EVALUATION OF HUMAN IMMUNOGLOBULIN EFFECTIVENESS IN PATIENTS WITH SENSORYMOTOR POLYNEUROPATHY ASSOCIATED WITH MONOCLONAL GAMMAPATHY OF UNDETERMINED SIGNIFICANCE
https://doi.org/10.20514/2226-6704-2018-8-4-278-284
Abstract
Introduction. A number of paraproteinemic polyneuropathy is directly linked to the monoclonal gammapathy of undetermined significance (MGUS). One of the first manifestations of MGUS in addition to the secretion of monoclonal immunoglobulin, and long before the manifestation of malignancy is polyneuropathy.
Materials and Methods. Were examined in 16 patients with polyneuropathy associated with MGUS in age from 53 to 78 years. Patients underwent a course of infusion therapy with human immunoglobulin in the dose of 0.4 g/kg for 5 days.
Results. After treatment revealed a reduction of the manifestations of the sensory component of the neuropathy, neuropathic pain and sensitive ataxia that was confirmed by electromyographic data of stabilography, and a rating on a scale Lovett, the scale of neuropathy disability score, the questionnaire «Pain detect». The motor component of polyneuropathy had more persistent symptoms.
Conclusion. Treatment with human immunoglobulin is effective in reduction of neuropathic pain and sensory ataxia and in increase of superficial and deep sensation, while the motor component of polyneuropathy had more persistent symptoms.
About the Authors
A. A. YakovlevRussian Federation
R. A. Gapeshin
Russian Federation
A. G. Smochilin
Russian Federation
M. V. Yakovleva
Russian Federation
References
1. Гинзберг М.А., Варламова Е.Ю., Рыжко В.В. и соавт. Клиниконейро физиологическое исследование хронической демиелинизирующей полиневропатии, ассоциированной с моноклональной секрецией. Медицинский совет. 2015; 10: 93-96. Ginzberg M.A., Varlamova E.Y., Ryshko V.V. et al. Clinical and neurophychological assessement of chronic demyelinating polyneuropathy assotiated with monoclonal secretion. Medical Council. 2015; 10: 93-96 [In Russian].
2. Левин О.С. Полиневропатии: клиническое руководство. 2-е издание. М.; 2006; 486 с. Levin O.S. Polyneuropathies: clinical guidelines. 2nd edition. Moscow; 2006; 486 p. [In Russian].
3. Schmidt E.B., Moller-Petersen J. Monoclonal Gammopathy in General Practice Diagnostic Value of Typing and Quantitation of Immunoglobulins. Scandinavian Journal of Primary Health Care. 1985; 3(2): 91-94. https://doi.org/10.3109/02813438509013923.
4. Kyle R.A. Monoclonal gammopathy of undetermined significance: natural history in 241 cases. Am. J. Med. 1978; 64: 814–26. https://doi.org/10.1016/0002-9343(78)90563-6.
5. Landgren O., Kyle R.A., Pfeiffer R.M. et al. Monoclonal gammopathy of undeterminedsignificance (MGUS) consistently precedes multiple myeloma: a prospective study. Blood 2009; 113(22): 5412–5. https://doi.org/10.1182/blood-2008-12-194241.
6. Беляков К.М., Густов А.В. Паранеопластические полиневропатии. Нижний Новгород: Издательство НижГМА. 2007; 96 с. Belyakov K.M., Gustov A.V. Paraneoplastic polyneuropathies. Nizhnii Novgorod: NizhGMA press; 2007; 96 p. [In Russian].
7. Dyck P.J. Detection, characterization, and staging of polyneuropathy: assessed in diabetics. Muscle Nerve 1988; (11): 21–32. https://doi.org/10.1002/mus.880110106.
8. Larue S., Bombelli F., Viala K. et al. Non-anti-MAG DADS neuropathy as a variant of CIDP: clinical, electrophysiological, laboratory features and response to treatment in 10 cases. Eur. J. Neurol. 2011; 18: 899–905. https://doi.org/10.1111/j.1468-1331.2010.03312.x.
9. Mata S., Borsini W., Ambrosini S. et al. IgM monoclonal gammopathyassociated neuropathies with different IgM specificity. Eur. J. Neurol. 2011; 18: 167–173. https://doi.org/10.1111/j.1468-1331.2010.03345.x.
10. Pestronk A., Florence J., Miller T. et al. Treatment of IgM antibody associated polyneuropathies using rituximab. J. Neurol. Neurosurg. Psychiatry. 2003; 74: 485–489. https://doi.org/10.1136/jnnp.74.4.485.
11. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br. J. Haematol. 2003; 121(5): 749-757. https://doi.org/10.1046/j.1365-2141.2003.04355.x.
12. Петров К.Б., Иванчин Д.М. Лечебная гимнастика при парезах стопы. ЛФК и массаж. Спортивная медицина 2008; 1(49): 37-43. Petrov K.B., Ivanchin D.M. Medical Gymnastics at Paralyses of the Foot. LFK i massash. Sportivnaya medicina. 2008; 1(49): 37-43 [In Russian].
13. Livenson Jay A., Dong M.Ma. Laboratory reference for clinical neurophysiology (1992). Pain. 2005; 313-314.
14. Young M.J., Boulton A.J.M., Macleod A.F. et al. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993; 36: 150–154. https://doi.org/10.1007/bf00400697.
15. Backonja M-M., Krause S.J. Neuropathic Pain Questionnaire-Short Form. Clin. J. Pain. 2003; 19: 315-316. https://doi.org/10.1097/00002508-200309000-00005.
16. Freynhagen R., Baron R., Gockel U., Tolle T. Pain detect: a new screening questionnaire to detect neropathic components in patients with back pain. Curr. Med. Res. Opin. 2006; 22: 1911-20.
17. Скворцов Д.В. Стабилометрическое исследование. Краткое руководство. М.: Мера-ТСП. 2010; 174 с. Skvortsov D.V. Stabilometric testing. Short guidance. Moscow: Mera-TSP. 2010; 174 p. [In Russian].
18. Банержи А. Медицинская статистика понятным языком. Перевод с английского под. ред. В.П. Леонова. М.: Практическая медицина. 2007; 287 с. Banergi A. Medical Statistics Made Clear. Translated from english by Leonov V.P. Moscow: Practical Medicine. 2007; 287 p. [In Russian].
19. Супонева Н.А., Павлов Э.В. Диагностика и базовая терапия хронических полиневропатий. Врач. 2009; 4: 43–44. Suponeva N.A., Pavlov E.V. Diagnostics and basic treatment of chronic polyneuropathies. Doctor. 2009; 4: 43–44 [In Russian].
20. Rosenberg N., Portegies P., de Visser M. et al. Diagnostic investigation of patients with chronic polyneuropathy: evaluation of a clinical guideline. J. Neurol. Neurosur. Psychiat. 2001; 71: 205–209. https://doi.org/10.1136/jnnp.71.2.205.
21. Супонева Н.А., Никитин С. Хронические полиневропатии, ассоциированные с моноклональными гаммапатиями. Врач. Москва: Издательский дом «Русский врач». 2010; 9: 51-54. Suponeva N.A., Nikitin S. Chronic polyneuropathies assotiated with monoclonal gammapathiesю Doctor. Moscow: Publ. house «Russian doctor». 2010; 9: 51-54 [In Russian].
22. Gorson K.C., Allam G., Ropper A.H. Chronic inflammatory demyelinating polyneuropathy: clinical features and response to treatment in 67 consecutive patients with and without a monoclonal gammopathy. Neurology. 1997; 48(2): 321-328. https://doi.org/10.1212/wnl.48.2.321.
23. Poncelet A. An algorithm for the evaluation of peripheral neuropathy. Am. Fam. Physician. 1998; 57(4): 755–764.
24. Radl J., Valentijn R.M., Haaijman J.J., Paul L.C. Monoclonal gammapathies in patients undergoing immunosuppressive treatment after renal transplantation. Clin. Immunol. Immunopathol.1985; 37(1): 98-102, https://doi.org/10.1016/0090-1229(85)90140-0.
Review
For citations:
Yakovlev A.A., Gapeshin R.A., Smochilin A.G., Yakovleva M.V. EVALUATION OF HUMAN IMMUNOGLOBULIN EFFECTIVENESS IN PATIENTS WITH SENSORYMOTOR POLYNEUROPATHY ASSOCIATED WITH MONOCLONAL GAMMAPATHY OF UNDETERMINED SIGNIFICANCE. The Russian Archives of Internal Medicine. 2018;8(4):278-284. https://doi.org/10.20514/2226-6704-2018-8-4-278-284