Journal
ANNALS OF CLINICAL AND TRANSLATIONAL NEUROLOGY
Volume 7, Issue 11, Pages 2297-2309Publisher
WILEY
DOI: 10.1002/acn3.51220
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Funding
- Japan Agency for Medical Research and Development (AMED) [JP20ek0109376]
- Japan Society for the Promotion of Science (JSPS) KAKENHI [JP18K15454, JP19K17036, JP20K16602]
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Objective: To characterize the frequency and patterns of optic, trigeminal, and facial nerve involvement by neuroimaging and electrophysiology in IgG4 antineurofascin 155 antibody-positive (NF155+) chronic inflammatory demyelinating polyneuropathy (CIDP). Methods: Thirteen IgG4 NF155(+) CIDP patients with mean onset age of 34 years (11 men) were subjected to neurological examination, blink reflex, and visual-evoked potential (VEP) testing, and axial and/ or coronal T2-weighted head magnetic resonance imaging (MRI). Results: Among 13 patients, facial sensory impairment, facial weakness, and apparent visual impairment were observed in three (23.1%), two (15.4%), and two (15.4%) patients, respectively. All 12 patients tested had blink reflex abnormalities: absent and/or delayed R1 in 11 (91.7%), and absent and/or delayed R2 in 10 (83.3%). R1 latencies had strong positive correlations with serum antiNF155 antibody levels (r = 0.9, P <= 0.0001 on both sides) and distal and F wave latencies of the median and ulnar nerves. Absent and/or prolonged VEPs were observed in 10/13 (76.9%) patients and 17/26 (65.4%) eyes. On MRI, hypertrophy, and high signal intensity of trigeminal nerves were detected in 9/13 (69.2%) and 10/13 (76.9%) patients, respectively, whereas optic nerves were normal in all patients. The intra-orbital trigeminal nerve width on coronal sections showed a significant positive correlation with disease duration. Interpretation: Subclinical demyelination frequently occurs in the optic, trigeminal, and facial nerves in IgG4 NF155(+) CIDP, suggesting that both central and peripheral myelin structures of the cranial nerves are involved in this condition, whereas nerve hypertrophy only develops in myelinated peripheral nerve fibers.
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