Multifocal motor neuropathy. Report of three cases at a reference hospital in Mexico
DOI:
https://doi.org/10.5281/zenodo.10713055Keywords:
Neurophysiology, Gangliosides, Nervous System DiseasesAbstract
Background: Motor multifocal neuropathy is an immunemediated neuropathy characterized by progressive and asymmetric weakness of the distal extremities, without sensory symptoms, and an important feature of conduction blocks. The objective of this study is to comprehensively describe the nosological and pathogenic implications of this neurodegenerative disorder, given the unclear diagnosis of MMN and the significant challenges it poses.
Clinical cases: We present three clinical cases with a chronic clinical presentation, in which neuroconduction studies were performed, revealing the presence of anti-IgM GM1 antibodies, consistent with the diagnosis of motor multifocal neuropathy. Although the treatment administered in these cases was successful, it is important to note that the diagnosis of MMN experienced some delay, emphasizing the need for greater awareness and understanding of this disease.
Conclusion: The diagnosis of motor multifocal neuropathy is often delayed, and an incorrect treatment can worsen symptoms, especially due to its similarity to other neuropathies and nerve and muscle diseases. Despite a generally favorable prognosis, the lack of early diagnosis can lead to severe motor sequelae. In this study, we provide detailed descriptions of three clinical cases from a reference center in Mexico, presenting their clinical manifestations, observed neurophysiological patterns, and treatment response.
Downloads
References
Stikvoort García DJL, Kovalchuk MO, Goedee HS, et al. Motor unit integrity in multifocal motor neuropathy: A systematic evaluation with CMAP scans. Muscle Nerve. 2022;65(3):317-325. doi: 10.1002/mus.27469.
Chiquete E, Vargas-Cañas ES, Plascencia-Álvarez NI, et al. Recomendaciones sobre el diagnóstico y tratamiento de la neuropatía motora multifocal . Rev Mex Neuroci. 2018;19(1):2-22.
Jusufović E. Multifocal Motor Neuropathy: Case Reports. Acta Clin Croat. 2018;;57(3):581-587. doi: 10.20471/acc.2018.57.03.23.
Gwathmey KG, Smith AG. Immune-mediated neuropathies. Neurol Clin. 2020;38(3):711-35. doi: 10.1016/j.ncl.2020.03.008.
Hameed S, Cascella M. Multifocal Motor Neuropathy. Treasure Island (FL): StatPearls Publishing; 2023.
Yeh WZ, Dyck PJ, van den Berg LH, et al. Multifocal motor neuropathy: controversies and priorities. J Neurol Neurosurg Psychiatry. 2020;91(2):140-148. doi: 10.1136/jnnp-2019-321532.
Kieseier BC, Mathey EK, Sommer C, et al. Immune-mediated neuropathies. Nat Rev Dis Primers. 2018;4(1). doi: 10.1038/s41572-018-0027-2.
Cats EA, van der Pol WL, Piepers S, et al. Correlates of outcome and response to IVIg in 88 patients with multifocal motor neuropathy. Neurology. 2010;75(9):818-25. doi: 10.1212/WNL.0b013e3181f0738e.
Straver DCG, van Asseldonk J-TH, Notermans NC, et al. Cold paresis in multifocal motor neuropathy. J Neurol. 2011;258(2):212-7. doi: 10.1007/s00415-010-5712-3.
Tajiri M, Kodaira M, Nakamura K, et al. Tongue hemiatrophy in multifocal motor neuropathy. Intern Med. 2023;(1329-22). doi: 10.2169/internalmedicine.1329-22.
Nunez MC, Nepomuceno BLM, Tiongson MLGP. Multifocal motor neuropathy with cranial nerve involvement and vocal cord paralysis: A case report. Cureus. 2022;14(5):e25179. doi: 10.7759/cureus.25179.
Eren F, Aygul R, Tenekeci S, et al. Multifocal motor neuropathy after SARS-CoV-2 vaccination: a causal or coincidental association? J Int Med Res. 2022;50(7):030006052211107. doi: 10.1177/03000605221110709.
Mesin L, Lingua E, Cocito D. Motor nerve conduction block estimation in demyelinating neuropathies by deconvolution. Bioengineering (Basel). 2022;9(1):23. doi: 10.3390/bioengineering9010023.
Ochsner F, Tatu L. Multifocal motor neuropathy with persistent conduction block: The seminal case. Eur Neurol. 2020;83(6):639-42. doi: 10.1159/000511732.
Beadon K, Guimarães-Costa R, Léger J-M. Multifocal motor neuropathy. Curr Opin Neurol. 2018;31(5):559-64. doi: 10.1097/WCO.0000000000000605.
Van Schaik IN, Bouche P, Illa I, et al. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of multifocal motor neuropathy. Eur J Neurol. 2006;13(8):802-8. doi: 10.1111/j.1468-1331.2006.01466.x.
Breiner A, Ebadi H, Bril V, et al. Ultrasound in multifocal motor neuropathy: Clinical and electrophysiological correlations. J Clin Neuromuscul Dis. 2019;20(4):165-72. doi: 10.1097/CND.0000000000000250.
Querol L, Illa I. Paranodal and other autoantibodies in chronic inflammatory neuropathies. Curr Opin Neurol. 2015;28(5):474-9. doi: 10.1097/WCO.0000000000000233.
Keddie S, Eftimov F, van den Berg LH, et al. Immunoglobulin for multifocal motor neuropathy. Cochrane Libr. 2022;2022(1). doi: 10.1002/14651858.CD004429.pub3.
Briani C, Visentin A. Therapeutic monoclonal antibody therapies in chronic autoimmune demyelinating neuropathies. Neurotherapeutics. 2022;19(3):874-84. doi: 10.1007/s13311-022-01222-x.
Gentile L, Russo M, Rodolico C, et al. Long-term treatment with subcutaneous immunoglobulin in multifocal motor neuropathy. Sci Rep. 2021;11(1):9216. doi: 10.1038/s41598-021-88711-9.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Revista Médica del Instituto Mexicano del Seguro Social
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.
