Do A-waves help predict intravenous immunoglobulin response in multifocal motor neuropathy without block?
✍ Scribed by Dale J. Lange; Rajwinder Nijjar; Andrei Voustianiouk; Gregory Seidel; Janki Panchal; Annabel K. Wang
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 260 KB
- Volume
- 43
- Category
- Article
- ISSN
- 0148-639X
No coin nor oath required. For personal study only.
✦ Synopsis
Introduction: Are there electrophysiological findings that predict response to intravenous immunoglobulin (IVIg) in patients with lower motor neuron (LMN) syndromes without multifocal conduction block (MCB)? Methods: We enrolled 9 patients with LMN syndromes without MCB to receive 18 weeks of IVIg therapy. Response was measured at weeks 2 and 18 using the Appel Amyotrophic Lateral Sclerosis (AALS) score (includes grip and pincer strength measures), ALS Functional Rating Scale (ALSFRS), and electrophysiological measures, including motor unit estimates (MUNEs). Results: No change occurred in AALS or ALSFRS scores posttreatment. Grip/pincer strength increased in 7 patients (P ¼ 0.028) after initial treatment (responders); 2 showed no improvement (non-responders). No electrophysiological measure changed after treatment in either group but MUNEs trended higher (P ¼ 0.055). ' 'Abnormal A-waves' ' (complex, repetitive biphasic, or present in multiple nerves) occurred in pretreatment studies more often in responders (P ¼ 0.028).Discussion:' 'Abnormal A-waves' ' may signal IVIg-responsive LMN syndromes even if conduction block is absent.