Background: Multifocal motor neuropathy with conduction blocks (MMNCB) is an i mmune mediated motor neuropathy. Previous long term IV immunoglobulin (IVIg) t reatment studies have documented improvement in muscle stre...Background: Multifocal motor neuropathy with conduction blocks (MMNCB) is an i mmune mediated motor neuropathy. Previous long term IV immunoglobulin (IVIg) t reatment studies have documented improvement in muscle strength and functional d isability but revealed a concomitant increase in acute axonal degeneration (AD) and conduction block (B). Objective: To determine the long term effects of IVIg therapy on clinical and neurophysiologic outcome measures in MMNCB patients res ponsive to IVIg. Methods: The authors reviewed medical records of 10 patients wi th MMNCB for outcomes in muscle strength (Medical Research Council score), funct ional disability (Modified Rankin Disability score), CB, and AD. All patients ha d received IVIg (2g/kg in 5 days for 3 consecutive months), followed by monthly maintenance therapy. Results: Patients were followed for an average of 7.25 year s (range, 3.5 to 12 years). There was significant and sustained improvement in m uscle strength and functional disability while on IVIg therapy. Furthermore, the authors found significant improvement in CB, decrease in AD, and evidence of re innervation by the end of the follow up period. Conclusion: Long term IV immun oglobulin therapy improves muscle strength and functional disability, decreases the number of conduction blocks and the extent of axonal degeneration, and promo tes reinnervation. These findings differ from previous reports of deterioration in neurophysiologic outcome measures. Comparison of the IV immunoglobulin regime n in those reports and this study shows that the authorspatients were treated with significantly higher IV immunoglobulin maintenance doses. These findings ha ve implications for the long term treatment of patients with multifocal motor n europathy with conduction blocks.展开更多
Introduction. Leflunomide is a new drug for the treatment of rheumatoid arthritis. Its mechanism of action is based on lymphocyte inhibition. We report the cases of two patients treated with leflunomide who developed ...Introduction. Leflunomide is a new drug for the treatment of rheumatoid arthritis. Its mechanism of action is based on lymphocyte inhibition. We report the cases of two patients treated with leflunomide who developed severe sensory-motor axonal polyneuropathy. Observation. Two women (61- and 70- year-old) presented with a sensory-motor axonal polyneuropathy beginning 5 months after onset of leflunomide treatment. Etiologic investigations were negative. The symptoms rapidly improved after withdrawing leflunomide. Discussion. The analysis of drug watch data found twelve patients with leflunomide-related neuropathy. Ten of them were more than 60 years old. The mean delay for onset of neuropathy was 9 months. The neuropathy improved after treatment withdrawal in seven patients. Conclusion. We consider these data strongly suggest that leflunomide is a cause of axonal sensory-motor neuropathy. The prevalence of such adverse events is still unknown.展开更多
文摘Background: Multifocal motor neuropathy with conduction blocks (MMNCB) is an i mmune mediated motor neuropathy. Previous long term IV immunoglobulin (IVIg) t reatment studies have documented improvement in muscle strength and functional d isability but revealed a concomitant increase in acute axonal degeneration (AD) and conduction block (B). Objective: To determine the long term effects of IVIg therapy on clinical and neurophysiologic outcome measures in MMNCB patients res ponsive to IVIg. Methods: The authors reviewed medical records of 10 patients wi th MMNCB for outcomes in muscle strength (Medical Research Council score), funct ional disability (Modified Rankin Disability score), CB, and AD. All patients ha d received IVIg (2g/kg in 5 days for 3 consecutive months), followed by monthly maintenance therapy. Results: Patients were followed for an average of 7.25 year s (range, 3.5 to 12 years). There was significant and sustained improvement in m uscle strength and functional disability while on IVIg therapy. Furthermore, the authors found significant improvement in CB, decrease in AD, and evidence of re innervation by the end of the follow up period. Conclusion: Long term IV immun oglobulin therapy improves muscle strength and functional disability, decreases the number of conduction blocks and the extent of axonal degeneration, and promo tes reinnervation. These findings differ from previous reports of deterioration in neurophysiologic outcome measures. Comparison of the IV immunoglobulin regime n in those reports and this study shows that the authorspatients were treated with significantly higher IV immunoglobulin maintenance doses. These findings ha ve implications for the long term treatment of patients with multifocal motor n europathy with conduction blocks.
文摘Introduction. Leflunomide is a new drug for the treatment of rheumatoid arthritis. Its mechanism of action is based on lymphocyte inhibition. We report the cases of two patients treated with leflunomide who developed severe sensory-motor axonal polyneuropathy. Observation. Two women (61- and 70- year-old) presented with a sensory-motor axonal polyneuropathy beginning 5 months after onset of leflunomide treatment. Etiologic investigations were negative. The symptoms rapidly improved after withdrawing leflunomide. Discussion. The analysis of drug watch data found twelve patients with leflunomide-related neuropathy. Ten of them were more than 60 years old. The mean delay for onset of neuropathy was 9 months. The neuropathy improved after treatment withdrawal in seven patients. Conclusion. We consider these data strongly suggest that leflunomide is a cause of axonal sensory-motor neuropathy. The prevalence of such adverse events is still unknown.
