TY - JOUR
T1 - Modified method of intravenous immunoglobulin administration for patients with intractable multifocal motor neuropathy
T2 - A case report
AU - Mukaino, Akihiro
AU - Nagaoka, Atsushi
AU - Yoshimura, Shunsuke
AU - Nakajima, Hideki
AU - Shiraishi, Hirokazu
AU - Motomura, Masakatsu
AU - Morikawa, Miyuki
AU - Kusunoki, Susumu
AU - Nakane, Shunya
AU - Ando, Yukio
AU - Tsujino, Akira
N1 - Publisher Copyright:
© 2017 Japanese Society for Neuroimmunology
PY - 2017/5
Y1 - 2017/5
N2 - Background: We report a case of a 64-year-old Japanese man who was diagnosed with definite multifocal motor neuropathy and successfully treated with administration of intravenous immunoglobulin (IVIg) spread over two separate weeks. Case presentation: After IVIg administration (30 g/day, five consecutive days), motor function was improved, but it was not possible to maintain the muscle strength just a few months after treatment. Although plasma exchange and cyclosporine were combined, the patient developed muscle weakness just 2 weeks after initial IVIg treatment. His grip strength decreased to 0 kg, proximal upper-limb muscle strength reduced to 2/5 according to manual muscle testing, and muscle weakness developed in the proximal lower limb muscle. We modified IVIg administration protocol from five consecutive days to two separate weeks: 3 days in the first week and 2 days in the third week without changing the total dose per month. After initiation of divided IVIg protocol, muscle weakness dramatically improved, and muscle power could be kept normal. Corrected optical density value of immunoglobulin M antibodies against GM1 elevated in the all clinical course did not correlate with muscle strength improvement. Serum immunoglobulin G levels became stable in ≥2000 mg/dL, and were associated with muscle strength improvement. Conclusion: Administration of IVIg over two separate weeks might be a treatment option in intractable patients with multifocal motor neuropathy.
AB - Background: We report a case of a 64-year-old Japanese man who was diagnosed with definite multifocal motor neuropathy and successfully treated with administration of intravenous immunoglobulin (IVIg) spread over two separate weeks. Case presentation: After IVIg administration (30 g/day, five consecutive days), motor function was improved, but it was not possible to maintain the muscle strength just a few months after treatment. Although plasma exchange and cyclosporine were combined, the patient developed muscle weakness just 2 weeks after initial IVIg treatment. His grip strength decreased to 0 kg, proximal upper-limb muscle strength reduced to 2/5 according to manual muscle testing, and muscle weakness developed in the proximal lower limb muscle. We modified IVIg administration protocol from five consecutive days to two separate weeks: 3 days in the first week and 2 days in the third week without changing the total dose per month. After initiation of divided IVIg protocol, muscle weakness dramatically improved, and muscle power could be kept normal. Corrected optical density value of immunoglobulin M antibodies against GM1 elevated in the all clinical course did not correlate with muscle strength improvement. Serum immunoglobulin G levels became stable in ≥2000 mg/dL, and were associated with muscle strength improvement. Conclusion: Administration of IVIg over two separate weeks might be a treatment option in intractable patients with multifocal motor neuropathy.
KW - intravenous immunoglobulin
KW - modification of administration
KW - multifocal motor neuropathy
KW - serum immunoglobulin G level
UR - http://www.scopus.com/inward/record.url?scp=85018417758&partnerID=8YFLogxK
U2 - 10.1111/cen3.12391
DO - 10.1111/cen3.12391
M3 - 学術論文
AN - SCOPUS:85018417758
SN - 1759-1961
VL - 8
SP - 141
EP - 145
JO - Clinical and Experimental Neuroimmunology
JF - Clinical and Experimental Neuroimmunology
IS - 2
ER -