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Multifocal motor neuropathy with high titers of anti‐ MAG antibodies
Author(s) -
Bridel Claire,
Horvath Judit,
Kurian Mary,
Truffert André,
Steck Andreas,
Lalive Patrice H.
Publication year - 2014
Publication title -
journal of the peripheral nervous system
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1
H-Index - 67
eISSN - 1529-8027
pISSN - 1085-9489
DOI - 10.1111/jns5.12069
Subject(s) - multifocal motor neuropathy , mismatch negativity , medicine , pathology , neuroscience , immunology , psychology , electroencephalography , psychiatry
Abstract Multifocal motor neuropathy (MMN) and anti‐myelin‐associated glycoprotein (anti‐ MAG )‐associated neuropathy are clinically and electrophysiologically distinct entities. We describe a patient with characteristic features of both neuropathies, raising the possibility of an overlap syndrome. A 49‐year‐old patient reported a history of slowly progressive predominantly distal tetraparesis, with mild sensory deficits. Nerve conduction studies demonstrated persistent motor conduction blocks outside compression sites, typical of MMN. Laboratory findings revealed persistently high titers of anti‐ MAG immunoglobulin M λ ( IgM λ ) paraprotein in the context of a monoclonal gammapathy of unknown significance. Skin biopsy of distal lower limb revealed IgM positive terminal nerve perineurium deposits. This case suggests that the distinction between subtypes of chronic inflammatory neuropathies may not be as clear as initially thought, and that the pattern of pathogenicity of anti‐ MAG antibodies may vary.