONOCLONAL GAMMOPATHY - STUDIES OF 11 PATIENTS [J].
DALAKAS, MC ;
ENGEL, WK .
ANNALS OF NEUROLOGY, 1981, 10 (01) :45-52
[7]   THE ROCHESTER DIABETIC NEUROPATHY STUDY - DESIGN, CRITERIA FOR TYPES OF NEUROPATHY, SELECTION BIAS, AND REPRODUCIBILITY OF NEUROPATHIC TESTS [J].
DYCK, PJ ;
KRATZ, KM ;
LEHMAN, KA ;
KARNES, JL ;
MELTON, LJ ;
OBRIEN, PC ;
LITCHY, WJ ;
WINDEBANK, AJ ;
SMITH, BE ;
LOW, PA ;
SERVICE, FJ ;
RIZZA, RA ;
ZIMMERMAN, BR .
NEUROLOGY, 1991, 41 (06) :799-807
[8]  
Ellie E, 1996, J NEUROL, V243, P34
[9]   PERIPHERAL NEUROPATHY AND MONOCLONAL IGM WITH ANTIBODY-ACTIVITY AGAINST PERIPHERAL-NERVE MYELIN - EFFECT OF PLASMA-EXCHANGE [J].
ERNERUDH, J ;
BRODTKORB, E ;
OLSSON, T ;
VEDELER, CA ;
NYLAND, H ;
BERLIN, G .
JOURNAL OF NEUROIMMUNOLOGY, 1986, 11 (03) :171-178
[10]   IMMUNOCHEMICAL AND CLINICAL EFFECTS OF IMMUNOSUPPRESSIVE TREATMENT IN MONOCLONAL IGM NEUROPATHY [J].
ERNERUDH, JH ;
VRETHEM, M ;
ANDERSEN, O ;
LINDBERG, C ;
BERLIN, G .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 1992, 55 (10) :930-934