Abstract
Objectives Recent studies of neuropathy associated with anti-myelin-associated-glycoprotein (anti-MAG) antibodies, have observed that the electrophysiological features are more heterogeneous than originally described. Our aim was to evaluate the clinical and electrophysiological features of anti-MAG neuropathy at our hospital.
Methods Patients followed up for anti-MAG neuropathy at Wellington Regional Hospital were identified by searching the Neurology outpatient clinic database. Their electronic records were reviewed to collect demographic, clinical, laboratory, electrophysiological, and treatment variables.
Results Five patients with anti-MAG neuropathy were identified; all Caucasian males, aged between 58 and 86 years at diagnosis. Neuropathy symptoms were present for between 2 and 10 years at diagnosis. All had a distal, sensory-predominant neuropathy, with asymmetric lower limb involvement in 3/5. All had an IgM-kappa paraprotein, and 2/5 were diagnosed of Waldenstrom’s macroglobulinaemia. Anti-MAG titres ranged between 5218 to >70,000 BTU. Lower limb nerve conduction studies demonstrated axonal loss, with absent sensory responses, and absent or very attenuated distal motor amplitudes (<1.0 mV) in all patients. Median nerve distal motor latencies ranged between 5.25 and 17.8 mV, and median nerve motor conduction velocities ranged between 20.2 and 46.0 m/s. Three patients received immunosuppression in the form of rituximab and/or chemotherapy, and one had a partial improvement in symptoms. Of note, all patients were ambulatory at last follow-up, at least 8 years from symptom onset.
Conclusion Our small cohort of patients with anti-MAG neuropathy demonstrated a fairly typical clinical syndrome, but a heterogeneous electrophysiological profile. All patients remained ambulatory in the long term.
