Journal
MUSCLE & NERVE
Volume 24, Issue 6, Pages 778-786Publisher
JOHN WILEY & SONS INC
DOI: 10.1002/mus.1069
Keywords
anti-myelin associated glycoprotein (anti-MAG) antibody; intravenous immunoglobulin (IVig); neuropathy; paraprotien; plasma exchange(PE); therapy
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We report our experience with 24 consecutively treated patients (15 men and 9 women, median age 64 years) with anti-myelin-associated glycoprotein (anti-MAG) neuropathy, The rates of response to plasma exchange (40%), immune globulin (16%), and cyclophosphamide-based therapy (36%) were similar, Five (24%) responded to the first treatment modality, 32% to a second, alternative modality, and 31% to a third, Only 4 of 12 responders had sustained improvement; the others relapsed after a median of 7 months. In those 4 patients, the median immunoglobulin M (IgM) level dropped by 25% compared to an increase of 24% in the nonresponders (P = 0.04), Thus, most patients with anti-MAG neuropathy failed to have sustained improvement after treatment, and none of the therapies emerged as superior. Disability improved transiently after therapy in approximately 50% of cases. A 25% reduction of the IgM level predicted sustained improvement, but was difficult to achieve. There were no clinical or electrodiagnostic features associated with a treatment response, nor did a reduction of the anti-MAG antibody titer correlate with clinical improvement, (C) 2001 John Wiley & Sons, Inc.
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